Myopia Progression in College Students: Key Factors and Treatments - Ophthalmology

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Myopia, or nearsightedness, is a common refractive error that affects a significant portion of the population, particularly among students and young adults. Understanding the progression of myopia, especially in college students, involves examining various factors that contribute to its development and potential treatments.

1. Differences Between Axial Length Changes and Refractive Error: The relationship between axial length (the distance from the front to the back of the eye) and refractive error (the degree of myopia) is not always linear. While an increase in axial length typically correlates with an increase in myopia, other factors can influence this relationship. For instance, changes in the cornea's curvature or the lens's shape can also affect refractive error. In your son's case, the axial length increased only slightly, yet the refractive error increased significantly. This discrepancy could be due to changes in the corneal curvature or lens accommodation, which may not be directly related to axial elongation.
2. Changes in Cornea and Lens: At 19 years old, while most eye growth has stabilized, it is still possible for the cornea and lens to undergo changes that can affect vision. Factors such as environmental influences, prolonged near work (like studying or using digital devices), and even hormonal changes can lead to alterations in the cornea's shape or the lens's flexibility. These changes can contribute to an increase in myopia, even if the axial length does not change significantly.

3. Use of Atropine and Its Effects: Atropine is commonly prescribed to slow the progression of myopia by inhibiting the eye's ability to accommodate (focus on near objects). While it can be effective, it does come with side effects, such as blurred vision for near tasks. This can create a challenging situation where your son may struggle to see clearly for both near and far tasks, depending on how his glasses are prescribed. It is essential to find a balance in his prescription that allows him to function comfortably in his daily activities while still managing his myopia. As for whether his axial length will continue to grow, it is generally expected that significant growth occurs before the age of 20, but some individuals may experience continued elongation into their early twenties.

4. Focus on Axial Length vs. Refractive Error: The debate between focusing on axial length control versus refractive error control is ongoing in the field of optometry and ophthalmology. While controlling axial length is crucial to prevent complications such as retinal thinning and detachment, refractive error is also a significant concern, especially for quality of life and daily functioning. In practice, both factors should be monitored. If axial length is stable, but refractive error continues to increase, it may warrant a reevaluation of the treatment approach. Conversely, if the axial length is increasing, it may be more critical to focus on interventions that can help slow this progression, such as continued use of atropine, outdoor activities, and reducing near work.

In conclusion, managing myopia progression in college students requires a comprehensive approach that considers both axial length and refractive error. Regular follow-ups with an eye care professional are essential to monitor changes and adjust treatment plans accordingly. It may also be beneficial to discuss alternative treatments or modifications to the current regimen that can help alleviate the side effects your son is experiencing while effectively managing his myopia.