Pseudomyopia in Children: A Guide for Parents - Ophthalmology

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Pseudomyopia, often referred to as "false myopia," is a condition that can occur in children, particularly those who are in the early stages of visual development. It is characterized by a temporary inability to focus on distant objects, which can be caused by excessive near work or prolonged periods of focusing on close objects, such as reading or using electronic devices. In your case, your child has a good naked eye vision of 1.0 (which is equivalent to 20/20 vision in the United States) but has been diagnosed with refractive errors of 200 degrees in the left eye and 250 degrees in the right eye.

The discrepancy between your child's naked eye vision and the refractive error measured by the autorefractor could indeed suggest the presence of pseudomyopia. This condition is often reversible and can be managed effectively with appropriate interventions. The use of atropine drops, as prescribed by your doctor, is a common approach to help control the progression of myopia and to relax the ciliary muscle, which can alleviate the symptoms of pseudomyopia. However, as you noted, atropine can temporarily blur near vision, making it challenging for your child to read or engage in close-up activities.

It is also important to consider the possibility of measurement errors during the refraction process. Autorefractors, while generally reliable, can sometimes yield inaccurate results due to various factors, including the child's level of cooperation during the test, the presence of accommodation (the eye's ability to focus on near objects), and even the child's overall visual fatigue at the time of testing. If your child was tired or had been engaged in extensive near work prior to the examination, this could have influenced the results.

To address your concerns, it is advisable to follow up with your eye care professional for a comprehensive eye examination. They may recommend additional tests, such as a cycloplegic refraction, which involves using drops to temporarily paralyze the ciliary muscle, allowing for a more accurate assessment of the refractive error without the influence of accommodation. This can help determine whether your child truly has myopia or if the initial findings were indicative of pseudomyopia.

In addition to medical management, there are several lifestyle modifications that can help reduce the risk of developing true myopia in children. Encouraging regular breaks during near work (the 20-20-20 rule: every 20 minutes, look at something 20 feet away for at least 20 seconds), ensuring adequate lighting while reading or doing homework, and promoting outdoor activities can all contribute to better visual health.

In summary, while your child's naked eye vision is excellent, the presence of refractive errors suggests that further evaluation is warranted to determine the underlying cause. Pseudomyopia is a possibility, and with appropriate management, including the use of atropine and lifestyle adjustments, you can help support your child's visual development. Always consult with your eye care provider for personalized advice and treatment options tailored to your child's specific needs.