Jacqui Krill comes in with her six-year-old daughter. “Oh Lauren, I like your new glasses, they look very smart!” exclaims Parveen...

“We go to the opticians every three months, and every time they say her eyesight is worse and we have to get new glasses,” says Jacqui. “It’s not the cost that bothers me but I wish they’d tell us if there was anything we could do to try and slow down the deterioration. What do you think, Parveen?”

Answer

There is a reasonable amount of data supporting the theory that spending more time outdoors can reduce the risk of myopia developing, although there is less pointing towards it reducing the deterioration of existing shortsightedness. Various theories as to the mechanism by which this occurs have been suggested, including being engaged in more physical activity, the greater viewing distance involved in being outside and exposing the eye to bright light.

Atropine eye drops have been shown to effectively control myopia by disabling the eye’s focusing mechanism but longer-term treatment has not been shown to be beneficial, and short-term use does not appear to markedly improve matters in the longer-term.

Side effects associated with topical atropine (e.g. discomfort, photophobia and blurred vision) are also compelling reasons to not pursue it as a treatment option. Orthokeratology has gained support over recent years. Wearing special gas permeable lenses (often referred to as Ortho-Ks) at night causes the shape of the eye to be maintained and has been shown to slow myopia progression.

Longer-term results have not yet been established, however. Multifocal contact lenses have shown great promise in shrinking the progression of myopia but, to date, studies have only been small. Multifocal spectacles have also shown some potential but the results have been less impressive than those conducted with multifocal contact lenses.

Undercorrecting myopia is not recommended as studies have shown that it may increase rather than slow down myopia. It also poses a safety risk as distance vision will be blurred.

The bigger picture

Myopia is hugely prevalent, but the precise cause is not known. It is thought that a number of hereditary and environmental factors are responsible. Parental myopia is certainly influential, with greater severity in one or both parents increasing the risk of it developing in children, but not necessarily dictating the extent of the condition.

Myopia, particularly high myopia, increases the risk of ocular co-morbidities, including retinal damage, degeneration and detachment, cataract development and glaucoma. There is also a significant financial burden and, in some cases, the condition can have a considerable impact on quality of life.

Extend your learning

• The scenario above refers at one point to “high myopia”. Do you know what this means? Find out about how mild, moderate and high myopia are defined at rnib.org.uk/eyehealth-eye-conditions-z-eyeconditions/myopia-and-high-degree-myopia.