Myopia and Nearsightedness – Causes, Risk Factors, and Treatment - How Do Ophthalmologists Treat It?

In technical terms, nearsightedness is called “myopia.” In this refractive error, the total refractive power of the eye does not correspond to the eye’s anatomical structure. As a result, a sharp image does not form at the center of the retina. 

The eye is relatively too long. This means that the image is sharp in front of the retina but blurry on the retina itself. Consequently, a nearsighted person’s distant vision is blurry. However, a nearsighted person can see clearly up close.

Figure: Schematic representation of a nearsighted eye. When looking at distant objects (black rays), no sharp image is formed on the retina. When looking at nearby objects, a sharp image is formed (blue rays).

The development of myopia is essentially genetically predetermined. It is therefore usually inherited. However, there are also environmental factors that play a role in the development or progression of myopia. Experts debate whether frequent and intense close-up activities, such as reading a lot, may contribute to the development of myopia. 

Studies show that children who sleep with a light on at night are more likely to develop myopia than children who sleep in the dark. Overall, the eye’s axial length in myopic individuals grows at an above-average rate. Over the course of a person’s life, certain circumstances can lead to an increase in the lens’s refractive power and to changes in the lens itself. 

This, too, can cause nearsightedness. Examples include structural changes associated with the aging of the lens or the early stages of cataract development. 

People with cataracts experience increasingly blurry and hazy vision, as if they had a veil over their eyes @ Mikolaj Niemczewski /AdobeStock

Similarly, hormonal fluctuations (such as during pregnancy) can lead to changes in the lens’s refractive power, as can fluctuations in blood sugar levels in people with diabetes.

Myopia is noticeable because distant objects appear blurry. People with myopia often hold objects close to their eyes. Children often do not mention their symptoms.

In schoolchildren, it becomes apparent when they cannot read text on the blackboard. Sometimes nonspecific symptoms, such as headaches, are also a sign of refractive errors in the eye.

An ophthalmologist makes the diagnosis. To do so, they measure and perform a refraction test on the eyes. During this process, they hold various lenses up to the eye.

The first-line treatment for myopia is wearing glasses. These glasses should be suitable for both everyday use and sports. Alternatively, contact lenses can be used to correct myopia. 

It is essential to handle contact lenses properly, especially with regard to cleaning and hygiene. 

In addition, you should opt for hard contact lenses rather than soft ones. Hard contact lenses are gentler on the eyes, even though getting used to them is significantly more difficult. 

Rigid contact lenses can also help counteract a rapid increase in nearsightedness. However, rigid contact lenses are not suitable for occasional use (e.g., for sports). In such cases, daily disposable lenses are the better choice.

Contact lenses are a very straightforward way to correct nearsightedness @ Kitreel /AdobeStock

Surgical Treatment

In general, surgery to correct nearsightedness on the cornea or the lens is also possible. This is called refractive surgery. A prerequisite is that the degree of nearsightedness is stable. In addition, the doctor must carefully examine the eyes to determine whether such a procedure is an option.

Myopia cannot resolve on its own. Those affected can manage their daily lives well with the help of corrective aids (glasses or contact lenses).

Treatment is also possible through surgery. However, nearsightedness may continue to worsen over the course of one’s life (up to age 30) even after surgery.

When choosing corrective aids or refractive surgery, it is essential to ensure they are suitable for sports. For glasses, this primarily depends on the material of the lenses and the design of the temples and frame. 

Specialized sports glasses are available; you can ask your optician for more information. When it comes to contact lenses, soft daily disposable lenses are particularly suitable. When it comes to surgical procedures to correct nearsightedness, there are differences in suitability for sports. Contact sports in particular (e.g., boxing) can pose a risk to the eyes following LASIK surgery.

Myopia refers to a common form of nearsightedness in which distant objects appear blurry, while nearby objects are usually seen clearly. The cause is often an imbalance between the length of the eyeball and the eye’s refractive power, so that light does not focus precisely on the retina. There are various forms of myopia, including simple myopia and axial myopia. In more severe cases, the condition is referred to as high myopia or even pathological myopia, which is associated with an increased risk of eye diseases.

Myopia can progress over the course of a person’s life, with nearsighted individuals and children being particularly affected. Increasing myopia often leads to a decline in visual acuity and significantly impairs distance vision. Various options are available to correct myopia, including traditional eyeglasses or contact lenses, as well as surgical procedures. The correction of myopia can be individually tailored depending on the severity of the refractive error.

In cases of severe nearsightedness—or at a value of -6 dpt or higher—the risk of retinal detachment and other changes, such as neovascularization, increases. Conditions such as cataracts may also be associated with nearsightedness. An eye exam with an ophthalmologist helps determine the appropriate treatment. Organizations such as the Professional Association of German Ophthalmologists and the German Ophthalmological Society are actively engaged in addressing the issue of myopia and its increasing prevalence. In everyday life, myopia is particularly noticeable when driving or looking into the distance, while nearby objects are easily recognized. The relationship to refractive power and the elongation of the eye also play an important role.

Overall, myopia results from complex factors; it can be congenital or develop later in life, and should be detected early to reduce long-term risks associated with myopia and preserve visual quality.