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Myopia: causes, risk factors

Causes and factors associated with myopia

The causes and factors associated with the development of myopia have been the subject of many studies for several decades. The'Increase in the frequency of myopia In the population of industrialized countries, particularly In Asia Where we talk about a real ' Outbreaks of myopia", encourages to find the causes and mechanisms involved in theexcessive elongation Of the eye, which is the main anatomical factor responsible for myopia.

Most myopias are the result of excessive elongation of the eyeballs. In this example where the distension of the posterior pole of the eyes is clearly visible in imaging (arrows), the length of the eyeballs (from the cornea to the fovea), measured in optical biometry with interferometric technique) was 27.4 mm to the right and 26.5 mm (non-muscular eyes generally have a length close to 23.5 mm).

Before reviewing the main factors, it should be recalled that at the present time the mechanisms involved in the onset and progression of myopia remain for many mysterious. Parcel information has been acquired over time, but it is difficult to establish cause-and-effect linkages, sorting between risk factors and causal mechanisms. This explains that there is still a need to devise effective strategies that would prevent or slow myopia. The Genetic studies Have revealed more than twenty gene loci that are able to promote the occurrence of myopia (some on the Chromosome 15): But the genetic traits identified Certainly interact with the environment To modulate the expression of the myopia phenotype.

The study of the causes and risk factors of myopia is punctuated by twists and turns; Some theories feed on the results of experimental studies, and suggest in return the realization of new experiments... whose conclusions sometimes go against the initial postulate. There are still many mysteries to be pierced to understand the origin of myopia. At the end of the years 90 and the beginning of the years 2000, factors Lifestyle related As the Time spent outside in childhood were put forward as Protective elements against myopia. Thus, as some previous studies have already suggested, the time spent practicing outdoor activities in childhood and adolescence would have a protective effect on the incidence of myopia error  (Guggenheim JA, Northstone K, McMahon G, Ness AR, Deere K, Mattocks C, St Pourçain B, Williams C. Time outdoors and physical activity as predictors of incident myopia in childhood: A prospective cohort study.) Invest invest Vis Sci. 2012 apr 6.

A study published in May 2015 confirms that The European continent is also reached by this "epidemic of myopia", and that the Level of education is positively correlated with myopia (Williams KM, Bertelsen G, Cumberland P, et al. Increasing prevalence of myopia in Europe and the Impact of Education. Ophthalmology. 2015 May 13).

NB: Listen to the programme of France Culture «public Science», of 22 May 2015, dedicated to the "epidemic of myopia" that this European multicentric study highlighted old continent.

See the documentary "Tomorrow, All myopic", Arte, Réal: F. Papillon & C. Killian, scientific adviser of Ganeshan

Listen to the show "From cause to effect, environmental magazine", France Culture, January 14, 2018

Listen to the show " Great good you do«, France Inter, 15 January 2018, devoted to myopia

Myopia and Visual deprivation

Experimental studies conducted in animals revealed an important principle: the induction of a Reduced vision (occlusion) or Fuzzy (Interference with improper corrective glass) in the animal results in a Eye elongation ; We're talking about nearsightedness of sensory deprivation. This phenomenon of myopia of deprivation concerns both chickens, guinea pigs, dogs or great apes (Irving et al. Inducing myopia, hyperopia, and astigmatism in chicks. Optom Vis Sci 1991; 68: 364-368 / Sivak et al. Bilateral experimental myopia in chicks. Optom live Sci 1989; 66: 854-858. 87 / HD & McFadden SA Howlett. Form-deprivation myopia in the guinea pig (Cavia porcellus). Vision Res 2006; 46: 267-283 / DL, Greene PR & Scholz RT Guyton. Dark-rearing interference with emmetropization in the rhesus monkey. Invest invest live Sci 1989; 30: 761-764).

In addition, if the 'sensory deprivation' is interrupted early enough, so a move towards the progressive correction of the refractive defect induced can be observed; for example, the eyeball growth slows)Troilo and Wallman. The regulation of growth and refractive eye state: year experimental study of emmetropization. Vision Research, 1991; 33:1237 - 1250).
It is suspected that the induction of a Extended retinal Blur Could regulate the development of myopia in animals (Wildsoet CF. Active emmetropization - evidence for its existence and ramifications for clinical practice. Ophthalmic Opt 1997 Dec; 17: 279-290). The fact that this phenomenon is widespread within a large number of animal hopes suggests that it is involved in human myopia. These data demonstrate in all case that there is one (or more) "vision-dependent" mechanism involved in the development of refractive error such as myopia. A "Error Signal" retinal Would be at the origin of a physico-chemical mechanism causing elongation of the eyeball.

After the age of 6 years, the corneal curvature changes more (Zadnik K, Manny RE, Yu JA, et al. Ocular component data in schoolchildren as a function of age and gender. Optom Vis Sci. 2003;80:226–236) , and so the onset of myopia evolving into adulthood is due to elongation of the eyeball.

Things are not so clear, because if we generalise this reasoning, the blur induced by a strong hyperopia (inverse defect from that of myopia, the eye is too short) should lead to the gradual correction of it. This was not observed in the animal, or the blur associated with high Hypermétropique defocusing does not appear to trigger excessive eye elongation; So there are other factors that are able to modulate this control loop.

The optical correction of nearsighted children should not be "corrected" (child remaining slightly nearsighted), or sur-corrigée (child becoming slightly farsighted with its correction in glasses or lenses), in order to allow the retinal image to be optimal. The concept of deprivation myopia caused some theories to explain the causes of the development of nearsightedness, whose theory related to a lack of accommodation.

Myopia and accommodation

THEaccommodation is the ability of the eye to perform the focus to see net of close targets (e.g. reading book). Accommodation has been incriminated as possible causal or triggering factor of myopia. At the origin of this suspicion was the fact that myopia is often found in individuals doing work closely in a prolonged manner, and that a certain degree of "accommodative laziness" ("accommodative lag" in English) had been put into Evident in myopic (Gwazda et al. Myopic children show insufficient accommodative response to blur. Invest invest Vis Sci, 1993,34: 690-694).

A lack of accommodation that could induce "retinal blur", the current myopia could be the fruit of a mechanism close to that involved in the myopia of "deprivation". Accommodation was also suspected of increasing the intraocular pressure, and induce a gradual distension of sclera, both of which are synergistic to increase the axial length of the eye and thus promote myopia. However, no study has shown that improving the quality of accommodation (e.g. progressive glasses in children) does not slowing down myopia. It is possible that short-sighted accommodate less because accustomed to perceiving the world in a fuzzy way, they benefit from neuro-cortical strategies to better interpret the retinal images and thus tolerate a slight blur close. If there is an association between myopia and accommodation, the existence of a causal link has not been demonstrated.

Myopia and outdoor activities

From 2008, an Australian study showed that children who practice littleOutdoor Outdoors Activities Are on average more myopic (or less farsighted) than those who practice outdoor activity on a regular and prolonged basis. Children who in addition to a low outdoor activity regularly practice activities that seek close vision (reading, video games on portable consoles, etc.) had Three times more likely to be myopic That those who practice a lot of outdoor activities and little reading activity (Rose et al. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology 2008 115: 1279-1285).

These data have been backed up by the results of a study led to Singapore on teenagers, who were all less myopic (or more farsighted) that they were practicing outdoor activities)Dirani et al. Outdoor activity in andmyopia Singapore teenage children. BR J Ophthalmol2009; 93: 997-1000).

It seems to be the Time spent outside Which is a protective element against myopia, rather than the practice of sport in itself (no influence of indoor sport on the prevalence of myopia). This was corroborated more recently by the study by Guggenheim et al. (Guggenheim JA, Northstone K, McMahon G, Ness AR, Deere K, Mattocks C, St Pourçain B, Williams C. Time outdoors and physical activity as predictors of incident myopia in childhood: A prospective cohort study. Invest invest Vis Sci. 2012 apr 6. [Epub ahead of print])

In addition, the influence of a reduction of the lighting on the progression of myopia has recently been identified in an animal model)Cohen et al. Dependency between light intensity and refractive light-dark cycles under development. Exp Eye Res 2011; 92: 40-46).
The biological mechanism at the origin of this protective effect is not clearly identified; It could involve a reduction of the retinal blur (Pupillary constriction linked to the high brightness and improvement of the depth of field). The secretion of Dopamine At the retinal level is stimulated by light, and dopamine has an inhibitory effect on ocular growth (ashby RS & Schaeffel F. The effect of bright light on lens compensation in chicks. Invest invest Vis Sci 2010; 51: 5247-5253).

Finally, in addition to the light intensity gap between the outside and the interior, the difference in spectral composition between natural and artificial light could play a role in the genesis of myopia (reduction in Blue Light which is the most abundant radiation in the outdoor environment - see below). These data suggest a causal relationship between the occurrence or worsening of myopia and the less time spent in outdoor activities for children.

A study conducted in October 2012 reported a very low rate of myopia in a population of schoolchildren in the province of Vintiane in Laos (Southeast Asia): The prevalence of refractive error (hyperopia, myopia, astigmatism) was 3.6% for a cohort of 2842 children (6 to 11 years) examined: The overall prevalence of myopia was only 0.8%. The children were of different ethnicities; Of these, the Yao (South China Population group) accounted for a risk factor of 11.3 for myopia, emphasizing the likely influence of Genetic factors. Nevertheless, the authors of this study stress that its results are consistent with those of previous studies, because the Lao children studied did not seek much their vision closely, compared to those of other countries with the infrastructure More developed schools (little or no school books, blackboard teaching) (Casson et al. Exceptionally low prevalence of refractive error and visual impairment in schoolchildren from Lao people democratic republic.) Ophthalmology, 2012:119:2021 - 2027).

Finally, a meta-analysis (a global analysis carried out from the collection of about twenty studies related to the subject) was also published in October 2012: It confirms the protective effect on the onset and progression of the myopia of time spent in Outside, suggesting that to curb myopia, it might be appropriate to have children practice outdoor activities (e.g. one hour per day of outdoor activity as an outdoor sport). However, the authors of the study remain cautious about the possibility of misinterpretation of their causal result: it might be possible for the association between time spent outside and less myopia to be linked to the fact that the Myopic children prefer other types of recreation and are less inclined to practice some outdoor activities (not to mention the fact that urban populations, where the prevalence of myopia is stronger, have fewer outside spaces). However, this meta-analysis reinforces the hypothesis of a Beneficial effect of regular outdoor activities To reduce the onset of myopia (Sherwin and al. The association between time spent outdoors and myopia in children and adolescents. Ophthalmology, 2012; 119:2141 - 2151). These activities however do not seem to reduce the speed of evolution of the short-sightedness once it installed)Wu PC et al. Outdoor activity during class recess reduces myopia onset and progression in school children. Ophthalmology. 2013; 120 (5): 1080-1085).

A randomized prospective study was conducted in China in children of 6 years; less impact of myopia was observed after 3 years, for the Group of children for whom a daily outdoor activity of 40 minutes had been established. (He Mr. Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial.) JAMA. 2015,15; 314 (11): 1142-8.)

More recently, the value of time spent on outdoor activities among children aged 3 to 9 years was confirmed by another study carried out in Europe (Shah RL, Huang Y, Guggenheim JA, Williams C. Time Outdoors at Specific Ages During Early Childhood and the Risk of Incident myopia. Invest Ophthalmol Vis Sci. 2017,1; 58 (2): 1158-1166).


Myopia and activities close (reading)

An Australian study showed that the Work closely, quantified by time spent and reading distance, had an indisputable influence on the existence of myopia in children aged 12 years. Children who Were reading more than 30 minutes a day Continuously with more risk of being myopic than those who read less than 30 minutes a day. Those reading less than 30 cm had a two and a half times greater probability of being myopic than those who read at a greater distance, and tended to exhibit a higher myopia (IP et al. Role of near work in myopia: findings in a sample of Australian school children. Invest invest live Sci 2008; 49: 2903-2910). Another study showed that children who read more than two pounds per week on average were more myopia (nearsightedness greater than 3 diopters) than those who read less)Saw et al. Component dependent risk factors for ocular parameters in Singapore Chinese children. Ophthalmology 2002; 109:2065 - 2071). The axial length averaged 0.17 mm larger in children who read more than two pounds per week.
It is necessary to keep from inferring from this work that reading promotes the onset of myopia; These studies only show that there is more chance of finding myopic children among readers who are more avid, and/or practicing less outdoor activity. Moreover, a longitudinal study conducted for 5 years on a sample of 1318 children aged 6 to 14 showed that the number of weekly hours of reading or computer screen work was not different before the occurrence of myopia, Between children who became myopic and those who were not. This study tends to show that there is no link between the causal work closely with development of myopia)Jones-Jordan et al. Visual activity before and after the onset of juvenile myopia. Invest invest live Sci, 2011; 52: 1841-1850).

Yet, various mechanisms to explain how close extended vision could induce myopia have been proposed, as the occurrence of an increase in intraocular pressure (action of the ciliary muscle, which contracts and increases intra injection pressure), or the action of the extra eye muscles on the sclerale wall, etc.

The duration of studies would alone be a risk factor for myopia, more than the coginitives performance itself, according to a study published in 2016 (Mirshahi A, Ponto KA, Ubert-Reh D, Rahm B et al. Myopia and Cognitive Performance: Results From the Gutenberg Health Study. Invest Ophthalmol Vis Sci. 2016,1; 57 (13): 5230-5236).

The explosion of mobile devices contributes to the time spent reading or viewing content "in near vision". Between 2009 and 2013, the number of smartphones used by the Korean population increased from 500,000 to 33 million (Korea Communication Commission. Statistics on wired and wireless communication service subscribers, 2013). There may be differences between the type of electronic terminal used and the myopic risk (more pronounced when caseusing a smartphone than a tablet (Liu S, Ye S, Xi W, Zhang X. Electronic devices and myopic refraction among children aged 6-14 years in urban areas of Tianjin, China.Ophthalmic Physiol Opt. 2019 Jul;39(4):282-293).


Myopia and blue and violet light

Incriminating (without formal evidence) as a risk factor for certain dégénratives ocular pathologies such as AMD (age-related macular dégénrescence), Blue Light, which includes radiation from the most energetic visible light spectrum (the shortest wavelengths are perceived as violets – 360 to 400 nanometers) could be a factor whose chronic deficit is a risk factor for the onset and The evolution of myopia (Torii, H. et al. Violet Light Exposure Can Be a Preventive Strategy against myopia Progression. Ebiomedicine, 2017:15, 210 – 219) .  Thus, myopia has evolved less rapidly in a group of myopic children equipped with transparent corrective contact lenses for Violet Light (some lenses, such as Aqua/Alcon Dailies are transparent to violet, while others, such as Acuvue True eye/Johnson and Johnson, filter about 50%). These results are strengthened by those of a study carried out in strong myopic adults operated by the installation of two types of Phake implant (ARTISAN ® vs ARTIFLEX ®). Patients receiving the ARTIFLEX implant benefited from lesser elongation of the eyeball over time: However, the transmission of this implant for Violet light is greater than that of the ARTISAN (Torii H, Ohnuma K, Kurihara T, Tsubota K, Negishi K. Iolet Light Transmission is related to myopia Progression in Adult High myopia. Sci Rep. 2017 6; 7 (1): 14523). These results corroborate observations that point towards an association between the risk of myopia and the time spent outdoors: in fact, short blue (and violet) radiations are not present in confined environments, but abound in Outside. They strongly question the interest of blue filters on eyeglass glasses and the lenses prescribed for the correction of nearsightedness in eyeglasses in children and young adults (but could logically be case Preferentially indicated for the correction of the hyperopia, the defect opposite that of myopia, and where it is hoped an elongation of the eyeball.


Myopia and computer

Many studies point The growing time spent on screen, especially by children and teenagers: the time spent viewing a computer screen or smartphone (time spent on the Internet) for younger generations is now higher than that spent in front of television. Consulting a computer or tablet screen will require close vision, and should logically be associated with an increased prevalence of myopia. A study was conducted between February 2010 and March 2011 in Taiwan by measuring the refraction of military conscripts aged between 18 and 24 years. A biometrics (measuring the length of the eye) was also carried out. For the diagnosis of myopia, the refraction had to be less than 0.5 diopters (D). A total of 2316 participants were registered. The prevalence of myopia was 86.1% with an average refractive error of-3.66 D, and an average axial length of 25.40 mm. Frequent consultation of the computer has been found associated with a higher axial length: this correlation is quite eloquent considering that myopia is primarily related to an excess of growth and axile length of the eyeball. Other risk factors associated with myopia were: parental myopia, higher levels of study, more time spent reading, shorter reading distance, less time spent in outdoor activities, (Lee and al. What factors are associated with myopia in young adults? A survey study in Taiwan Military Conscripts. Invest invest Vis Sci. 2013 Feb 5; 54 (2): 1026-33)


Myopia and month of birth

Some studies have shown a link between month of birth and risk of developing myopia. Indeed, the prevalence of myopia is higher in subjects born in spring or summer than in those born in autumn. The mechanics behind this variation in vision are not well understood, and may be related to variations in day length during the development of vision in infants (see:Lee DC et al. An epidemiological study of the risk factors associated with myopia in young adult men in Korea.Sci Rep. 2018 Jan 11;8(1):511). This data suggests that the development of myopia may be influenced by the conditions surrounding the first few weeks of life (Matsuda K, Park K. Recent trend of increasing myopia can be traced to infancy. Med Hypotheses. 2019 Jul;128:78-82).



Myopia and level of education

Many studies have shown a strong Positive correlation between level of education, graduate studies and myopia (Katz et al. Prevalence and risk factors for refractive errors in year adult inner city population. Invest invest live Sci 1997; 38: 334-340 / Wang et al. Refractive status in the Beaver Dam Eye Study. Invest invest live Sci 1994; 35: 4344-4347 / Tay et al. Myopia and educational attainment in 421,116 young Singaporean males. Ann Acad Med Singapore 1992; 21: 785-791).

It was even reported a positive correlation between the total duration of the studies and length of the eye at a Chinese origin Singaporeans: the increase in the length of the eye was 0.60 mm for each decade of study)Wong et al. Variations in ocular biometry in year adult Chinese population in Singapore: the Tanjong pay Survey. Invest invest live Sci 2001; 42: 73-80).

A Relationship between myopia and education was also found in European myopic (Williams KM1, Bertelsen G2, Cumberland P3, et al. Increasing Prevalence of Myopia in Europe and the Impact of Education. Ophthalmology. 2015 May 13)

The North American continent is no exception to this association between myopia and level of education (Nickels S et al Myopia is associated with education: Results from NHANES 1999-2008. PLoS One. 2019 Jan 29;14(1)). The absence of correlation between study level and corneal curvature suggests that the mechanisms involved in this association influence the ocular elongation or optical power of theCrystalline lens.

The superior study level and the duration of the studies are certainly closer to the risk represented by reading factor. However, there are also the hypothesis of common genes for intelligence and myopia.


Myopia and Anthropometry

In children and adolescents, a Stature (size) More important was also found to be a risk factor associated with myopia. The correlation between size and myopia was absent in adults (Rim TH et al. Body Stature as an Age - Dependent Risk Factor for Myopia in a South Korean Population.) Semin invest. 2016 apr 8:0.). This study found a correlation between level of education and myopia among adults (South Korea). The increased prevalence of myopia is found in patients with Marfan syndrome, which also exhibit a higher average size (TR1, Zetterstrom Konradsen C.) Descriptive study of ocular characteristics in Marfan syndrome. ACTA invest. 2013; 91 (8): 751-5). Despite a sometimes significant elongation of the eyeball, the degree of high myopia is not significantly higher due to a lower average keratometry (corneal power reduction partially offset the increase in the ocular axial length).

Nevertheless, it appears that the prevalence of high myopia is higher in taller, thinner patients (low BMI: body-mass index) (Lee DC et al. An epidemiological study of the risk factors associated with myopia in young adult men in Korea.Sci Rep. 2018 Jan 11;8(1):511). On the other hand, obesity would be more correlated with the risk of hyperopia; the presence of excess orbital fat preventing the elongation of the eyeball has been cited to explain this feature.


Myopia and intelligence

Many studies report the existence ofAssociations between myopia, intelligence, academic success e.g: Williams et al. Comparison of measures of reading and intelligence have risk factors for the development of myopia in a UK cohort of children. BR J invest. 2008; 92 (8): 1117-21). Short-sighted have on average higher scores on intelligence tests and test (cognitive)Cohn and al. Myopia and intelligence: a pleiotropic relationship? UM. Genet, 1988; 80: 53-58).

These results suggest a genetic part in myopia, because intelligence is partly transmitted hereditary way. However, it cannot be concluded that there would be one or more common genes between intelligence and myopia. In most published studies, tests where short-sighted are the most successful are those who rely mainly on tests where reading and language play a prominent role. In fact, studies also show that short-sighted read more and longer than non short-sighted, and the influence of reading in these results is certainly present. A possible but unproven theory suggests that the short-sightedness and intelligence may share a common genetic background. The naturally gifted intellectually people read more, which would explain the link between myopia and extended reading. Reading certainly promotes the intellectual, and if a cause and effect link between myopia and extended reading (an association demonstrated between reading and myopia is without prejudice of a direct causal link), it could also explain these data, without resorting to genetics.


Myopia and sex ratio

Are you there more myopic among boys or girls? Published studies do not determine with certainty, and the results found in an age category are not necessarily valid in a sample of age (different)JM Hirsch. The change in refraction between the ages of 5 and 14, theoretical and practical considerations. Am J Optom Arch Am Acad Optom, 1952, 29:445 - 459). A more recent study found a prevalence of nearsightedness greater among men in the population aged)Tan et al. Prevalence and risk factors for refractive errors and ocular biometry parameters in year elderly Asian population: the Singapore Longitudinal Aging Study (SLAS). Eye, 2011, 25 (10): 1294-301).


Short-sightedness of the parents

An Australian study showed that the Presence of myopia in one of the parents Multiplied by two the risky for a child to be myopic. When both parents are myopic, the risk is multiplied by eight! This risk is also greater if the myopia of one or more parents is pronounced (IP and colll. Ethnic differences in the impact of parental myopia: findings from a population-based study of 12-year-old Australian children. Invest invest live Sci 2007; 48: 2520-2528.73).

The axial length of the eyes of children is greater when parents are myopic)Zadnik et al. The effect of parental history of myopia we children' Sandy size. JAMA 1994; 271: 1323-1327). If the prevalence of myopia is stronger in myopic children, it is tempting to blame the influence of genetic factors. However, because other factors of risk above mentioned, myopic parents tend to raise their children in an environment may be more "myopiegene": fewer outdoor activities, more intellectual reading activities)Edwards MH. Effect of parental myopia on the development of myopia in Hong Kong Chinese. Ophthalmic B.j. Opt 1998; 18: 477-483). The protective effect of the outdoor activities seems to exercise as much about the children of myopic parents than not myopic parents.

Myopia and peripheral refraction

The fovea is the seat of the fine vision, and occupies about 1 degree in the Center of the visual field. Myopia is defined as an excessive refraction of the light rays emitted by the distant sources observed (the image of these sources is then projected on the fovea). The vision embraces the entire visual field and the sources located outside the central degree are also imaged on the retina. The way in which the light rays emitted by peripheral light sources (ex: 15 ° eccentricity) are focused on the extra fovea retina concerns the study of the Peripheral refraction (as opposed to the central fovea refraction). Experimental studies conducted in animals have shown that the peripheral retina plays an important role in the process of emmétropisation (control of the growth of the eyeball designed to maintain a balance between focal power of the couple Cornea Crystalline lens and distance from the retina) (Smith et al. Effects of foveal ablation we emmetropization and form-deprivation myopia. Invest invest live Sci 2007; 48: 3914-3922).
On average, peripheral refraction is less myopic (more hyperopic) than central refraction. A study conducted in 822 children aged between 5 and 14 years showed that the eyes of myopic children have a higher relative hyperopia in the periphery than the eyes of children Emmétropes and farsighted) (Mutti et al. Peripheral refraction and ocular shape in children. Invest invest live Sci 2000; 41: 1022-1030). These findings may seem surprising, but optically, due to the peripheral retinal curvature, and the impact of peripheral sources from rays, these can then quite be defocused more 'far' behind the retinal plan (peripheral farsightedness). This peripheral defocus is potentially the source of eye elongation, and a development of myopia.

The ethnic differences between Asian and African children of origin have been found in a U.S. study: the peripheral refraction of eyes of Asian children was generally more hypermetropique than even myopic African children. (Mutti et al. Refractive error, axial length, relative and peripheral refractive error before and after the onset of myopia. Invest invest Vis Sci 2007; 48: 2510-2519).

A more hypermetropique deviation of the peripheral refraction has been also found at children and nearsighted adults of Chinese origin. On the other hand, the farsighted eyes of Chinese adults and children tended to have a more myopic peripheral refraction)Chen et al. Characteristics of peripheral refractive errors of myopic and non-myopic eyes Chinese. Vision Res 2010; 50: 31-35). These data were confirmed by a study recently conducted in children of Chinese origin in Singapore)SNG et al. Peripheral refraction and refractive error in singapore chinese children. Invest invest live Sci, 2011; 52: 1181-1190).

Peripheral refraction is influenced by various factors, including the corneal Asphericity (variation of the edge curvature of the cornea). Only longitudinal studies could accredit the responsibility of asphericity of the cornea in the genesis of myopia. A longitudinal study recently conducted in 187 children ages averaged 7.2 years showed that during their follow-up, that the initial peripheral refraction had no influence on the risk of developing myopia. On the other hand, become myopic eyes have developed a more hypermetropique peripheral refraction at 30 ° in nasal and temporal thus, the initial state of the peripheral refraction does not appear to affect the risk to become myopic, but on the other hand, the appearance of myopia seems to alter peripheral refraction.


Myopia and cataract

Myopia seems to favour the occurrence of certain types of cataracts such as nuclear cataract, and the posterior capsular cataract (see page on cataract). This association has been underlined by two studies (recent)Pan et al. Myopia and Age-related Cataract: A Systematic Review and Meta-analysis. Am J invest. Aug 9, 2013 and Pan and al. Myopia, axial length, and age-related cataract: the singapore malay eye study. Invest invest Vis Sci. 2013 Jul 2; 54 (7): 4498-502). Cataract may in turn increase initially axile myopia (related to the excessive length of the eye). Myopia increase mechanism is related to the increase in the index of refraction of the cristallinien kernel: we talk about "index myopia" (see the page dedicated to the) various types of myopia). Thus, myopia argues with the occurrence of early cataract and faster evolution. Cataract surgery can correct or reduce myopia, by the use of a suitable power implant.


Contact lenses and myopia

The "brake" effect on the myopia of a correction in Contact lenses Rather than in glasses is often debated. Some studies have not been able to show any statistically significant difference (DG, Soni PS, TO Salmon and al Horner. (1999) progression Myopia in adolescent wearers of soft contact lenses and shows. Optom Vis Sci 1999; 76: 474-9 - Katz J, Schein OD, Levy B et al. A randomized trial of rigid gas permeable contact lenses to reduce progression of children's myopia. Am J invest, 2003; 136, 82-90). Some studies even suggest an increase in the speed of development of myopia in the adolescent from glasses to a correction in lens correction)Fulk GW, Cyert the Parker of et al. The effect of changing from glasses to contact lenses soft we myopia progression in adolescents. Ophthalmic B.j. Opt, 2003; 23, 71-7 - Marsh-Tootle WL, Dong LM, Hyman L, et al. Myopia progression in children wearing shows vs. switching to contact lenses. Optom live Sci, 2009; 86, 741-7). Yet the equipment in conventional contact lenses could alter peripheral refraction, inducing a peripheral myopisation rather than a peripheral hypermetropisation, and thus have a beneficial effect on the development of myopia. This theory is at the origin of the development of contact lenses, to the gradient of curvature amended to accentuate this effect of peripheral myopisation multifocal.

A study of homozygous twins suggested that bifocal lenses may have a beneficial effect by slowing down the development of myopia)Hasebe S, Nakatsuka C, Hamasaki I et al. Downward deviation of progressive addition lenses in a myopia control trial. Ophthalmic B.j. Opt, 2005; 25, 310-14). A laboratory (CooperVision) has developed "double focus" lenses ' MiSight), by the juxtaposition of areas of varying powers, which create a peripheral retinal myopisation, in order to slow the growth of the eye. A study showed that this equipment could slow the growth of the eye ((0.11 ± 0.08mm in avec la lentille à double focus versus 0.22 ± 0.09mm avec les lentilles conventionnelles) ())Anstice NS, Phillips JR (2011) Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmology, 2011; 118, 1152-61).


Myopia and Orthokeratology

The Orthokeratology is to Wear rigid lenses at night, so as to induce corneal deformation (central flattening) and correct myopia, because the effect of the nocturnal port tends to persist during the day, after removing the lenses in the morning. It is difficult to validate the hypothesis of a braking effect of orthokeratology on myopia, due to methodological problems (absence of control group, transient modification of ocular geometry, etc.). In addition, Orthokeratology exposes microbial complications, particularly in children (Watt K, Swarbrick HA. Microbial keratitis in overnight orthokeratology: review of the first 50 casees. Eye Contact Lens, 2005; 31, 201-8). The assumed braking effect would result from the change in asphéricité of the cornea (less prolate/More oblate geometry), allowing for the inducing of peripheral retinal myopia. Recent studies have certified a beneficial effect of orthokératomogie on the ratentissement of myopia (Leo SW. Current approaches to myopia control. Curr Opin Ophthalmol. 2017; 28 (3): 267-275).


Myopia and keratoconus

The keratoconus represents a particular situation where myopia is acquired later in life (late adolescence, young adulthood) and progresses rapidly. Keratoconus can occur in initially myopic, emmetropic or hyperopic eyes. Myopia induced (or accentuated) by the keratoconus is not related to an elongation of the eye but to the increase in corneal curvature which partly defines the clinical picture of this condition. The increase in the optical power of the central region of the cornea leads to the appearance of myopia (excess corneal vergence with respect to the axial length, whereas the eye concerned had been able to grow without excess and reach emetropia, or to be affected by stabilized myopia).

corneal myopia unilateral keratoconus example

Myopia mainly of corneal origin on the right side (about 16D) in a patient with unilateral keratoconus. Part of this type of myopia is acquired and linked to an increase in the optical power of the cornea (refraction, corneal topography, biometry, photo of the corneal profile of each eye.). In this example, suffering from moderate myopia, the patient has rubbed his right eye almost exclusively with the phalanges for years (he sleeps with his head resting on the same side). The mechanical energy carried by the phalanges caused an architectural disorganization of the corneal tissue, and local inflammation responsible after a certain time for an irregular but isometric (without distention) thinning and deformation of the cornea: camber in the lower paracentral region and flattening at the peripheral level. This camber increases the refractive effect of the cornea. Irregularity is responsible for the appearance of significant astigmatism. This table is that of a unilateral keratoconus. The axial length of the keratoconus side (24.45 mm) is shorter than that of the unharmed side because it is slightly rubbed (24.72 mm). If the curvature of the right arch had remained the same as that of the left eye, the right eye, less elongated, would be the least short-sighted. There is a difference of about ten diopters between the spherical equivalent of the right and left eye, as well as between the keratometry of the right and left corneas.


Recent and sometimes contradictory studies show that the dimensions of the eyeballs are not very different overall from those of healthy subjects, particularly with regard to the posterior segment of the eye (Jian W et al Ocular dimensions of the Chinese adolescents with keratoconus.BMC Ophthalmol. 2018 Feb 13;18(1):43) (Lanier JD et al. Axial length in keratoconus.Cornea. 1992 May;11(3):250-4.)

Patients with advanced keratoconus all have strong myopia of corneal origin: an increase in corneal curvature of 10 Diopters (e. g. keratometry from 43D to 53D) is responsible for a comparable increase in the spherical myopic equivalent. According to the author of this site, keratoconus is caused by eye rubbingexcessive and prolonged. The impact of these frictions on the cornea is responsible for progressive thinning and deformation; their effect on the posterior segment is poorly documented. The classical theory, which states that keratoconus results from a deformation linked to a primitive biomolecular alteration of corneal tissue, is invalidated by the observation of ocular manifestations of Marfan's disease. During this condition, characterized by protein damage responsible for a progressive loss of the elasticity properties of the supporting and ligamentary tissues, the eye becomes distended overall. In addition to axial myopia (which is important for the clinical diagnosis of the condition), there is thinning and flattening of the cornea, not an increase in its arch... as expected due to progressive distention of the corneal stroma.



The precise mechanisms responsible for the excessive elongation of the eyeball, which is responsible for most myopias, remain largely unknown. Studies suggest that epidemiologically, children of Asian origin are more frequently affected by myopia, and that there is a positive (not proven causal) link between prolonged reading and myopia, as well as a negative link between outdoor activities and myopia. The population of the European continent is proportionally less affected by myopia than that of the Asian continent, but the prevalence of myopia is increasing. Outdoor activities could have a protective effect, and it seems reasonable not to deprive our children of their myopia.



See also:


Can we slow down myopia?

Risk factors for myopia

Surgery for myopia

Keratoconus in brief


51 responses to "myopia: causes, risk factors"

  1. Philippe Lefebvre says:


    I am father of a 8 year old mi Thai, french mi. Looking at him, he has a much higher genetic inheritance from my side. He lives in Bangkok.
    I just discovered his myopia.
    The Thai doctors I have consulted do, as in your article, show only hypotheses that can enlighten the onset of myopia.

    His vision will be corrected. Wearing glasses.

    I had thought about laser surgery that me has been formally deprecated for a child of his age as the eye evolves.

    So, my question is about what to do for years to come, especially on the time spent in front of various screens which he is very fond.
    Is it better to curb its taste for games, movies etc or is it inflicting something that is now useless..? In other words, his myopia can worsen, even when wearing glasses, if he continues to indulge in his favorite games..?
    Imposing a maximum reading time is it always useful while the evil is done..?

    Thank you for your answer

  2. Dr. Damien Gatinel says:

    Current recommendations for correction of nearsightedness in children advocate simply to correct it in full (no sub correction). It would also appear that the regular practice of outdoor activity may have a protective role of the less suppression on the development of myopia. Laser surgery is actually against specified. Work on screen, "in-door" and activities closely associated with the prevalence of myopia, but their role in the evolution of this is difficult to quantify. The myopia of children is unfortunately to move with the times, because the myopic eye is "too long", and continued growth to 18 to 23 years approximately (sometimes more).

  3. azzout lyazid says:

    I have my 11 year old daughter who is myopic, she saw a ophthalmologist last year (she was a 7/4) bezel door, lately had a college nurse visit which found that her eyesight has fallen again!!!! The shock with the glasses his vision is 3 and 4. We fell high. She's a very bright girl at school is like she's only 11 years old that means the problem is not going to stop evolving! What will become of them is 15 years or 18/20 years old. Can she become blind???? I await your advice with impatience doctor. Thank you in advance.

  4. Dr. Damien Gatinel says:

    The myopia of your daughter will actually evolve into adulthood. It is important that she could benefit from a good optical correction. Nearsightedness is however relatively "banal" among adolescents. Your daughter will not blind but must correct his myopia with glasses from glasses and lenses. Refractive surgery will be proposed as an adult if she wishes.

  5. GROSS Celia says:


    I would like to ask you a question. I'm farsighted since childhood (I'm 22). My optician recently made me an eye test and he told me that I have become short-sighted.
    Is it possible to suddenly change ametropia?

  6. Dr. Damien Gatinel says:

    It is possible to develop a myopia of late after being slightly longsighted but this situation is relatively rare. Supported studies (ex: preparation of competition) can occaseionner what is colloquially called "the myopia of the student. Anyway, please make sure that your refraction measurement made without you accommodiez. A priori, myopia causes a permanent Visual blurring for distant targets, and if you feel this vagueness, it is that you become nearsighted. Conversely, a slight farsightedness occaseionne possibly visual fatigue, headaches, but not Visual blurring in 22 years.

  7. MOUGIN Anaïs says:

    First of all, thanks for this very interesting article.
    Here's my question:
    I have been myopic since I was a child, and I had surgery at the age of 20 (my myopia was then quite high, about-9 diopters). Following this operation I had recovered a good view, about-0.5 diopter. The problem is that since then, my myopia still evolves steadily, and there, at 34 years, I am at-3 diopters... How do you explain that? Isn't the view supposed to stagnate around 20-25 years? Besides, will my myopia still continue to evolve?
    Thanks in advance for your return.

  8. Dr. Damien Gatinel says:

    Your situation is unfortunately typical. Myopia measured in dioptres-9 at the age of 20 years is never stable myopia. A high degree of myopia reflects a rapid evolution and who will not be stopped by time, or of course a refractive surgery. To be distinguished from the low myopia and medium-sized (up to-6 or - 7 D), which stabilize after growth of the globe eyepiece (20s), of the highest myopia, are because they are just evolving. If you don't had not been made, you would today, 14 years later, a myopia of-13 D about... However, it is possible to envisage a reprocessing if the residual thickness of the rear wall of the cornea is sufficient. An assessment and preoperative measures are needed to validate this possibility.

  9. Angélique says:


    So I have questions, I'm short-sighted since the age of 5 years, my parents are not short-sighted and have no problem view, nor anyone in my family also (whether as maternal paternal side).
    I wanted to know the causes of my myopia, child I was all the time outside, around 6 years I was a lot in front of the TV in the morning, the rest of the day outside. So I have no criteria here quoted.
    Today I have 27 years and I have-6 left eye and-4 right eye... Am I going to pass this myopia on to my children?? Where do these views come from?

    Thank you for your answer

  10. Dr. Damien Gatinel says:

    It is difficult to predict if you will send your myopia to your children. In this article, are cited factors of risk and correlation, statistical value, but who do not always predict or explain the onset of myopia at the individual level. Many case of myopia are "sporadic", they can be "'genetic mutations, of unknown factors, a"dysarmhonie"between certain biometric parameters such as the curvature of the cornea and the length of the globe-induced ocular (in general, this disharmony does not explain the myopia greater than 4 or 5 diopters).

  11. Milene says:

    I have been short-sighted since I was 17 (today I have 20). I would like to know when the myopia stabilizes when it starts late? Plus I noticed that I see better when I think the head back is this normal?

  12. Dr. Damien Gatinel says:

    Your myopia is certainly known as the place of "short-sightedness of the student", related to school work and efforts in near vision. This type of myopia usually continues to evolve with the end of the studies. Better see by tilting the head back is probably related that the upper eyelid then shrink the diameter of the pupil of entry of the eye ("filter a few rays"). Reduction of the diameter of the pupil to reduce retinal blur induced by mild nearsightedness.

  13. Dr. Damien Gatinel says:

    Your question is interesting. Actually, considered generally as NET vision to 6 meters (which can reach 20/10 is the maximum of the retinal resolving power) is a clear vision at infinity. The vergence of a target to 6 m is 1/6 d or diopter 0.15, which is theoretically significant. 4 m, the same calculation provides a vergence of 0.25D which corresponds to the limit of detection of the defocus of the human eye. In practice, there is often that the light hypermetropia, even become presbyopic, have better vision (at least on the subjective level) to 10 meters, or even 30 meters to the classical distance of reading in a cabinet of ophthalmology.

  14. Caroline says:

    Thank you for all the explanations.
    My aged son, now 13 years old, had a hyperopic with a 2-year-old adjusted strabismus at 9 9 years.
    Today I am told that a slight myopia appears. It's a great player and Addict to video games...
    Should it decrease significantly his time spent in front of video games?
    He wants to do archery but he does not see the reliefs... Is the practice of this activity against him indicated where on the contrary can it be beneficial?
    Thank you for coming back.

  15. Dr. Damien Gatinel says:

    The onset of myopia in adolescence can quite replace a farsightedness. Children are born farsightedness, then the eye grows and hyperopia is corrected 'naturally' for the farsighted. When the eye is longer than the 'optimal' length (which depends on some parameters such as the power of the cornea and the crystalline lens), myopia appears. The risk factors are indicated in the article, and currently, the lack of time spent outdoors seems to be correlated with the onset of myopia. The practice of a regular outdoor activity could have a beneficial effect and slow the progression of myopia.

  16. Thomas says:


    First of all thanks for this article, very clear and informative.

    I have concerns about the evolution of my myopia:

    My case:
    -No case of myopia in my family
    – Visual acuity > 10/10th since my childhood, until I was 30 (at least, date of my last visual Test by occupational medicine)
    – I'm 32 years old... for about one to two months, I have a loss of details on the elements from afar (> 3m), left eye side (eye-manager).
    – I just went to see a ophthalmologist, which confirms me that I am myopic from-0.75 d on the left eye

    I admit I don't understand how it can happen at that age, and especially way too fast...
    My ophthalmologist has no answer to my questions:
    – Where does this sudden myopia come from?
    – Will it evolve?

    I spend my life in front of the screens, without necessarily taking a break during my long working days. So, I guess that there is an environmental link, even if I play sports outdoors when I can.
    The first signs of gene appeared during the treatment of chalazions on this eye... (Maxidrol + hot water compresses) and I suspect that there is a causal link, but I am certified not to...

    In short, I confess to being somewhat worried.

    Thank you for your answer

  17. Dr. Damien Gatinel says:

    The late onset of myopia is sometimes observed in case of work extended in near vision (myopia "of the student"). We must also eliminate other rarer causes as the beginning of nuclear cataract. Finally, in patients who work great on screen, sometimes a trend in the practice of vigorous eye rubbing, who can, through a modification of the geometry of the cornea, causing a slight myopia and astigmatism.

  18. Jacques says:


    The ophthalmologist of the children (including one to 11 years, correction of-3; 50 to an eye and-4,00 to the next progression of-0; 75 in a year for an eye) is the sous-correction ADPT. Yourself, you ladecouragez. The arguments of the two positions are all too logical.

    How to slice, from my point of view of philistine? Are there comparative studies? They all go in the same direction? Also on the lenses

    Other questions:
    1. Is it advisable that they do not wear their glasses, when they do not really need a precise vision, for example when they relax playing table tennis?
    2. Reading in the car can have an impact on their vision in general, and their myopia in particular (they read approximately 30 mins in the morning and 15 mins in the evening).
    3. Therefore an indoor sports activity has no positive influence on their myopia, as opposed to an outdoor activity. But what difference is there for example between one part of basketball or tennis indoors and another in outdoor. They focus their vision on the same distances. In addition, there is a lot of talk about this beneficial effect of distant vision on myopia, but what is this distance? 10m, 100m, 1000 meters?

    Thank you for this site and your responses: it's all just great!

    And thank you in advance for your answer.


  19. Dr. Damien Gatinel says:

    Interest of not not as correct children well noted in several well-conducted studies, because it seems that the retinal blur induced myopia is meem a source of accentuation of the elongation of the eye (and so an accentuation of myopia). If it is possible for your children to play tennis of table without glasses is their short-sightedness is low, and it is difficult to say if on an individual level, this will have a positive or negative impact on their Visual become. Extended reading has been correlated to myopia in children, but then again it is not to prohibit children to read, drive or at home. Provide sufficient lighting is certainly beneficial in all case. Indoor sporting activities certainly do not have the same effect as outdoor... because the positive effect is not related to the sport but simply time spent out. Superior brightness outdoor several magnitudes to that to which we are exposed inside. The distance of vision does not have a blatant role in this prevention effect of myopia with the "outdoor" activities

  20. Elisa says:


    Thank you for this site.

    I understand from one of the responses above that a high myopia (-9 and in the past) will never stop evolving. I'm in the same case that this person (myopia of-9 operated for 22 years, and I again lost 1.5 diopters since, which brings me 7 years later to-2.5 because I had not recovered) possible unretouched because the wall is limited. Should I so get ready to rock again in the high myopia and if so, what options are available to me? Is it possible to implement some years after lasik ICL in this case? (I know that it is possible to do the reverse).
    Thank you!

  21. Dr. Damien Gatinel says:

    If the posterior residual wall is too thin, it might be considered;
    -Make a PKR (without raising the flap)
    – Raise the flap and issue the correction on the posterior side of the
    – Implant an intraocular lens (ICL) but your myopia is too "weak" at the moment.

    I usually prefer the second solution, if the flap has a sufficient thickness, which must be checked by performing a measure by OCT of the cornea.

  22. Lucie says:

    Thank you for this informative article.
    I wanted to know how far we're starting to see blurred with a myopia of about-1?
    Does having a squint favor the onset of myopia?
    Thanks in advance for your answers

  23. Dr. Damien Gatinel says:

    In theory, a myopia of - 1 d causes a Visual blurring beyond the distance of one meter, about. Strabismus does not cause nearsightedness in the sense where this optical defect translated generally excessive length of the eyeball.

  24. Joey says:

    Hello, I'm 15 years old and since my 10 ~ 11 years old I'm nearsighted.

    Left eye:-4 ~-4.5
    Right Eye:-3 ~-3.5

    I would like to know if this will stop one day, every year I go to my eye doctor to correct my sight. I wear glasses. I spend a lot of time in front of my computer I would like to know if this impact on my view.

    My mother is also short-sighted but not wearing glasses, his father is also and in door.

    My view going down? Thank you for your response.

  25. Dr. Damien Gatinel says:

    Unfortunately, the progression of myopia is individually difficult to predict, but there are statistical trends, which show that average myopia is evolving faster in adolescence, but usually stabilizes between 20 and 25 years. Most nearsightedness is weak and appears late and more its stabilization is early and vice versa. In your situation, hopefully priori myopia progresses more a lot (maybe an additional diopter?), but this depends on genetic and environmental factors, as well as the duration of your studies secondary and/or higher potential. The prolonged close work (screens, books), seems to be an aggravating factor, may be because he has the corollary less time spent outdoors (children who spend time outdoors on a regular basis seem to be least reached myopia than the others).

  26. […] right choice for kids Editions Thierry Souccar Damien Gatinel (doctor): myopia definition, mechanisms, epidemiology, factors of risk, (a great article [...]

  27. John Gonzaga says:

    Hello doctor,
    My 10 year old daughter has been myopic since she was 6 years old and her myopia is constantly evolving and fast (-0.75 in 8 months). We live in Dubai and here we are recommended the orthokeratology. But at no time we were told about the infectious risks. Do you think that the benefit/risk ratio is satisfactory today? What is the opinion of the Medical Corps in France?
    Thanks in advance for your answer

  28. Dr. Damien Gatinel says:

    The Orthokératotologie is a relatively recent technique, but seems to provide an interesting corrective response for the myopia of children and adolescents. Some studies suggest that optical aberrations generated by orthokeratology may counterbalance those that would cause the progression of myopia. More simply, it is possible that the correction in orthokeratology may hinder the progression of myopia. This data will have to be confirmed by other studies. The infectious risk associated with the wearing of lentils is to be considered, but strict adherence to the rules of maintenance and port is enough to greatly reduce this one.

  29. Svitlana Krynytska says:

    Hello doctor,
    In order to reduce growth or increase in myopia, our ophtamologue has prescribed Atropine 0.01% (1 taste in each eye per day over 6 months) for our 10 year old daughter. Instead of an increase of 0.75 it could be reduced to 0.25 per year. What do you think?
    Thank you in advance for your advice.

  30. Dr. Damien Gatinel says:

    There are indeed protocols based on the use of atropine at these low dilutions, which seem to slow the progression of myopia in children, without inducing too much discomfort for reading and light. If the treatment is well tolerated, it is certainly worth pursuing.

  31. Backgammon says:


    For a child who spends a lot of time on tablet, computer, console, ...
    Do you think that making him wear glasses + 0.50 D during these activities (with treatment against blue light) can avoid the onset of myopia.
    On the other hand, are glass shots with blue light filter really effective and from what age do you advise them?

    Thank you in advance for your reply.

  32. Dr. Damien Gatinel says:

    There is no scientific data to support the interest of the measures you are advocating to reduce or slow myopia.

  33. Daniel says:

    Hello doctor,

    Are there any case where the myopia correction operation is absolutely to be avoided? If so, could you tell me which ones? Thank you in advance for your reply.

  34. Dr. Damien Gatinel says:

    There are several contraindications to the surgery of myopia, at the forefront of which is the presence of permanent corneal deformation (keratoconus). If the myopia is too strong (and/or the cornea too fine), a complete correction is impossible. It is necessary to wait until the patients have reached the majority, that the myopia is stable, and that there is no associated evolutionary eye disease.

  35. Fanny says:

    Our 7-year-old daughter wears glasses to correct her myopia since September. Its correction was-0.75/-0.50. After a further examination in March (7 months) She is diagnosed at-1.25 for both eyes, a very strong progression. The Optimetriste advises us to orient ourselves to ways of controlling myopia of the Orthokeratologie type. In addition to the risks of infection and the stresses that this presents in terms of routine for a child of this age, I wonder what happens if there is "forgetting" lenses for one night, and is there a benefit to starting this type of treatment as early or as We can wait to see the evolution for a few years. What would be the other options? We are a little lost!! Both parents are very myopic (Papa-4 operated, Maman-7), but later onset of myopia (Papa 17 years old, mom 10 years old). Thank you for your reply. Very interesting Site.

  36. Dr. Damien Gatinel says:

    Recent studies suggest that Orthokeratology would have a braking effect on the evolution of myopia in children. This technique is indeed a particular constraint. It is advisable to consult an experienced practitioner who specializes in the adaptation of myopic children. In some countries (e.g. Singapore), studies have been conducted to assess the effect of diluted atropine solutions (0.01%) in daily instillations. There also a braking effect has been highlighted, even if a kickback effect is suspected at the stop (resumption of the evolution of myopia when the eye drops are interrupted). In all case, an appropriate correction (no sub-correction) is required. Close monitoring will check the kinetics of the evolution of myopia, and it is not certain that your daughter's myopia exceeds the degree of her parents.

  37. Panda says:

    I am myopic since I was very small, my myopia (-9 and-9.5) had stabilized versmes 20 years but I see today that I do not see well from afar.... I'm 32 years old, after reading your article so I think to be part of evolutionary myopia.
    I have to make an appointment with my ophthalmologist next week and I'll see him in six to seven months. Do I have to ask to go urgently or wait for 6 months knowing that I can no longer read some signs when I drive?
    Thank you for your answer.

  38. Dr. Damien Gatinel says:

    The discomfort with driving is a limitation and a handicap that would be worthwhile to correct, especially for security reasons. It is indeed likely that your myopia has evolved over the past decade.

  39. Sabrina says:


    Thank you for your article rich in information.

    My 6-and-a-half myopic daughter at-12 on each eye probably suffers from an evolutionary myopia (-10 last year)
    It is frequently followed by its ophthalmologist to check if the retina is not affected and adapt the glasses according to the evolution of its view.

    We advise you to try bifocal lenses or eye drops treatment?
    Can permanent rigid lenses help slow myopia or improve visual comfort?
    As a practitioner, can you follow up on his pathology, the case appropriate can you direct us to one of your colleagues specialist for this kind of case?

    Thank you very much

  40. Dr. Damien Gatinel says:

    I do not care about the myopia of the children, you need to address a specialized pediatric ophthalmology service (e.g. Rothschild Foundation, Necker Hospital or keychain). There is no such thing as a priori universal correction protocol, apart from the rigid lenses in this field.

  41. Oj says:

    I have read I do not know where, that the consumption of sugar would be related to the epidemic of myopia.
    Too much insulin would increase the eye as well as height.
    This would be particularly evident in the Inuit where myopia exploded at the same time as diabetes.
    Could it be that our refined carbohydrate diet is the cause of all this?

  42. Dr. Damien Gatinel says:

    Some studies suggest a link between insulin resistance and excessive eye growth. However, sugar is not the first risk factor to involve in the genesis of myopia. In addition, diabetes is a source of many complications, including oculars; In particular diabetic retinopathy. It is especially on this side that it is important not to release the surveillance and continue the research.

  43. Lo says:

    Hello, I am 19 years old and a small myopia to the right eye (-0.75). It has been five years that it has not moved. I control every year with the ophthalmologist. However since the beginning of my studies at the university (a little over a year) I am obliged to ask enormously my vision closely all day, and I often see blurry, even from my left eye which has 10/10, but temporarily, after soliciting Long my vision closely. After 5-10 minutes, my eyesight becomes normal again, but I worry: can my myopia in the long run actually increase or even appear on my eye intact, even if it is normally stabilized for a long time? Or are these episodes of blurring only visual fatigue and will always remain temporary? Thank you in advance.

  44. Dr. Damien Gatinel says:

    "Student Myopia" is a late myopia (onset or aggravation), occurring in prolonged sessions in close vision. There are no proven methods to prevent it, but it is certainly appropriate to perform "visual pauses", i.e. interrupt the reading closely and look away from time to time, to release the accommodation.

  45. Francois says:

    I was recently diagnosed with mild myopia at 34 years of age.
    The order says:-0150 and-0.25 (-0.25 180) – (this must be it, but I have a little trouble reading it, the fault in writing, not in my eyes!)
    I can't quite understand whether late myopia when absent in childhood, adolescence, and up to thirties is common (it seems to me that there is also a slight astigmatism for an eye).

    1-my ophthalmo. has established his diagnosis from an examination of the eyes by a machine and not from a test of sight. Does this diagnostic means evacuate the risk of diagnosis of "false myopia" due to fatigue or other?

    2-I am a little afraid that adopting a correction would lower my distant view without glasses because of an adaptation because of the habit (I read a lot of conflicting things about it online). I still see far enough, I can read more than 5 meters of the inscriptions but it is true that the letters "droan" a little bit + slight doubling.
    So I hesitate a little to take the leap.

    Here is a quick review of "what is said", are these assertions false?

    – "For a myopic, it is true that not wearing glasses constantly makes the view go up a bit."

    – "the wearing of glasses allowing a balanced and comfortable situation, we quickly find no more correct vision without glasses, eyes and brain losing rapidly, to return to their natural state, this elasticity, this faculty that they have developed and maintained for a long time to "force" continuously in an unconscious way to have a clear view. Especially as the eye loses irremediably its strength of accommodation with the age. What can make it seem that "glasses degrade vision" is in fact simply the brain and its visual system that seek a comfortable and balanced situation and quickly refuse to fatigue and return by forcing, accommodating, the imbalance preference for the accreditation and comfort of a perfectly corrected view with the glasses. »

    "So yes, in a number of case rehabilitation exercises, and Visual training brings benefits, yes some myopia are not and so can disappear. "

  46. Dr. Damien Gatinel says:

    It is not advisable to carry out an optical equipment on the basis of a simple machine test (autofractometer). If you have been accommodating during the measurement, then a false myopia may appear (or a real accented one). You manage without glasses thanks to the left eye which is very little nearsighted. In General, the discomfort occurs in night vision (dilation of the pupil which increases the retinal blur of light myopic). If it turns out that you are nearsighted, it is best to correct in glasses or lenses this myopia, at least to carry out certain activities in a comfortable or safe way (ex-driving). This is not likely to accentuate your nearsightedness. The late onset of myopia may be related to prolonged reading (student myopia), which occurs during periods of intense review, preparation of examinations, contests, etc.

  47. Elodie says:

    Hello, I am 40 years old and I have been wearing glasses for my myopia since I was 8 years old.
    For about a year, I have seen some kind of Visual persistence from some light sources.
    To give an example, difficult to describe, these are bright light sources, coming from outside Windows, computer screen, lamps... the discomfort from the bright contrast between the light source and the darker environment.
    This causes a persistence of this light source as a clear veil that I notice when I look at this light source. The kind of discomfort/veil going in the opposite direction of the sweep with my eyes. If I look from right to left, the veil will come from left to right... on both eyes.
    So I had to do a review with good results. They're talking about transient halos. At the slit lamp everything is normal, cornea, Crystalline lens and previous segment... Normal macular profile, no alteration of photoreceptors. No problem of vascularization, good fovelolar reflection and absence of papillary excavation.
    The ophthalmologist concluded it has a phenomenon of age and my brain... normal for him in myopic.
    The concern is that it starts to become a real problem on a daily basis. Sometimes I feel that something happens to me on the corner of the eye, for driving at night it's problematic, the headlights annoy me...
    Is there really no solution for these kinds of phenomena? I am very surprised that I was sent home with nothing to advise me...
    Thank you for your possible help.

  48. Dr. Damien Gatinel says:

    Your symptoms are actually a little atypical, and do not evoke a specific pathology (there is besides can be nothing pathological). Monitoring may be necessary to control the transparency of the Crystalline lens and eliminate a beginner cataract, for example, or any other alteration that may result in the perception of a veil.

  49. Francois says:

    Good morning, sir

    I just wanted to thank you for your response to the autofractometer diagnosis.
    To make sure of the diagnosis, I took an appointment. in an ophthalmology Centre.


  50. Dounia says:

    Hello doctor, thank you very much for this article. My brother was diagnosed at 9 years of a myopia ~-3D ~-2.5 D and today he is 13 years old and his myopia has evolved to ~-4.25 D ~-3.5 D.. I read that during adolescence the myopia increases in terms of progression... Can its myopia develop into a strong myopia? Knowing that I too am myopic (-3D to 18yrs)
    And to what age can myopia stabilize?

  51. Dr. Damien Gatinel says:

    A priori, the myopia you report should not evolve towards a strong myopia (defined as greater than-6D), but the evolution is sometimes a little unpredictable, annual or bi annual monitoring is necessary.

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