A Nearsighted Issue

WHEN I WAS IN GRAD SCHOOL, I recall learning about myopia. I was celebrated for my low amounts of myopia: “When you turn 40, you will be so grateful for the -1.50 refractive correction that you have.” It was as if it was a good thing. Since then, I have regarded my myopia as a good thing. As I am entering my presbyopic years, I am pleased that I can take my glasses off to see better up close, but there are other things that I wish I had known.

Reading the research on myopia and its effects on the eyes has made me pause and question this commonly held belief. Bullimore and Brennan have published much work on the damaging effects of myopia. One such article, “Myopia Control: Why Each Diopter Matters,” revealed that any amount of myopia increases our risk of disease. They showed that, for each 1D increase in myopia, there is a 67% increase in the prevalence of myopic maculopathy. Or another way of putting it is that, if you can slow myopia by 1D, “it should reduce the likelihood of a patient developing myopic maculopathy by 40%.”1

These statistics are huge, especially when we celebrate a condition like myopia in our presbyopic patients. Now, if someone has myopia, we manage it and work to slow it down, but when a child is emmetropic at the age of 5, rather than hyperopic, do we celebrate that the child will undoubtedly become myopic?

With the risk of blinding diseases, caused by myopia, on the rise, it is extremely important for us to treat our early presbyopic patients in a new way. First, we need to stress the importance of early intervention. It has always seemed that if we can catch eye disease early, we have a better chance of slowing and halting the damaging effects. So for your presbyopic myopic patients, remind them that they have risks of disease and how important it is for them to have their eyes checked yearly.

The second part of this new approach to treatment is related to patient education. Kids tend to do things that their parents do. As such, we need to tell parents to get their kids outside more during the day and off their screens. We should make sure to tell them that, if their child is myopic, it is nothing to celebrate. They need to see someone who can manage their child’s myopia and slow the progression of the myopic disease.

While we have historically celebrated low myopia with presbyopia, I think the age of elation has passed. We will take all of the vision improvement we can get for these patients, but I certainly do not want to celebrate their increased risk, or their children’s, of progressive vision loss as they age. ■


  1. Bullimore MA, Brennan NA. Myopia control: why each diopter matters. Optom Vis Sci. 2019;96(6):463-465.