Month: May 2020

• Patients with myopia are commonly referred to as being “near-sighted”.  This is because, even without their glasses, they are able to see clearly when looking at things up close.  Their problem is with looking far away.

• All refractive errors (essentially the reason for needing glasses) are caused by a mismatch of power in the eyes.  In the case of myopia, the power (created by the cornea/clear surface and intraocular lens) is too great for the length of the eye, or, conversely, the length of the eye is too long for the power of the eye.  Either case means that light is focused in front of the retina (back part of the eye), resulting in a blurred image.

• Because of the mismatch, minus (concave) lenses are prescribed.  Due to their structure (thinner in the center, thicker on the edges), concave lenses cause light to diverge (spread apart).  This divergence moves the eye’s natural focus point back – putting it right on the retina, and providing a clear image.

• Refractive errors in general are thought to be inherited.  Myopia is no different.  If you have two parents who are near-sighted, you definitely have a higher likelihood of being near-sighted. (I looked for specific figures on how much this increases your risk, but didn’t find any.)
• Becoming near-sighted has also been associated with an increase in near work, decreased time outdoors, and a lack of physical activity. 
• Relatively recent reports suggest a potential connection between myopia and inflammation, specifically in children with inflammatory conditions (ie: diabetes mellitus, uveitis, lupus).
• Near-sightedness may also be associated with different genetic conditions, such as connective tissue disorders, Stickler’s syndrome, and Down Syndrome.
• Patients with Retinopathy of Prematurity often are extremely myopic.

When should I suspect myopia?

• Patients often start becoming near-sighted between 8 and 10 years of age.  However, myopia can occur at any age.
• Some signs of being myopic are:
• Squinting when looking far away
• Holding objects close, or getting really close to objects to see them
• Complaining of being unable to see the board at school, or difficulty seeing signs

Does myopia get worse?

Are there any complications with being near-sighted?

• As myopia is associated with a longer eye, near-sighted people are at a higher risk of retinal holes, tears, and detachments due to retinal stretching.
• Myopia, especially high myopia, that continues to progress rapidly after the normal years may be considered degenerative myopia.  Patients with degenerative myopia are at a higher risk for complications that may significantly impair vision.
• Near-sighted patients are also at a higher risk for glaucoma.

Can myopia be treated?

• A ton of research is currently being done regarding myopia progression and potential treatment options to decrease myopic progression.  I’ll talk about that some other day.
• Most often, patients are prescribed glasses or contacts to improve vision.
• Special lenses (Ortho-K) may also be worn overnight in some cases to allow people to go without their normal lenses during the day.
• Refractive surgery can be used to change the power of the eye.  It’s important to remember though that correcting the power of the eye does not change your risk for complications secondary to being near-sighted.

what’s the difference between an optometrist and an ophthalmologist, and who should I see for (insert problem here)?

I need glasses or contacts.

• This is generally an optometrist’s job.  Both doctors are capable of writing prescriptions, but optometry as a rule has a greater emphasis on refractive error management.  That said, not all optometrists love spending all day asking, ‘which is better, one or two’ – some of us have further specialized as well, so, before coming to the office, consider asking what all will be included in your exam.

• Optometry is generally the best starting place for these complaints.  We are trained to treat ocular surface disease and remove superficial foreign bodies (things that you get in your eye). As the gatekeepers to ophthalmology, we can assess the problem, determine the severity, and refer if needed. 

My primary care doc says I need a diabetic eye exam.

• OD’s are again my first choice for diabetic eye exams.  As the early stages of diabetic retinopathy are currently managed by observation only, optometrists are more than able to monitor for disease progression.  If significant changes occur that require further treatment, we will then refer to ophthalmology for intervention and management.

• Double vision is something neither general optometry nor general ophthalmology (from my experience) likes to work with.  So, find a provider on either side of the optometry/ophthalmology wall who specializes in binocular vision or neuro/neuro-rehab.  In ophthalmology, these are often pediatric or neuro-ophthalmologists.  For the optometry side, it can be harder to find specialists (some states don’t allow OD’s to claim specialization), so be sure to call and verify that the doc you’re going to be seeing feels comfortable assessing causes of double vision.

I have (insert ocular disease here).

• With a known ocular condition, treatment and management can fall on both sides of the optometry/ophthalmology wall – it really depends on what the disease is and how far it has advanced. Most common ocular diseases (glaucoma, dry macular degeneration, early cataracts, mild/moderate hypertensive and diabetic retinopathy) can be managed by optometry.  Once they progress/if they progress to a point of needing surgical intervention, then management is transferred to ophthalmology.