Is Myopia a Disease?
The World Health Organization (WHO) projects that 50% of the world’s population will have myopia by 2050, a staggering figure. Myopia significantly increases the risks of serious, sight-threatening diseases such as retinal diseases and glaucoma. We know the prevalence of myopia increased 66% in just 30 years in the U.S. alone between the early 1970s and early 2000s. So, with myopia on the rise and the serious eye health consequences of higher myopia, why is there still no clarity on the question, “Is Myopia a Disease?”
The answer, like many in medicine, relates to how we define myopia and measure it.
What Is Myopia?
The definition of myopia is an eye that is too long from front to back. This causes the symptom of nearsightedness or blurry distance vision. Historically, eye doctors like myself have been trained to equate myopia as synonymous with nearsightedness and treat them as a “refractive error”, along with other conditions of the eye such as hyperopia (farsightedness) and astigmatism (an eye that isn’t perfectly round). These conditions cause blurry or distorted vision, at near, distance, or at all ranges of vision. Fortunately, most are easily compensated for with glasses or contact lenses, so as an eye doctor I have a lot of tools to help people see clearly. When I went to optometry school the focus was on providing my patients with clear vision. We didn’t put any focus (no pun intended) on the size of a myopic eye.
However, myopia is different from other refractive errors like hyperopia or astigmatism. Myopia typically starts in childhood and progresses (the eye keeps getting bigger), or gets worse, until early adulthood. During this time the symptom of myopia, blurry distance vision, gets worse, meaning the patient needs stronger glasses to continue to see clearly. If blurry distance vision is the symptom of myopia, what exactly is myopia? Stated again, myopia is an eye that is growing too long. How do we know this? We measure it using special non-invasive technology to calculate the length of the eye from the front (cornea) to the back (retina). This distance is known as the axial length and is measured down to fractions of a millimeter with advanced equipment. So, myopia is an abnormal elongation of the eye.
Myopia and the Risks
Myopia matters because it is proven that higher myopia significantly increases the risks of serious, sight-threatening complications. A person with a higher myopic prescription of -6.00D has a 40 times greater risk of myopic maculopathy and 3 times greater risk of glaucoma than a person with no myopia. The elongation of the eye is what’s at issue; the greater the myopia, the longer the axial length of the eye and thus greater risk. It is critical that myopia is treated (like most things in medicine, earlier treatment works better) to reduce its progression both to ensure clarity of vision and reduce the risk of serious eye health consequences. A recent Wall Street Journal article about myopia and it’s treatment, which featured an interview with a Treehouse Eyes patient, stated “every amount of myopia matters in terms of increasing risk.”
Is Myopia a disease?
Encyclopedia Britannica defines a disease as “any harmful deviation from the normal structural or functional state of an organism, generally associated with certain signs and symptoms and differing in nature from physical injury.” Myopia increases the risk of serious eye health issues, so it’s clearly harmful. Myopia also has symptoms, blurry distance vision, that are not caused by an injury. Myopia has both genetic and environmental factors that contribute to both its onset and progression. Simply put, Myopia is clearly a disease. One that requires treatment to reduce the negative impact it can have on a person’s eye health and vision.
Myopia is a disease that has potentially serious consequences which will impact over 4 billion (about half the planet!) people by 2050. Fortunately, we can treat myopia and not just compensate for the symptoms to help reduce the burden of this disease. Interventions, including specially designed contact lenses and prescription eye drops, are proven to reduce the progression of myopia. Because myopia usually starts in childhood, these interventions are used with children while their eyes are still growing. As medical professionals, we have an obligation to offer these treatments to children and discuss the implications of myopia with their parents, so that we can treat this disease and help the over 15 million children in the U.S. alone who already suffer from myopia.
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Dr. Gary Gerber, O.D.
Chief Myopia Eradication Officer