High Myopia: Symptoms, Progression, and Vision Concerns

Report on High Myopia Consultation

Hello Doctor: I have high myopia (550, 600).
Last week, during a fundus examination, the doctor mentioned that there were no significant issues with the retina, some degeneration of the vitreous body, but the optic nerve seemed to have atrophied due to changes in the axial length associated with myopia, requiring further examination.
However, after undergoing OCT and visual field tests the next day, the assessment was that the RNFL is indeed thinning, but this condition is currently not threatening my vision and only requires ongoing monitoring.
I would like to ask the doctor: 1) What symptoms are associated with optic nerve degeneration, elongation of the axial length, and vitreous degeneration? Will these three conditions continue to worsen indefinitely, or will they stabilize at some point, and is there a possibility of improvement through certain interventions? 2) Will my current condition cause blurred distance vision or poor night vision, or are these two symptoms due to other reasons? 3) After the age of 25, will my myopia continue to increase? Additionally, it is said that most increases in myopia in adults are due to pseudomyopia; is this true? It sounds quite serious, so I can't help but be concerned.
Please clarify, doctor! Thank you!

Danxin de xiao ying, 20~29 year old female. Ask Date: 2020/01/25

Dr. Gao Pilin reply Ophthalmology

Hello,
1) I would like to ask what symptoms are associated with optic nerve degeneration, elongation of the eyeball, and vitreous degeneration? Will these three conditions continuously worsen without limits, or will they stabilize at some point, and is there a possibility of improvement through certain methods? Generally speaking, with a prescription of around -500 to -600 diopters, these degenerative changes are quite limited, so there is no need for concern.
Optic nerve degeneration can lead to changes in visual fields, elongation of the eyeball can worsen myopia, and retinal thinning may occur.
Vitreous degeneration may cause floaters or lead to retinal traction.
2) I would like to know if my situation could cause blurred distance vision or poor night vision, or if these two symptoms have other causes? Typically, with a prescription of around -500 to -600 diopters, as long as the correct prescription is provided, these issues should improve.
3) I would like to ask if myopia can still increase after the age of 25? Additionally, it is said that most increases in myopia in adults are due to pseudomyopia; is this true? After the age of 25, myopia generally stabilizes, but there is still a possibility of increase.
Pseudomyopia is caused by the ciliary muscle, and it can be distinguished from true myopia by using cycloplegic agents.
Your condition is not severe, and you should follow your doctor's instructions for monitoring, so there is no need for concern.
Taiwan E-Hospital Puzi Hospital Ophthalmology: Monday, Tuesday, Thursday, Friday from 8:00 AM to 12:00 PM; Wednesday from 2:00 PM to 4:30 PM.
Online responses are for reference only; if necessary, you should seek medical attention at a healthcare facility.
I hope to have the opportunity to serve you.
Best regards,
Gao Pi-Lin

Reply Date: 2020/01/25

More Info

High myopia, or severe nearsightedness, is a condition that can lead to various ocular symptoms and complications. As you have experienced, it can be associated with changes in the retina, vitreous body, and optic nerve. Let’s address your questions in detail.

1) Symptoms of Optic Nerve Degeneration, Axial Elongation, and Vitreous Degeneration:
- Optic Nerve Degeneration: This can manifest as changes in visual acuity, color perception, and contrast sensitivity. Patients may notice blurriness or difficulty in focusing, particularly in low-light conditions.

- Axial Elongation: This is a structural change that occurs in high myopia, leading to a longer eyeball. Symptoms can include increased difficulty in seeing distant objects clearly and potential visual distortions.

- Vitreous Degeneration: As the vitreous gel inside the eye becomes more liquid and less gel-like, patients may experience floaters or flashes of light. In some cases, this can lead to posterior vitreous detachment, which may cause visual disturbances.

The progression of these symptoms can vary. While some individuals may experience continuous deterioration, others may reach a plateau where symptoms stabilize. In some cases, interventions such as corrective lenses, surgical options like LASIK or vitrectomy, and regular monitoring can help manage symptoms and potentially improve vision.

2) Visual Disturbances:
Your concerns about blurred distance vision and poor night vision are valid. In high myopia, the elongation of the eye can lead to a mismatch between the focusing power of the lens and the length of the eyeball, resulting in blurred vision. Additionally, night vision issues can arise due to the eye's inability to properly adjust to low-light conditions, which may be exacerbated by retinal changes associated with high myopia. Other factors, such as dry eyes or fatigue, can also contribute to these symptoms.

3) Progression of Myopia After Age 25:
It is common for myopia to stabilize in early adulthood, but some individuals may still experience changes in their prescription into their late twenties or even early thirties. The notion that most adult myopia progression is "pseudomyopia" refers to temporary changes in vision due to excessive near work or eye strain, which can often be resolved with proper rest and eye care. However, true progression of myopia can occur due to genetic factors, environmental influences, and lifestyle choices.
In summary, while high myopia can lead to significant visual challenges and potential complications, understanding the nature of these changes and maintaining regular eye examinations are crucial. It is essential to work closely with your eye care provider to monitor your condition and discuss any new symptoms or concerns. Regular check-ups can help detect any changes early, allowing for timely intervention if necessary. Additionally, adopting good visual hygiene practices, such as taking breaks during prolonged near work and ensuring proper lighting, can help mitigate some symptoms associated with high myopia.

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