Myopia: Addressing Concerns About Prescription Changes

Q: Myopia: Addressing Concerns About Prescription Changes

Hello Mr. Weng： 1. There are also genetic factors that influence non-pathological conditions. 2. The ciliary muscle is located inside the eye, and eye strain can sometimes be caused by the muscles outside the eyeball. Muscle relaxant drops may be neede

Concerns about various issues related to glasses often stem from a fear of worsening prescription?

Hello, doctor! I am around 25 years old and have high myopia (recently worsening to -12.00 in both eyes).
I have been undergoing regular check-ups for six months, and my current glasses only reduce the prescription by 50 degrees.
I have been troubled by the issue of choosing the right prescription for a long time, as I am afraid of making the wrong choice and worsening my condition.

[Question 1] Besides prolonged near work causing excessive contraction of the ciliary muscle and elongation of the eyeball, are there other non-pathological causes of myopia? (I want to minimize factors that contribute to the worsening of myopia, and I am using adult-strength atropine eye drops at bedtime to help control my prescription.)
[Question 2] The ciliary muscle contracts for near vision and relaxes for distance vision, but when I try to focus on distant objects, I feel more strain and discomfort instead of relaxation.
Although my prescription may be slightly undercorrected, theoretically, shouldn't looking at distant objects allow the eyeball to relax? Additionally, when trying to see distant objects clearly, shouldn't the ciliary muscle still relax? Why do I feel tightness and soreness around the eye muscles, even experiencing a sensation of pressure in the entire eyeball? What muscles are being pulled, and could this contribute to the worsening of my myopia?
[Question 3] I am currently considering two options: 1.
Re-prescribing to the full prescription, or 2.
Maintaining the current prescription with a reduction of 50 degrees.
Which option is truly better for my eyes?
[Question 4] If I re-prescribe to the full prescription, I understand that the additional 50 degrees will increase my burden for near work.
However, to what extent will this burden be, and what actual negative impacts could it have?
[Question 5] While the effects of the long-acting atropine have not yet worn off, will using my eyes be harmful or have adverse effects? Sometimes, when the atropine effect has not completely worn off (which takes about 4-5 hours), I occasionally have to get up in the middle of the night for work.
I currently know that there are no side effects, but I am unsure how it would feel to strain my eyes to look at a computer screen while the atropine effect is still present.

Weng Xiansheng, 20~29 year old female. Ask Date: 2022/06/02

Dr. Gao Pilin reply Ophthalmology

Hello Mr.
Weng:
1.
There are also genetic factors that influence non-pathological conditions.

2.
The ciliary muscle is located inside the eye, and eye strain can sometimes be caused by the muscles outside the eyeball.
Muscle relaxant drops may be needed to alleviate the symptoms.

3.
You can use the prescription obtained after dilation to fit glasses for distance and another pair for near vision.
Alternatively, consider using multifocal lenses.

4.
An additional 0.50 diopters may be needed for near vision, as the ciliary muscle requires more effort.
Therefore, the above suggestions can be considered.

5.
It's not a problem; the management of myopia in children is similar.
Additionally, the effects of atropine will take about a week to wear off.

Reply Date: 2022/06/02

More Info

Understanding myopia, especially in the context of high myopia, involves addressing several concerns regarding its progression and management. As a 25-year-old with a recent prescription of -12.00 diopters, it’s understandable to have apprehensions about the potential for further deterioration of your eyesight. Let’s address your questions systematically.

Question 1: Non-pathological Causes of Myopia
Myopia, or nearsightedness, is primarily influenced by genetic and environmental factors. While prolonged near work, such as reading or using screens, can lead to excessive contraction of the ciliary muscle, resulting in elongation of the eyeball, other contributing factors include:
1. Genetics: A family history of myopia significantly increases the likelihood of developing it.

2. Lack of Outdoor Activity: Studies suggest that spending less time outdoors can contribute to myopia progression. Natural light exposure is believed to play a protective role.

3. Visual Stress: Continuous focusing on close objects can lead to visual fatigue, which may exacerbate myopia.

4. Poor Lighting Conditions: Insufficient lighting while reading or working can strain the eyes, potentially worsening myopia.

Using atropine eye drops at night is a recognized method to slow myopia progression, and it’s good that you are considering this approach.

Question 2: Eye Muscle Fatigue and Relaxation
When you attempt to focus on distant objects, the ciliary muscle should theoretically relax, reducing strain. However, if you experience discomfort or fatigue, it could be due to several reasons:
1. Muscle Fatigue: The muscles controlling eye movement (extraocular muscles) may become fatigued from prolonged use, leading to discomfort.

2. Visual Acuity: If your prescription is slightly off, even a small reduction in power can cause your eyes to work harder to achieve clarity, leading to strain.

3. Accommodation Issues: If your eyes are not able to relax fully, it may be due to a condition called accommodative spasm, where the ciliary muscle remains contracted even when looking at distant objects.

This discomfort does not directly cause myopia progression, but chronic strain can lead to visual fatigue, which may influence your overall eye health.

Question 3: Prescription Choices
Choosing between a full prescription and a reduced one involves weighing comfort against visual clarity. A full prescription may provide clearer vision but could increase the strain when focusing on near tasks. Conversely, a reduced prescription may be more comfortable for close work but could lead to blurred distance vision. The best approach is to consult with your eye care professional to find a balance that suits your lifestyle and visual needs.

Question 4: Impact of Full Prescription
If you opt for a full prescription, the additional -50 degrees will indeed increase the demand on your eyes when focusing on near tasks. This could lead to symptoms of eye strain, such as headaches or fatigue, especially if you engage in prolonged near work. It’s essential to monitor how your eyes respond and adjust your usage accordingly.

Question 5: Atropine Effects and Eye Strain
Using atropine while its effects are still active can lead to increased sensitivity to light and difficulty focusing, particularly on near objects. If you find yourself needing to work on a computer or perform tasks that require close vision while the medication is still effective, it could lead to discomfort or visual strain. It’s advisable to limit such activities until the effects of the medication have fully worn off.

Conclusion
Managing high myopia requires a multifaceted approach, including regular eye examinations, appropriate corrective lenses, and possibly pharmacological interventions like atropine. It’s crucial to maintain open communication with your eye care provider to tailor a management plan that addresses your specific needs and concerns. Regular follow-ups will help monitor any changes in your vision and allow for timely adjustments to your treatment plan.

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