Why Does Myopia (Nearsightedness) Keep Getting Worse?


If you or someone you know has nearsightedness (myopia), you might have noticed that the condition often seems to get worse over time. Year after year, the prescription for glasses or contact lenses needs to be updated, and the lenses become stronger. This phenomenon raises an important question: Why does myopia keep progressing? More importantly, why is myopia becoming so widespread? In fact, it's estimated that by 2050, nearly half of the world's population will be nearsighted. Understanding the reasons behind this increase and learning how to manage it can make a significant difference in preserving eye health.

The Two Main Factors Behind Worsening Myopia

To grasp why myopia gets worse, it's crucial to look at two primary factors: genetics and lifestyle.

1. The Role of Genetics

Genetics plays a foundational role in determining whether a person will develop myopia. Studies show that genetic factors account for approximately 20% to 35% of the risk of becoming nearsighted. If one of your parents is nearsighted, your likelihood of developing myopia is higher than average. If both parents are nearsighted, your risk increases even further.

But genetics doesn't just influence whether you’ll develop myopia; it also impacts how severe it can become. For instance, families with a history of high myopia are more likely to have children who will need stronger prescriptions as they age. This hereditary aspect underscores the importance of being proactive about eye health, especially if myopia runs in the family.

2. The Impact of Lifestyle

While genetics set the stage, lifestyle factors are the actors that can accelerate or decelerate myopia's progression. Our modern way of living, particularly during the formative years of childhood and adolescence, has drastically changed over the past century. This shift is one of the key drivers of the rising rates of myopia.

  • Increased Indoor Time: Historically, children spent much of their time outdoors, which is beneficial for eye health. However, modern lifestyles have shifted toward more indoor activities. Whether it's due to urbanization, safety concerns, or a cultural shift toward indoor entertainment, children today spend significantly less time outside compared to previous generations. The lack of natural light exposure has been linked to an increased risk of developing myopia.

  • Sedentary Habits: Alongside spending more time indoors, children are leading more sedentary lifestyles. The days of active, outdoor play have been replaced with hours spent sitting in front of screens—be it television, computers, or gaming consoles. This reduction in physical activity may contribute to the progression of myopia, although the exact mechanisms are still being studied.

  • High Near Work Demand: The term "near work" refers to activities that involve focusing on objects close to the eyes, such as reading, writing, or using digital devices. With the rise of smartphones, laptops, and tablets, the demand for near work has skyrocketed. Children are engaging in near work for extended periods, both for educational purposes and leisure, like playing video games or browsing social media. This constant close-up focus is believed to contribute to the elongation of the eyeball, which is the anatomical basis of myopia.

The Consequences of Worsening Myopia

As myopia progresses, the immediate consequence is the need for stronger glasses or contact lenses. However, the impact of severe myopia goes far beyond just thicker lenses. Higher degrees of myopia are associated with a greater risk of developing serious eye conditions later in life, such as:

  • Cataracts: Clouding of the eye's natural lens, which can lead to vision impairment.
  • Glaucoma: A group of eye conditions that damage the optic nerve, often due to high pressure in the eye, leading to vision loss.
  • Myopic Maculopathy: Degenerative changes in the central part of the retina (the macula), which can severely affect central vision.
  • Retinal Detachments: A condition where the retina pulls away from its normal position, potentially causing permanent vision loss if not treated promptly.

The link between severe myopia and these eye conditions is well-documented. The elongation of the eyeball, which characterizes myopia, stretches and thins the retina and other eye structures, making them more susceptible to damage.

Why Does Modern Lifestyle Worsen Myopia?

The exact reasons why modern lifestyle factors like increased near work and reduced outdoor time exacerbate myopia are still being researched. However, current understanding suggests that prolonged near work may cause the eye to adapt by elongating, which increases myopia. Additionally, spending less time outdoors may reduce exposure to natural light, which is thought to help regulate eye growth.

Some researchers propose that the balance between near work and outdoor activities affects the eye's development during childhood. The eye's ability to focus on distant objects may weaken with excessive near work, leading to an increased risk of myopia. Furthermore, there's evidence to suggest that time spent outdoors, particularly in natural sunlight, can help slow down eye growth, reducing the risk of myopia development.

What Can We Do to Slow Down the Myopia Pandemic?

While the modern lifestyle is unlikely to change drastically, there are effective strategies to manage and slow down the progression of myopia. In eye care, this approach is known as myopia control or myopia management. It involves a combination of interventions designed to slow the progression of myopia in children and adolescents.

Myopia Control Strategies

  1. Prescription Eye Drops: Certain medications, such as low-dose atropine eye drops, have been shown to slow the progression of myopia in children. These drops work by temporarily relaxing the eye's focusing mechanism, which may help reduce the stimulus for the eye to elongate.

  2. Specialized Glasses Lenses: Special lenses, like those designed for peripheral defocus, can reduce the strain on the eyes during near work and help slow the progression of myopia. These lenses are available in different designs, including bifocal and progressive lenses, which can be customized based on the child's specific needs.

  3. Orthokeratology (Ortho-K) Contact Lenses: Ortho-K lenses are rigid gas-permeable contact lenses worn overnight. They temporarily reshape the cornea, allowing clear vision during the day without the need for glasses or contacts. Beyond providing clear vision, Ortho-K lenses have been shown to slow the progression of myopia in children.

  4. Investigational Treatments: Emerging treatments, such as red light therapy, are being explored for their potential in myopia management. Although still in the research phase, these innovative approaches offer hope for additional strategies to control myopia in the future.

By combining these strategies, eye care professionals aim to slow down the rate at which myopia progresses in children. In some cases, myopia control can even halt the progression entirely, especially if intervention begins early. The goal is to keep the level of myopia as low as possible, reducing the need for stronger prescriptions and lowering the risk of associated eye diseases.

Tips for Parents: How to Manage Myopia in Children

While myopia can develop at any age, the most significant changes occur during childhood and adolescence. This period is a critical window for implementing myopia control strategies. As a parent or guardian, you play a vital role in supporting your child's eye health. Here are some actionable tips to help manage and potentially slow the progression of myopia in your child:

1. Encourage Outdoor Time

Spending time outdoors has been shown to reduce the risk of developing myopia and slow its progression in children who are already nearsighted. Aim to have your child spend at least 2 hours outside every day. Outdoor activities provide natural light exposure, which is beneficial for eye health and helps counteract the effects of prolonged near work.

2. Limit Screen Time and Near Work

While it's difficult to eliminate screen time entirely, especially in a world where digital devices are integral to education and entertainment, it's important to set limits. The American Academy of Pediatrics recommends no more than 2 hours of entertainment media per day for children. Encourage regular breaks from near work by following the "20-20-20" rule: every 20 minutes, have your child look at something 20 feet away for at least 20 seconds.

3. Regular Eye Examinations

Vision screenings at school or the pediatrician's office are helpful, but they are often limited in scope. A comprehensive eye examination by an optometrist or ophthalmologist is essential, ideally by the time your child starts kindergarten, or even earlier if there are any concerns. Early detection of vision problems allows for timely intervention, which can make a significant difference in managing myopia.

Final Thoughts

Myopia is a growing concern that affects millions of people worldwide, but by taking proactive steps, we can manage its progression and protect our vision. Early intervention, regular eye exams, and adopting a balanced lifestyle that includes plenty of outdoor time and limited screen use are key strategies in myopia management.

For more detailed information on how to choose the right glasses, contact lenses, or medications for managing myopia, be sure to watch our upcoming video on these topics. Subscribe to the Dr. I Health Channel and turn on notifications to stay updated on the latest in eye health.

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