User:Paul Romano, Ed BV&Sq

From EyeWiki

Myopia or "Near sightedness" = poor distant vision.(categories: Pediatric Ophthalmology; Refractive Error Management) is due to the eye being longer than necessary to properly and precisely focus light rays on the retina, resulting n a blurring of visual images. Because patients do not like to wear spectacles, or other forms of optical correction needed for myopia compensation and because myopia without optical compensation is, per se. a significant visual impairment, and because myopia typically begins and progresses significantly in childhood, and is at least partially due to reading a lot, as is typical of school and childhood, and if and when it becomes severe enough, can cause real loss of vision, pain and blindness, it is appropriate medically to try to prevent it completely or to at least slow or reduce or prevent its progression when it does arise (and to monitor children to detect its onset).

      Now the serious question: what if anything should be done to prevent myopia or to halt its progression when it does appear. Such action would appear to be medically appropriate for the aforementioned problems.
      Although it has been known for more than century that atropine eye drops, which dilate the pupil, and paralyze the ability for the eye to focus for near vision and reading, will halt myopia "in its tracks" so to speak, its use to do this has BEEN CONTROVERSIAL and never widely adopted by ophthalmologists, pediatric or general.
       The reasons for this include: only a few cases of myopia are ultimately vision threatening, and none are life threatening. Eye doctors think spectacles and other vision corrections, especially including highly profitable surgery are "OK" even though patients strongly disagree with glasses and "rather not" regarding expensive and (it always is) scarey surgery... BUT the desire to avoid spectacle correction is HUGE in the general population. Look how they run from such "correction" by various "reading glasses" of age related (40ish) distancing of reading vision (presbyopia).
      But how about myopia in kids: Only a handfull or two of pediatric ophthalmologists agree with us, but they are smart people. We think your should watch kids closely for the classical typical progression from hyperopia and myopia and step on it with atropine (maybe only once a week may be enough so  titrate each patient), +3.50 D. bifocal spectacles (progressive) and to protect their retinas from imagined but very feared (by opponents but only imaginary) damage from light toxicity, photochromic darkening lenses, and billed caps (even 4" large billed) which by themselves cut light exposure 50%.  The biggest problem is that mothers object to this treatment of their children and are hard to convince of its longer term benefits. OK wait until they are ready to go to college and pay for laser surgery then! Sadly, the pathologic myopes are lost by then.  

Paul Romano, MD, MSOphthal, Ed BV&Sq

Dillon, Colorado, USA

Founder, Founding Editor and Publisher, Binocular Vision and Strabismus, quarterly

Financial Disclosures
Owner of the scientific publication, "Binocular Vision and Strabismus", owner of Binoculus Publishing, which is its publisher, and of other related scientific medical books and publications.

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