Myopia is the visual condition in which only nearby objects appear in focus, much like a camera permanently focused at a close distance (Nearsightedness = without glasses or optical correction only near objects, typically when held very close to the eyes, are sighted). Nearsightedness is caused by either the eye being too long (axial myopia) or eye having too much refractive power (refractive myopia). Either way, light entering the eye gets focused "in front" of the retina rather than being focused "on" the retina, resulting in an out-of-focus or blurred image. The higher the myopia, the greater is the image blurring.

• 0.75 diopter of myopia reduces vision to 20/40 and the visual efficiency is reduced to 83% (20/20 is 100% visual efficiency). 20/40 vision is the cut-off used in most states for getting a driver's license. At or above 0.75 diopter of uncorrected myopia, you will fail the vision test to get a driver's license.
• 1.50 diopter of myopia reduces vision to 20/80 level and the visual efficiency is reduced to 58%.
• 2.50 diopter of myopia reduces vision to 20/200 level and the visual efficiency is reduced to 20%. 'Best corrected' vision worse than 20/200 is the 'legal definition of blindness'. Therefore at or above 2.50 diopter of 'uncorrected' myopia the eyesight is reduced to a vision-level that defines 'legal blindness'. Without glasses or contact lenses, a myope of -2.50 D sees what a legally blind person is able to see.
Important note: The above is valid only if you do not wear corrective glasses or contact lenses. Assuming the eye is otherwise healthy, with appropriate optical correction, vision in myopes can improve to 20/20. In general, myopes are capable of achieving normal vision with optical correction (or laser vision correction - LASIK, Epi-LASIK & LASEK). 'Legal blindness' or 'low vision' definitions apply only to best (optimally) corrected vision and not to uncorrected vision. Therefore a myope of -2.50 diopters, who has a 'uncorrected' vision of 20/200 is NOT legally blind if with appropriate optical correction vision can improve to better than 20/200.

Myopia most often develops and progresses between the ages of 7 and 16 years, then stabilizes in the late teens. Doing near work places one at risk for myopia. As many as 20 - 40 % of emmetropes (those with 20/20 vision and without refractive error) who pursue occupations with extensive near work requirements are likely to become myopic before the age of 25. When near work is excluded, less than 10% develop myopia. Prevalence of myopia has been positively correlated with level of family income, level of education of parents, refractive status of parents, reading ability, scholastic success, and intelligence. There is a strong association between parents with myopia and their children. If a child has two myopic parents the prevalence of myopia in children is 33 percent. With one myopic parent, it is reduced to 18 percent. If neither parent is myopic, it is only 6 percent. Therefore the odds of having myopia increase with increasing numbers of myopia parents.

It is generally believe that myopia is inherited, that is, one is born to be nearsighted and the eyes will attain the predetermined level of nearsightedness and the only management issue is to accurately determine the refractive error and use optical devices that allow clear vision (glasses, contact lenses). Environmental influences (near work, psychological stress & nutrition) are also thought to play a role. Herein lays the controversy. There are several claims that the environmental factors play a far greater role in myopia development than is traditionally accepted and appropriate modifications lessen, reverse or even prevent myopia development. There is an understandable desire for preventing or reducing nearsightedness using non-surgical methods, however considerable disagreements exist regarding the effectiveness of available optical or behavioral therapies. We have attempted to provide detailed and unbiased evidence regarding these controversies.
The genetic and environmental etiologies are not mutually exclusive - a point that does not appear to have been appreciated by many authors, who refute one by providing evidence supporting the other.

AgingEye Times acknowledges the contribution of Dr. Klaus Schmid in authoring an encyclopedic treatise on Myopia - The Myopia Manual, which provided the framework for this work. After reading this manual you will gain a better understanding of the various mechanisms and factors that produce myopia and will learn some of the means to treat its symptoms.

The Conundrum of Myopia

Chapter 1 What is Myopia 1.1 How does it Feel being Myopic? 1.2 Basic Terminology of the Anatomy of the Eye 1.3 Accommodation 1.3.1 Myopia and Emmetropia 1.3.2 The Classical Theory of Accommodation 1.3.3 A Controversial Hypothesis 1.4 Refractive Myopia 1.4.1 Night Myopia and Tonic Accommodation 1.4.2 Pseudomyopia 1.4.3 Other Types of Myopia 1.5 Axial Myopia 1.6 "What Type of Myopia Do I Have?" 1.7 Consequences and Risks of Higher Myopia 1.8 Myopia and Age 1.9 Accommodation and Age 1.10 Some more Age Related Geometrical Changes of the Eye 1.11 The Refraction Chapter 2 What Causes Myopia? 2.1 Is Myopia Inherited? 2.2 Connective Tissue Disorders 2.3 Active Growth by Imaging Effects 2.4 Mechanical Effects 2.5 General Overview of the Causes of Myopia Chapter 3 Observations & Experimental Results 3.1 Distribution of Myopia by Region, Age, Gender and Ethnicity 3.2 Accommodation and Near Work 3.2.1 Experiences and Results 3.2.1.1 General Experiences and Results 3.2.1.2 The Strength of Accommodation 3.2.1.3 Timing- and Hysteresis- Effects of Accommodation 3.2.1.4 Aniso-Accommodation 3.2.1.5 Is there a Connection between Blur Sensitivity and Accommodation Deficits? 3.2.1.6 Accommodation and the Nervous System 3.2.1.7 Accommodation and Biochemistry 3.2.1.8 Summary of Results about Accommodation 3.2.2 Proposed Therapies Based on the Accommodation Issue 3.2.2.1 Relaxing and Exercising 3.2.2.2 Biofeedback 3.2.2.3 Undercorrection for Near Work, Plus-, Bifocal- and Progressive- Glasses 3.2.2.4 Intermittent, Short Term Wearing of Plus Glasses 3.2.2.5 Plus glasses - are they Effective via Reduced Accommodation or via Modified Vergence? 3.2.2.6 Comparison of the Various Optical Methods 3.2.2.7 Psychological Problems with Special Glasses for Near Work 3.2.2.8 Permanent Undercorrection instead of Undercorrection for Near Work only 3.2.2.9 Is the Accommodation System Getting too Lazy by the Plus Glasses? 3.2.2.10 Summary of the Accommodation Based Therapies 3.3 The Effects of Image Quality 3.3.1 Basic Results 3.3.2 Connective Tissue Related Results 3.3.3 Some More Biochemical Results 3.3.4 Remarks on the Image Quality Model 3.3.5 "Emmetropization" towards Myopia 3.3.6 Contrast and Spatial Frequency 3.3.7 Monochromatic Aberrations 3.3.8 Image Quality and Accommodation 3.3.9 Summary of the Effects of the Image Quality

Study Designs of Trials in the Treatment of myopia

Petition to FDA

VDU

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