Myopia and high degree myopia

Myopia, often known as "being short sighted", causes your vision to be blurry in the distance but clearer when looking at things up close. It’s a very common condition and for most people it can easily be dealt with using contact lenses or glasses, which will make your vision clear and crisp.

How the eye works

Light rays enter the front of our eye through the clear cornea and lens, which together bend the light so that it can focus sharply on the retina at the back of the eye. This gives us a clear, sharp image. The cornea focuses the light towards our retina, and the lens fine tunes the focussing of this light

The retina is a delicate tissue that lines the inside of your eye and is made up of light sensitive cells. Your retina converts the light into electrical signals that travel along the optic nerve to our brain. The brain interprets these signals so we can “see” the world around us. The retina is supplied with blood by a delicate network of blood vessels on its surface and by a layer of blood vessels (the choroid) underneath the retina.

Myopia

For vision to be clear, light entering your eye needs to be focused accurately on your retina. Light entering your eye is first focused by the cornea and then fine focused by the lens. This focusing system of your eye makes sure that when light enters your eye it is sharply in focus as it hits the retina. This means that we see everything in focus without any blurriness.

There are three types of eye conditions where the eye is unable to correctly focus light onto the retina. These are called refractive errors and can cause your vision to be blurred. They are:

  • Myopia (short sightedness)
  • Hypermetropia (long sightedness)
  • Astigmatism, where the shape of your eye is more like a rugby ball than a spherical football

Myopia, often known as “being short sighted” causes your vision to be blurry in the distance but clearer when looking at things up close. It is a very common condition of the eyes and for most people it can easily be dealt with using contact lenses or glasses, which will make your vision clear and crisp.

People with myopia have an eye which bends the light coming into your eye too much, which means that the light comes to a focus point before it reaches your retina. This makes vision blurry and is caused by the eyeball being too long or the cornea (the clear window at the front of the eye) being more steeply curved. When you move closer to an object, this changes the focussing of the light and the object is then in focus on the retina and therefore looks clear.

People with myopia need a glasses prescription with a minus lens to reduce the amount the light bends by when coming into your eye.

Classification and grading of myopia

How much myopia someone has depends on:

  • the length of your eyeball from front to back
  • how steep your cornea is
  • how powerful the lens inside your eye is.

When you go for an eye test the optometrist (optician) is able to work out what focusing power your eye has. Optometrists measure the focusing power of your eye using dioptres. This is a technical term for how strong a lens would have to be to give you focused vision. The common way for writing myopia is to say how many dioptres your lens would need to be to correct your sight back to its normal level.

Generally speaking this is written like “-3.00 dioptres (D)”. On your glasses or contact lens prescription a minus sign is used to show that the lens you need corrects for myopia. The higher the number the more short sighted you would be.

  • Mild myopia includes powers up to -3.00 dioptres (D)
  • Moderate myopia, values of -3.00 to -6.00D
  • High myopia is usually myopia over -6.00D

Most people with myopia are below -6.00D, but some people have much higher levels of myopia. How high your myopia is can be a sign of whether it may lead to further problems with your eyes. Most people with myopia of less than -6.00D don’t develop any further problems and the blurriness their myopia causes is easily dealt with by glasses or contact lenses. This is sometimes known as simple myopia. Some people with myopia higher than -6.00D may be at risk of certain eye conditions that require treatment other than spectacles. This is also known as degenerative or pathological myopia, but not everyone with myopia above -6.00D will develop this.

Development of myopia

You can develop myopia at any age, however it does have a tendency to develop in childhood or teenage years and it can get worse as you get older. Myopia can become more stable in adulthood; however there may be episodes where the myopia continues to increase. These episodes can happen at any age and are more common if you have higher levels of myopia. In general the younger you are that myopia begins to develop, the higher the level of myopia you will reach.  For some people their myopia reaches a certain level and stays the same for many years.

Causes of myopia

It’s not known what causes myopia and research suggests there could be a number of different reasons for it to develop. Myopia does run in families so is thought to be partly genetic. Children who have one parent with myopia have a higher chance of developing myopia. This chance increases if both parents have myopia.

Myopia can also develop because of other conditions you may have. If you have diabetes you may experience temporary myopia when your blood sugar level is not well controlled. Glasses alone may not be the best way to correct the change in your vision. Good control of your blood sugar levels will help stabilise your vision and your diabetic nurse and GP would be able to help you to achieve this.

Some types of cataracts can also cause myopia to develop. The myopic changes caused by early cataracts can be corrected by glasses. When cataracts continue to develop this may not be possible and surgery to remove the cataracts would improve your vision. 

High myopia

If you have high myopia (over -6.00D) your eyes may be healthy and with glasses or contact lenses you may have good vision. You tend to have high myopia because your eye has grown in length. This means that even though your eyes are healthy, you are at a higher risk of developing eye conditions and changes associated with the lengthening of the eye and stretching of the retina.

One eye condition that you may experience is a posterior vitreous detachment (PVD). A PVD occurs because of natural changes to the jelly (the vitreous) in your eye and does not normally threaten your sight. It tends to develop later on in life, but it can develop earlier if you have myopia.

If you have high myopia then there is a higher chance of you developing a retinal detachment. This is where a hole or tear can develop in your retina when it has been stretched. The fluid in your eye can leak through this gap and behind your retina. This can cause your retina to detach from the back of your eye. The symptoms of a PVD and retinal detachment are:

  • flashing lights
  • a recent onset, increase or change in your floaters
  • a curtain effect coming down, up or across your vision.

It’s important if you notice any of these symptoms or any new symptoms that you have your eyes checked immediately by an eye specialist.

You also have a higher risk of developing glaucoma (raised eye pressure) and you may develop cataracts (clouding of the lens) at an earlier age. 

Pathological myopia

If you have been diagnosed with pathological myopia you have very high myopia and your eye may also show degenerative changes affecting the back of the eye. These changes can cause a reduction in your sight.

Retinal atrophy

The stretching of your retina as your eye grows longer causes it to become thinner. A common change in pathological myopia is areas of retinal atrophy. These are areas where your retina has become very thin and can affect how your retinal cells work. When an optometrist or ophthalmologist looks into your eye the areas of atrophy look very pale and blood vessels that are behind the retina can be seen through them. Your vision at these areas may be reduced or even blanked out causing blind patches in your sight. Retinal atrophy can occur anywhere on the retina and if it happens in the macula (central area of the retina), it can affect your central vision.

Lattice degeneration

At the edge of your retina there may be retinal changes and thinning that develops, known as lattice degeneration. In many people lattice degeneration is regularly monitored by an eye specialist and usually causes no problems. The presence of lattice degeneration increases the risk of retinal detachment. Laser treatment or cryotherapy (freezing treatment) may be needed to these areas to prevent a retinal detachment from developing.

Lacquer cracks

As the eye stretches it can cause breaks to appear on the retina, which look like fine lines. These are known as lacquer cracks and are breaks that occur in the membrane between the retina and its underlying blood supply (Bruch’s membrane). There isn’t any treatment for lacquer cracks and they don’t affect your vision directly. However they are the first signs of further problems which can develop and cause changes to your vision.

New vessels

In some people new blood vessels can grow from the blood supply underneath the retina (from the choroid layer), through lacquer cracks or areas of atrophy and onto the retina. This is known as choroidal neovascularisation (CNV). These new blood vessels can bleed very easily as they are very weak and fragile, causing damage and swelling to the retina.

If new blood vessels develop at the macula (the central part of the retina) it’s known as myopic macular degeneration or myopic maculopathy. Changes to your central vision can make it difficult to read and see people’s face. You may also find that your colour vision is affected and straight lines look bent or distorted.

The damage to the retina caused by new blood vessels causes scarring, which can permanently affect your vision.

At the macula, this scarring is called a Foster Fuchs spot. This is a circular area of pigment which develops after the new blood vessels and bleeding has gone.

Treatment of myopia

Most people who have myopia don’t have any complications and will only ever need glasses or contact lenses to make their vision sharper. If your prescription is over -10.00D, then you would be entitled to a NHS complex lens voucher to use towards the cost of your glasses or contact lenses. Your optician would be able to tell you how much this voucher is worth.

The higher your level of myopia is, the higher the risk of developing eye conditions and the changes associated with myopia. If your retina has been damaged then your vision may need more than glasses to help you see well.

A low vision clinic, which is located in an eye hospital, can be very helpful. Low vision aids, such as magnifiers, can help to make things you are looking at bigger. They will be able to provide practical help and advice on how to use your remaining vision. Your eye specialist or your GP would be able to refer you to the low vision clinic for an assessment.

There are no treatments available to stop your eye from developing the complications of high or pathological myopia. This is because it’s not possible to control the growth of your eye. Currently treatment is aimed at improving your vision and to treat any complications if and when they happen. You will be monitored regularly by your eye specialist who will check the health of your eyes. It’s important to have your eyes checked by your eye specialist as soon as possible if you notice any changes to your vision or any new symptoms.

The type of treatment you may need will depend upon the eye condition or the change that has developed. Not all the eye changes that happen in pathological myopia can be treated. There are a number of complications which may occur because of pathological myopia and these include:

Cataracts

A cataract is when the lens inside your eye becomes cloudy. This cloudiness can cause symptoms such as blurred or misty vision, colours appearing dull, or problems seeing clearly at night. Cataracts can take some time to develop before they affect your vision. When your daily activities are being affected by your cataracts, they can be treated using surgery to remove the cloudy lens and replace it with an artificial one.

Glaucoma

Glaucoma is a where the optic nerve, which carries electrical signals from your retina (the light sensitive cells at the back of your eye) to your brain, is damaged by the pressure of the fluid inside your eye.

If you have been diagnosed with glaucoma then you may be prescribed eye drops to help control your eye pressure. It’s very important that you use your eye drops as advised by your eye specialist as this will prevent you from experiencing any future sight loss due to glaucoma. It’s also important to attend any hospital eye appointments regularly to monitor your glaucoma.

Retinal detachment

A retinal detachment can be repaired by different types of surgery. If you have symptoms of a retinal detachment, it’s important that you are seen by an eye specialist immediately. They would be able to assess the detachment and decide which type of surgery would be best for you.

New blood vessels

New blood vessels that may develop can be treated with a type of laser, known as photodynamic therapy (PDT).  Before the laser is used a light sensitive drug called Verteporfin is injected into your arm. The Verteporfin will travel to your eye through your blood vessels and will fill the new blood vessels that are growing. Your eye specialist will be able to see these new vessels clearly and apply the laser to them. The laser causes a reaction with the drug which seals off any new blood vessels that may be growing. This treatment needs to be given at the early stages of the blood vessel growth so that it can prevent the new blood vessels causing damage.

Recently anti vascular endothelial growth factor (anti-VEGF) medications have been developed to stop the new, leaky blood vessels from growing. Anti-VEGF treatments are given by an injection into the eye and work by reducing the growth of new blood vessels and the oedema (swelling) they may cause. Doing this can reduce the risk of scarring and damage to the retina caused by these new vessels, which in turn can help to avoid further sight loss.

Light sensitivity

A large proportion of people who have pathological myopia suffer from light sensitivity known as photophobia. You may find bright light uncomfortable or you find it difficult to adapt to changing levels of lighting. Using sunglasses, tinted lenses and sunshields can all help to reduce the discomfort and glare you may experience in everyday living.

Coping

Most people who have myopia find their vision improves when they wear their glasses or contact lenses. However, it’s completely natural to be upset when you are diagnosed with an eye condition associated with myopia. It’s normal to find yourself worrying about the future and how you will manage a change in your vision.

It can sometimes be helpful to talk over some of these feelings with someone outside your circle of friends or family. At RNIB, we can help with our telephone Helpline and our Emotional Support service. You may also find your GP or social worker can help you find a counsellor if you feel this might help you.

Help to see things better

Having pathological myopia can cause changes to your vision in the long term, but much can be done to help you make the most of your remaining vision and adapt to any changes.

There are lots of things that you can do to make the most of your remaining vision. Making things bigger, using brighter lighting or using colour can all help towards making things easier to see. There is more about this in our “Starting out: making the most of your sight” leaflet, which is available from our Helpline on 0303 123 9999, or you can download it below.

You can also ask your ophthalmologist, optician or GP to refer you to your local low vision service, which can provide you with magnifiers to help with reading and advice on lighting to help you make the most of your sight. Local social services should also be able to offer you information on being safe in your home and getting out and about safely. If you need it, they should also be able to offer you some practical mobility training to give you more confidence when you are out.

Our Helpline can also give you information about low vision clinics and the help available from social services on 0303 123 9999. They can also offer help if you have any difficulties accessing these services.

Support

Whether you have just been diagnosed with an eye condition associated with myopia or have been living with it for a while, we are here to help and support you at every stage.

RNIB
105 Judd Street
London
WC1H 9NE

The RNIB Helpline is your direct line to the support, advice and products you need. We’ll help you to find out what’s available in your area and beyond, both from RNIB and other organisations.

Whether you want to know more about your eye condition, buy a product from our shop, join our library, find out about possible benefit entitlements, be put in touch with a trained counsellor, or make a general enquiry, we’re only a call away.

RNIB Helpline
t: 0303 123 9999
helpline@rnib.org.uk

We’re ready to answer your call Monday to Friday 8.45am to 5.30pm.

Macular Society
PO Box 1870
Andover
SP10 9AD
t: 0300 3030 111
www.macularsociety.org

Other useful contacts

Royal College of Ophthalmologists
18 Stephenson Way
London
NW1 2HD
t: 020 7935 0702
www.rcophth.ac.uk

Driver and Vehicle Licensing Agency (DVLA)
Drivers Customer Services (DCS)
Correspondence Team DVLA
Swansea SA6 7JL
t: 0300 790 6801
www.dvla.gov.uk

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