THE MYOPIA ABOUT NEARSIGHTEDNESS
 
Merrill D. Bowan, O.D.
 
 
I. The Cure for Myopia.   III. What Can be Done?
 II. What is Myopia?         IV. The Future.  
 
I. THE CURE FOR MYOPIA (Nearsightedness).
 
Q.  Can myopia be reversed?
A.  Unfortunately, no.    
Q. Can myopia be prevented?
A.  Fortunately, yes, most of the time.  That's the cure for myopia: PREVENTION.
 
Q.  But what about surgery?  I see many ads.
A.  Radial corneal surgery and lasers only address symptoms of the problem.  Studies have never shown close associations of myopia with the corneal shape.  Just as you learned in school, in myopia the eye is optically too long.  The great majority of refractive surgery patients will need glasses or contact lenses over the weeks, months or years following the surgery.
 
Q.  But what are the best things that can be done for myopia?
A. Work to prevent progression of nearsightedness, once it's started.  The only real cure for myopia is to prevent it.  You have to understand what myopia is.
 
 
II.  WHAT IS MYOPIA?    
 
 Myopia is one of three adaptive optical errors that occur as  responses of the visual system  to sustained, repeated stress -- they are stress diseases.  The others are astigmatism and progressive hyperopia -- farsightedness.  In nearsightedness, the eye is optically too long.   Astigmatism distorts the image on the back of the eye and  farsightedness causes the individual to pay too much attention to focusing on near work, causing eyestrain and reduced performance.
 
The idea that myopia is genetic is not borne out by the available data.  Family histories, at best, have only a modest predictive value for eye problems.  Genetics may predispose certain families toward specific eye problems, but the trigger to the distortion of the optics of the eye is stress and reading, in the great majority of cases.  Since the human eye is almost full size by age four and certainly adult size by age eight, the concept of an eye that "grows" too long is not a valid concept.  Most myopia begins after age eight.  Most beginning myopes get their first glasses at ages 9 to 10, but there is a new group of beginning myopes who have begun to emerge over the past 20 years: adults who use computers.
 
A British ophthalmologist has described myopia as "juvenile expansile glaucoma", caused by reading.  Technically, he's probably correct, although it's a benign condition, and not the adult, damaging form of glaucoma.  Myopia has affected mankind since the beginning of time whenever the visual system is stressed and the individual can't or won't escape the stressing environment.  The combination of events that causes the nearsightedness include extended nearwork, depletion of Vitamin C, stress-induced calcium losses, muscular weakening of the rear chamber of the eye, and increased pressure in the eye relative to the softened sclera, the white superstructure of the eye.  The combination results in a gradual ballooning of the eye -- incredibly, adding only 1/2 mm. of extra length to the eye reduces vision to 20/200 or poorer!  The increased length of eye is all in the posterior chamber.  
 
III. WHAT CAN BE DONE?  
The main factors in preventing nearsightedness are proper nutrition, preventive lenses to protect normal farsightedness, proper visual hygiene, and stress reduction techniques.  To elaborate:
     
1) Nutrition - supplementing the diet with several hundred milligrams of vitamin C each day is reasonable.  (Experts have estimated that cavemen received 1100mg. or more per day in their diets.)  Adequate dietary levels of calcium, magnesium, and zinc are in order, as well.  Children given calcium in one British study showed stabilization and reversal of their myopia.  A diet adequate in fresh fruits and vegetables should be preventative, but not many children have the taste or opportunity to do so.  B-complex vitamins help to reduce the effects of stress of any sort.
 
2) Proper visual hygiene :  
 A) Posture: sitting upright for reading or writing is very important.  The visual system works best in a slightly downcast position.
 
B) Lighting: lighting engineers recommend a 200 W. glare-free study lamp.  The benefit is to increase figure-ground contrast and also to constrict the pupil, which increases the depth of field and thus reduces the need for critical focusing, which is the primary distress on the visual system.
 
C) Time:  the eyes appear to be designed for up to 20 or 30 minutes of sustained work without sustaining ill adaptive effects.  Therefore, eye breaks every half hour - looking away and stretching hard or walking away for a moment, plus a walk-away for 10 minutes every 90 minutes when reading, writing, or computing, will minimize the stress effects on most people's eyes.
   
3) Preventive lenses  -  "Plus 50" or "Plus 75" reading lenses are powerful tools against myopia for most students, beginning as early as second grade for most, though some students are showing signs of this developmental nearsightedness by the middle of first grade.  Personality style analysis can help to detect earlier need for these "brain glasses", as they're sometimes called: children prone to myopia seem to be the sort who are intelligent, analytical, withdrawn, stress-absorptive, underactive children, who are driven to please their superiors.  Bifocals with clear top portions are sometimes a more practical way to provide the reading lenses without the bother of taking them off to see distance objects.
 
Rigid, gas permeable contact lenses have been shown to slow or stop progression, but just why isn`t exactly clear.  Soft contact lenses are well-known to permit progression: it`s called "myopia creep".
 
Base-in prisms ground into the lenses have had preventive value since the mid-1800's when ophthalmologists in Germany used them on students becoming progressively more myopic.  They are still sometimes used for this purpose. [There are no guarantees that preventive lenses will work for any particular individual, but research shows that they do work 60-70% of the time.  Our only other option is to do nothing and watch the 60-70% of at-risk people get worse and worse vision.]
 
4)  Stress reduction techniques - action is a useful antidote to stress. The body under stress gives all the appearance of being readied for fight or flight, even when either of those responses would not be appropriate.  So a walking program, or low-impact aerobics, a sports hobby or other energy-burning activity will tend to help.
 
Relaxation, meditation, and/or prayer are scientifically proven ways of reducing stress.  Progressive relaxation techniques were used for fighter pilots in WWII and Korea to not only reduce stress, but also improved flying combat skills.  They reduce stress effects and can improve thinking skills in students, as well - it would be interesting to study formally.  Teaching children how to take a "5-minute vacation" as Dr. Herbert Benson talks about in his book "Beyond the Relaxation Response", would be beneficial at many levels.  
 
"Children need more baseball, less T.V.", said Dr. Francis Young, a primate researcher from Oregon.  He was responding to questions about his conclusions of what made animals nearsighted in his experiments.  Children need more outdoor activity and preferably interacting with other children.
 
Performance anxiety needs to be dealt with constructively, as well as control issues, so that a pattern of prolonged distress response(s) doesn't become a habit.
 
IV. THE FUTURE  
 
Will there ever be a remedy for nearsightedness?  It's hard to see how that can be, especially since our society is moving toward MORE nearwork with the advent of the microcomputer and the Internet Age.  Hopefully, more and more vision care providers will finally acknowledge that functional nearsightedness (the nearwork theory) is responsible for most garden-variety nearsightedness - up to 75% it would appear.  Then we can get on with the real cure for myopia, PREVENTION.
 
For Additional Reading:
 
Bowan, MD: The Control of Myopia;  Journal of Optometric Vision Development; Volume 12, Number 2, June, 1981.
 
Bowan, MD: Stress and Eye: New Speculations on Refractive Error;  Journal of Behavioral Optometry; Volume 7, Number 5, 1996.
 
Forrest, E: Stress and Vision; Optometric Extension Program , Santa Ana, CA, 1988.
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