Myopia Progression in Adults: Common Misconceptions and Solutions

Q: Myopia Progression in Adults: Common Misconceptions and Solutions

Hello, Student Lin：<br>1. <br>After reaching adulthood, the degree of myopia is less likely to increase; however, if the eyes become fatigued due to the ciliary muscle working hard, there may still be a chance for a temporary increase in prescription, typically within a range of

The issue of increased refractive error in adults?

Hello, Doctor.
I have been nearsighted for many years.
As far as I remember, my prescription has remained stable at -2.25 diopters from the age of 19 to 23 during my university years.
However, it seems that a year after my last measurement, my prescription has increased to "https://i.imgur.com/P5jDZcz.jpg." This measurement was conducted by a more meticulous optometrist, not just a simple comparison or direct machine measurement.
During my four years in university, I visited ophthalmology multiple times, and the doctors consistently emphasized that my prescription would not worsen after adulthood (different ophthalmologists at various clinics all said the same thing).
Therefore, I was quite shocked when I learned about the new prescription results.
After returning home, I searched for foreign studies, which indeed confirmed that there is a possibility of prescription increase in adulthood.
Following this event, I hope to clarify a few questions with you:
1.
If it is true that prescriptions do not change after adulthood, could this recent measurement result be due to temporary pseudomyopia caused by excessive eye strain over the past few weeks or months? If that is the case, would wearing glasses with this new prescription lead to a rapid increase in my actual prescription? (Since the increase in my prescription is only temporary, would wearing glasses with a stronger prescription exacerbate the situation?) I have often heard in Taiwan that it is better to have a slightly lower prescription; however, after researching recent studies from Europe and the United States, these studies indicate that the common belief in Taiwan is incorrect, as individuals who choose a lower prescription in the studies experienced greater myopia progression.
2.
How can I take care of my glasses? Since I still need to use my laptop, iPad, and smartphone regularly, it is quite challenging to reduce the actual usage time.
I wonder if eye exercises, such as moving my eyes, would be helpful?
3.
If eye exercises do not help, would the medication "Neostigmine Methylsulfate 0.1mg" prescribed by the ophthalmologist be beneficial? As far as I know, the only recognized eye drops for preventing myopia are cycloplegics.
However, whenever I ask the doctor for a prescription, they again say that adults do not experience an increase in prescription.
I am curious if using cycloplegics every night before bed as a preventive measure against worsening myopia poses any risks.
Thank you, Doctor.

Lin Tongxue, 20~29 year old female. Ask Date: 2020/09/18

Dr. Gao Pilin reply Ophthalmology

Hello, Student Lin:
1.
After reaching adulthood, the degree of myopia is less likely to increase; however, if the eyes become fatigued due to the ciliary muscle working hard, there may still be a chance for a temporary increase in prescription, typically within a range of 25-50 diopters, which is considered normal variation.
Insufficient prescription can lead to worsening myopia, but this is more common in minors than in adults.
2.
The simplest method to protect your eyes is the 20-20-20 rule: every 20 minutes of computer use, look away from the screen for 20 seconds and focus on an object 20 feet (approximately 6 meters) away.
If you can blink 20 times during this break, that would be even better.
3.
Neostigmine helps relax muscles and reduce fatigue; however, it does not aid in the progression of myopia.
Adults do not need to use dilating drops, as they have minimal effect.

The Ophthalmology Department at Puzi Hospital in Taiwan is open on Monday, Tuesday, Thursday, and Friday mornings from 8:00 AM to 12:00 PM, and Wednesday afternoons from 2:00 PM to 4:30 PM.
Online responses can only serve as a reference; if necessary, it is important to seek care at a medical facility.
I hope to have the opportunity to assist you.
Best regards,
Gao Pilin

Reply Date: 2020/09/18

More Info

Myopia, or nearsightedness, is a common refractive error that affects a significant portion of the population, including adults. Your experience of a sudden increase in myopia after years of stability raises several important questions about the nature of myopia progression, particularly in adults. Let's address your concerns one by one.

1. Myopia Progression in Adults: It's a common misconception that myopia does not progress after a certain age, particularly in adulthood. While many individuals may experience stabilization of their refractive error after their teenage years, this is not universally true. Factors such as prolonged near work, digital screen usage, and insufficient outdoor time can contribute to changes in refractive error even in adults. The increase in your myopia could indeed be due to a combination of these factors, including eye strain or fatigue, which can lead to temporary or "pseudomyopia." However, if your myopia has increased significantly, it is essential to have a comprehensive eye examination to rule out any underlying conditions.

Regarding your concern about wearing glasses with a higher prescription, if the increase in your myopia is indeed temporary, wearing glasses that are too strong could potentially lead to discomfort or visual fatigue. However, it is crucial to wear the correct prescription to ensure clear vision and reduce eye strain. The notion that wearing slightly weaker glasses can prevent myopia progression is not supported by recent studies, which suggest that wearing the appropriate prescription is essential for visual health.

2. Eye Care Practices: To maintain eye health, especially when using digital devices, consider implementing the 20-20-20 rule: every 20 minutes, take a 20-second break to look at something 20 feet away. This practice helps reduce eye strain. Additionally, ensure that your workspace is well-lit and that you maintain a proper distance from screens. Regular eye exercises, such as rolling your eyes or focusing on distant objects, can also help alleviate fatigue. However, these exercises alone may not significantly impact myopia progression.

3. Medications and Eye Drops: Regarding the use of Neostigmine Methylsulfate, this medication is not typically used for myopia management. It is primarily a treatment for certain types of glaucoma and may not have a direct effect on myopia. The use of atropine drops, a type of cycloplegic agent, has been studied for its potential to slow myopia progression in children, but its efficacy in adults is less clear. Using such drops without medical supervision can lead to side effects, including blurred vision and light sensitivity. Therefore, it is crucial to consult with an eye care professional before considering any pharmacological intervention for myopia.

In conclusion, while it is possible for myopia to progress in adults, it is essential to differentiate between true progression and temporary changes due to eye strain. Regular eye examinations, proper use of corrective lenses, and good eye care practices are vital in managing myopia. If you have concerns about your vision or the effectiveness of your current treatment plan, I recommend discussing these with your eye care provider, who can offer personalized advice based on your specific situation.

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