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Posted on 04-28-2014

Some Thoughts on Myopia Reduction

Myopia/nearsightedness is one of the most common visual conditions. Nearsightedness affects more and more people every day. Some insist it is hereditary. Some contend that it is caused by the way we visually interact with our environment. I believe both factors can come into play. Amount of time doing close work, amount of time spent indoors, posture and lighting have all been implicated in the appearance and increase of nearsightedness in people of all ages.

Arthur Marten Skeffington

A.M. Skeffington, the father of modern optometry described reading as a “socially compulsive visually near-centered task that is biologically unacceptable.” Skeffington said this in the 1960s if not earlier. This idea is certainly worth considering since the written word is relatively new in the history of humankind. Reading is significantly different from virtually all other visual activities. Many behavioral optometrists understand that visual problems, including nearsightedness, astigmatism and strabismus often result from inefficient visual processing at near. Symptoms like headaches, dry eyes, eye fatigue, drowsiness from reading and increasing nearsightedness also result from poor visual performance at near.

Many optometrists and researchers are focused on the issue of close work in general, believing that it is the mere fact that reading is done within arm’s reach that makes it problematic. It is true that the human focusing system is designed to be more relaxed when looking at something far away and we must focus harder to see clearly when reading or looking at anything that is close to us. Some experts say that the human visual system was designed for distance viewing and that too much close work can be problematic. I just don’t see it that way. Our ancient ancestors certainly did a considerable amount of close work - they made clothing, tools and art, prepared meals, processed hides, gathered plants for food and medicine. The advent of smart phones, iPads, etc. is only going to make matters worse for many people.

I believe the big difference has to do with two things, 1) most close work in modern culture revolves around flat things like paper, computers, etc. and 2) most close work in modern culture occurs in the absence of actual manipulation by the hands. Here’s why these things matter. We have two eyes in the front of our heads in order to provide two slightly different views of the world. The brain processes these two viewpoints to enable us to have depth perception and perceive the world as 3-dimensional. If you have gone to a 3-D movie and it didn’t really look 3-D it is because your brain is not integrating the input from the two eyes the way it should. We are meant to interact with 3-dimensional objects and activities. The brain gets annoyed and fatigued by the constant interaction with flat surfaces. It’s kind of like the very bright child that does poorly in school; this child might get poor grades, not because the material is too difficult, but because it is too easy. The human visual system wants 3-D. In addition to the fact that there were little or no flat surfaces with abstract symbols on them back in the day, any close work that was done involved use of the hands. Not the way we use our hands to peck at a keyboard, maneuver a mouse or joystick or even touch a screen. Our ancestors were manipulating real objects. Add to this the difference in immediate environment - though they likely threw stones, they didn’t live in glass houses; they spent much more time outdoors and could (and almost assuredly did) look off in the distance regularly, which would be helpful in reducing near-point stress.

Also, a great deal of nearsightedness emerges as a direct result of wearing glasses that “correct” nearsightedness. Typical lenses for nearsightedness are appropriate for looking at things that are at least twenty feet away. Wearing these lenses for activities closer than twenty feet causes increased stress on the visual system and consequently an increase in nearsightedness in many people for many years. Do not read with your distance glasses even though it might seem fine.

Iatrogenic Myopia Reduction

Many people are interested in myopia control and myopia reduction. Some seek me out specifically for that reason. The majority of the public is satisfied with the style of eye care they currently receive, not realizing there are alternatives. The typical eye exam is designed to mask the obvious symptom as quickly and completely as possible with no thought to the likely causes or future consequences. Most people’s idea of vision care is sit in a chair, read a chart, get dilated, force yourself to adjust to the new glasses. Is this because the approach is just that good or because this is what most eye care professionals have settled on and made available almost to the exclusion of other approaches?

The nature of my practice is such that almost everyone who does vision therapy with me ends up seeing more clearly with weaker lenses that they had when we first met. This is not something most of my patients are even thinking about. Usually, they just want to get rid of their headaches, dry eyes, double vision, eye fatigue or to read more easily, work longer at the computer without eyestrain or play sports better. I believe that good eyesight tends to be the result of a smoothly operating visual system, not the starting point. I see myopia reduction happen all the time, sometimes without even trying. It’s just because everything is working better. And because it’s something I am open to, unlike most eye doctors who expect people’s eye to get worse all the time.

I do think that most visual symptoms arise from the biologically unacceptable, socially compulsive, inescapable nature of modern life. I think that given the opportunity to get more from an “eye exam” than what remains currently in vogue, many more people would opt for what behavioral optometry has to offer rather than settling for what is generally available. That is why I offer visual evaluations, not eye exams.

Next time: Why Some Children Don't Like To Read

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