Myopia

doi:10.1136/bmj.324.7347.1195

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Douglas R Fredrick (dfred@itsa.ucsf.edu), associate clinical professor of ophthalmology

Department of Ophthalmology, University of California, 10 Koret Way, San Francisco, CA 94143-0730, USA

Shortsightedness is becoming more common. Douglas Fredrick describes recent research into this condition and discusses future management of patients

Myopia is a leading cause of loss of vision throughout the world, and its prevalence is increasing. Although most researchers agree that people's refractive status is in large part genetically determined, a growing body of evidence shows that visual experiences early in life may affect ocular growth and eventual refractive status. This review describes recent human and animal research into the pathogenesis of myopia and discusses implications for the management of patients.

Summary points

The prevalence of pathological myopia leading to vision impairment is increasing in many parts of the world

Animal models in multiple species show that early visual experience affects growth of the eye and eventual refraction

Ocular growth is modulated by biochemical processes occurring in the retina, choroid, and sclera

Topical medications and bifocal spectacle lenses or rigid lenses may slow the progression of myopia but cannot prevent pathological myopia

Fig 1

High (pathological) myopia often leads to atrophy of the choroid and subsequent retinal macular degeneration, with loss of central visual acuity and high incidence of retinal detachment, glaucoma, and strabismus

Methods

This review article was prepared by searching Medline for citations of articles in English using the keyword “myopia.” In addition, abstracts from the annual meetings of the Association for Research in Vision and Ophthalmology were reviewed.

Myopia, commonly referred to as shortsightedness, is a common cause of visual disability throughout the world. The World Health Organization has grouped myopia and uncorrected refractive error with cataract, macular degeneration, infectious disease, and vitamin A deficiency among the leading causes of blindness and vision impairment in the world.1 People with myopia can be classified in two groups, those with low to modest degrees of myopia (referred to as “simple” or “school” myopia, …