Understanding Myopia

Historically, myopia has been considered harmless. Myopia causes blurred distance vision, or nearsightedness, that can be easily corrected by glasses or contact lenses. The common understanding of myopia is that the retinal surface sits behind the focal point of the eye, leading to blurred distance vision. The blurred vision, however, is a symptom of a progressive disease characterized by excessive eye growth, putting myopic patients at risk of developing serious sight-threatening and potentially irreversible complications such as myopic macular degeneration, retinal detachment, glaucoma, and cataracts later in life.
The risk of developing these complications rises exponentially with increasing axial eye length or refractive error, even at the lowest increments. In other words, there is no safe level of myopia. Myopia is emerging as the greatest eye health threat of the 21st century. In the past twenty years, myopia cases have nearly doubled, and it is projected to reach up to half of the world's population by 2050. As global cases increase, the magnitude of myopia-related public health risks have become more widely acknowledged.
As the complications typically develop in adulthood, we are on the cusp of seeing a significant rise in these sight-threatening complications. The good news is we also have a broader understanding of myopia development, which can help us reduce the severity of myopia and curb this emergent health crisis for today's children.
When we are born, our eyes are usually just under 17 mm in axial length. Infants are usually farsighted, meaning images entering the eye are focused behind the retina. By the time we are around 6 years old, our eyes have an axial length of roughly 22.5 mm. In normal development, axial growth stabilizes, usually at less than 24 mm, with our eyes reaching maturity by late teens or early to mid-twenties. Eye length develops in a coordinated fashion to focus images on the retina and produce clear vision. Myopia develops when this regulation is disrupted and the eye grows too long.
The earlier someone develops myopia, the greater the likelihood of developing higher levels of myopia because the eye grows more rapidly in younger children and will likely progress for a greater number of years. Although genetic factors play a role in myopia development, altered lifestyle factors like increased near work and decreased time outdoors have been implicated as factors in its rapid global rise. These lifestyle changes likely disrupt the eye's normal growth signals, causing the eye to grow longer than it should.
Further investigation is needed to understand the exact processes and signals that the eye uses to drive the growth of the eye. The benefits of time outdoors could be related to the impact of different visual environments such as viewing objects from afar vs. up-close such as when reading a book, or it could be the large, focused field of view in the outdoor visual environment.
In addition, brightness or type of light, such as sunlight vs. indoor lighting could play a role. While the process linking increased near work and myopia is not understood, there is little evidence that the use of handheld digital devices specifically is associated because myopia began increasing long before their creation. New studies are being initiated continually to further develop our understanding of these mechanisms.
Myopia is irreversible, but it is possible to slow eye growth through certain therapeutic treatments. To start, encouraging healthy lifestyle changes including increasing the amount of time spent outdoors and reducing the amount of near work activity may reduce axial elongation. Patients should work with their eye care professional to find appropriate treatment options based on individual needs and lifestyle.
Johnson & Johnson Vision has been a leader in myopia research for over 15 years, and they continue to be dedicated to expanding knowledge in this evolving field. Myopia is the vision health crisis of our times, but they believe that together we can meet the challenge and provide everyone with a chance for better eye health. They are committed to continue to lead with science and take the right steps now to change the trajectory of myopia.
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