Understand how myopia gets worse due to aging and underlying conditions.
From childhood to adulthood, myopia is a condition that can affect many of us. So what are the risk factors for developing myopia? How does it change from childhood to adulthood? Why is keeping myopia from progressing important?
In this post, let’s explore these questions to understand myopia better and answer the question: Why does myopia get worse with age? So, let's dive in!
What are the risk factors for myopia in children and adults?
Myopia, or nearsightedness, is a condition that affects both children and adults and is influenced by a combination of hereditary and environmental factors. A meta-analysis study found that children with one myopic parent were 1.5 to 2 times more likely to develop myopia, with the risk increasing to 3 times if both parents have myopia.1
The key environmental risk factors associated with myopia include reduced time spent outdoors, increased years of education, and near-work activities, such as reading and screen time.2
Vision may fluctuate in adulthood due to natural progression or other risk factors. For example, the early development of cataracts and presbyopia (farsightedness) may lead to what seems to be improved near vision, but eventually myopia get worse over time.3 Systemic diseases, such as diabetes, can also change how the eye focuses the light, or a refractive shift, ultimately leading to a change in vision.4 And certain medications, including anti-glaucoma drugs and pain control medications, have also been associated with myopic or hyperopic shifts.5
‘During early cataract development, people with refractive errors may experience improved vision. This is also called “the second sight of the elderly.
When does myopia get worse in children?
Myopia can begin at any age, but most cases start at school age, typically between 6 and 14. While there is no firm consensus on when myopia stops progressing, a 2013 myopia study found that the mean age at which myopia stopped getting worse was 16 years, with most, 96%, at the age of 24.6
While myopia tends to stop worsening in early adulthood, there is still a possibility for myopia to progress with age. In fact, studies have found that some people, after their 20s, will continue to worsen. This progression may be attributed to various factors, including lifestyle changes, environmental factors, or hereditary factors.7
How does myopia change with age?
Typically, myopia gets worse during childhood and adolescence. A study has found that nearsightedness progresses most rapidly at its onset, about -0.5 D per year. This rate of progression decreases over time, typically stabilizing around the mid-twenties to early thirties.14
- Age 0 to 5, a worsening of -0.49 D per year
- Age 6 to 10, a worsening of -0.51 D per year
- Age 11 to 15, a worsening of -0.46 D per year
- Age 16 to 20, a worsening of -0.23 D per year
- Age 21 to 25, a worsening of -0.11 D per year
- Age 26 to 30, a worsening of -0.07 D per year
As we grow older, our eyesight can change in different ways. A study explored the relationship between age and the refractive power of the eyes. The results showed that refractive errors change with age and are affected by factors such as the severity of cataracts and diabetes.8
- Age 43 to 59, an improvement of +0.48 D
- Age 60 to 69, +0.03 D
- Age 70 and older, a worsening of -0.19 D
Cataracts, a common age-related condition affecting the eye's lens, were also found to be strongly related to the amount of change in refractive errors. People with mild cataracts at the start of the study showed an improvement of +0.35 D. At the same time, those with severe cataracts showed a worsening of -0.53 D.9
Why is it important to slow or stop the worsening of myopia?
Myopia is characterized by the elongation of or structural changes in the eye, which contributes to an increased likelihood of vision-threatening complications. People with high myopia (> 6.00 D) had a higher likelihood of severe eye complications, such as myopic macular degeneration, retina detachment, cataracts, and glaucoma.10
While corrective lenses or surgery such as LASIK or intraocular refractive surgery can correct the refractive error, it's important to note that these treatments do not address the underlying structural change of the eye that drives vision-threatening complications. Therefore, it's crucial for people with or parents with children living with myopia to take steps to prevent abnormal eye elongation, reducing the risk of severe eye complications.
Can myopia be reversed?
Even with all of the treatment options available today, myopia can't be reversed. However, the refractive error can be corrected.
Myopia control treatments can sometimes lead to a slight improvement in the axial length of the eye initially. This was observed in studies and real-life cases, such as orthokeratology (Ortho-K), atropine, and emerging red-light-based treatments.11, 12
Some individuals and health centers are promoting visual training as a cure for or can reverse myopia; visual training, also known as eye exercises, may involve muscle relaxation techniques, eye yoga, biofeedback, eye patches, eye massage, or using under-corrected prescription lenses.
However, medical experts from the American Academy of Ophthalmology found no evidence that these interventions affect the progression of myopia, including slowing abnormal eye elongation or reducing the risk of vision-threatening complications.13
In some cases, visual training may lead to an improvement in subjective visual acuity—seeing slightly better. This improvement could be due to temporary relief of accommodative spasm, changes in the tear film layer (acting like a contact lens), pupil constriction (pinhole effect), or better interpretation of blurred images.13
Key takeaways
In conclusion, the state of our vision is a delicate and intricate aspect of our overall health and well-being, shaped by factors such as age and underlying health conditions.
Babies are born with hyperopia, which often resolves by school age. Myopia may develop during school years and stabilize in adulthood. Some people may experience improved vision in their 40s, followed by their myopia getting worse in their 70s. However, regardless of how it changes, a sudden worsening of vision should always warrant a visit to the doctor.
And who knows, in the unfortunate event of getting an intraocular lens surgery for cataracts might just be the ticket to 20/20 vision again!
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13. AAO Complementary Therapy Task Force, Hoskins Center for Quality Eye Care. Visual Training for Refractive Errors CTA - 2013. Accessed May 27, 2024. https://www.aao.org/education/complimentary-therapy-assessment/visual-training-refractive-errors-cta--october-200
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