Patient's question:
What are the better ways to treat myopia?Doctor's answer:
Hello; The treatment of myopia can be divided into surgical and non-surgical methods. (1) The best treatment for myopia—wearing a pair of suitable glasses. Patients with myopia have varying degrees of reduced distant vision, making it blurry to see objects several meters away. When going to the mall, they cannot see the displayed goods and price tags clearly; when walking on the street, they cannot recognize familiar people coming towards them and avoid greeting them, leading others to think they are being snobbish or ignoring them; students make mistakes on the blackboard exercises and do their homework incorrectly. All these things make myopes suffer greatly. To step out of this blurry world, the only solution is to wear glasses. However, some patients with myopia would rather see things unclearly and squint anxiously than wear glasses. The reason is that young people find it inconvenient to wear glasses, fearing that they might bump into things or fall. Some also think that wearing glasses is not attractive and affects their appearance. They are afraid that once they wear glasses, their prescription will only get stronger, and they will never be able to take them off. They keep the glasses they have prepared in their pockets and only wear them when looking at distant objects. In fact, this idea is incorrect. People with myopia, due to parallel light entering the eye not being able to focus on the retina, cannot see distant objects clearly. Although close objects are relatively clear, the close distance of the eyes from the book during study can easily cause eye fatigue. Children with myopia may appear less active, have difficulty concentrating in class, have difficulty seeing the blackboard, and their academic performance may decline. Sometimes, they may also develop strabismus. If they wear a pair of suitable myopia glasses, the image in front of the retina can be moved backward to fall exactly on the retina, allowing them to see things clearly immediately. This will bring great convenience to both work and study—why not do it? As for the inconvenience of wearing glasses and their unattractiveness, these concerns should be dispelled. Wearing glasses is to correct vision defects and reduce eye fatigue. After wearing them for a while, people get used to them, and there is nothing unattractive about it. Will the myopia degree get worse after wearing glasses? We say it generally will not. Whether the myopia degree develops or not is unrelated to wearing glasses. Indeed, some people with myopia have experienced their myopia degree worsening after wearing glasses for a period of time and need to have their vision rechecked and glasses replaced. What is the reason for this? Some people feel that everything is fine after getting their glasses, but they still read or write with their eyes very close to the book, pay little attention to vision health, read for too long, or read lying down, walking, or in poorly lit places. Over time, this also leads to vision fatigue and an increasing myopia degree. Some young people regard wearing glasses as a burden, wearing them sometimes and not wearing them at other times, wearing them when they are happy and not wearing them when they are unhappy, or only wearing them when looking at distant objects, keeping their eyes in an unstable state, which will also gradually deepen the myopia degree. There are also people who have not had a dilation eye exam or whose optometrist lacks experience, resulting in unsuitable glasses. Some also buy or wear glasses randomly from stores or from others. Even if they can see clearly after wearing them, it is not sustainable, and over time, the eyes will feel sore and uncomfortable. Not only does the vision not improve, but the myopia may even worsen. Therefore, people with myopia must go to the hospital for a dilation eye exam or have an experienced optometrist examine their vision to get a pair of suitable glasses. They should wear them all day except when sleeping and washing their face. Remember never to borrow glasses blindly. How can you get a pair of accurate and comfortable glasses? For adolescents with myopia, it is essential to have their vision checked at the hospital and undergo a dilation eye exam. A dilation eye exam is also known as an objective eye exam, which uses drugs (such as 2% homatropine or 1% atropine eye drops) to completely paralyze the ciliary muscles, dilate the pupils, and lose their function, then perform the eye exam. This eliminates the interference and false myopia components caused by function, objectively and accurately determining the refractive state of the eye. Then, based on the eye exam prescription, the lenses are ground, and the ground lenses are fitted onto the selected glasses frame. Usually, a follow-up eye exam is performed after a certain time after the dilation eye exam. Observe whether the trial lenses with the objectively determined refractive power cause any abnormal discomfort, such as dizziness, nausea, blurred vision, distorted vision, or unsteady walking. Through the follow-up exam, the objective dilation eye exam results are consistently combined with the subjective post-exam results, maximizing the quality of the glasses exam to achieve the best vision correction effect. Some young people are reluctant to have a dilation eye exam, fearing discomfort in their eyes and difficulty seeing close objects after dilation. In fact, this concern is unnecessary. The drugs used in pharmacology for dilation eye exams (such as atropine or homatropine) are anticholinergic drugs. Their function is to relax the dilator pupillae muscle and ciliary muscle, resulting in pupil dilation and paralysis of function. This drug effect is only temporary, and as long as the drug is no longer used, its paralyzing effect will naturally disappear after a certain period of time. If a dilation eye exam is not used, due to the function of the ciliary muscles and lens, the result may be an overly strong prescription or false myopia. Therefore, adolescents with myopia should have a dilation eye exam and select appropriate myopia glasses. Only in the following cases: (1) If the examination finds shallow anterior chamber, high intraocular pressure, or a high normal limit, suspecting glaucoma, detailed medical history should be taken, and a clear diagnosis should be made before the eye exam. Glaucoma patients are absolutely from having a dilation eye exam. (2) Severe lens or vitreous opacity, corneal leukoma, due to the difficulty of examination, dilation eye exams are also meaningless. (3) Severe pupillary adhesion, even with dilation drugs, the pupils cannot dilate normally, and dilation eye exams are unnecessary. (4) People over 40, due to weakened ciliary muscle ability, generally no longer have dilation eye exams. Currently, the main material for making lenses is optical glass, also known as optical lenses. In addition, there are optical resin lenses. Optical glass has the following advantages: (1) High transmittance, with a transmittance of up to 92%. If a single or multiple layers of magnesium fluoride antireflective film are coated on the lens surface, the transmittance can reach 99.2%. (2) Absorbs ultraviolet light to avoid damage to the eyes from ultraviolet light. (3) Chemical stability, resistant to corrosion from acids and alkalis. (4) Constant refractive index, with an accurate refractive index of 1.523, which is constant and accurate, ensuring accurate diopter after processing. The characteristics of optical resin are light weight, hardness close to glass, and a refractive index of 1.490. New high-refractive-index thermosetting resins have a refractive index of 1.600, with a superhard coating and anti-reflective multilayer coating, enhancing wear resistance and a transmittance of up to 98%, and can block ultraviolet light. Lenses ground from optical resin are less prone to breaking and injuring the eyes, making them safer and are now widely used. Crystal material is hard and wear-resistant with good thermal insulation, but its ultraviolet absorption performance is worse than optical glass, and its transmittance is also poor, making it an unsuitable material for making lenses and not a good choice for eye care. The processing of lens diopter must be precise, and the ground lenses must match the prescription. The error in diopter should generally not exceed the national standard of 0.04D-0.09D from the Ministry of Light Industry. The optical center distance of the two lenses should also match the pupillary distance of the two eyes. The glasses commonly seen and worn by people are those placed on the nose or clipped on the ears, which are very inconvenient. There are also some people with one eye having a much higher myopia degree than the other, or one eye having had cataract surgery while the other is normal. Due to the significant refractive difference between the two eyes, one eye sees things larger while the other sees them smaller, and the visual center cannot fuse them together. Therefore, ordinary glasses cannot be worn. In recent years, a type of glasses that can be worn but not seen has emerged, commonly known as contact lenses. They are directly placed on the tear film surface of the cornea, with a liquid lens formed by tears between the cornea and the lens. This forms a new refractive system consisting of the lens, liquid lens, cornea, and other refractive media of the eye. Medically, it is called a corneal contact lens. Contact lenses can be divided into hard contact lenses and soft contact lenses based on the material of the lens. Hard contact lenses are made of organic glass mainly composed of methyl methacrylate, are hard, and are not easily deformed. They are suitable for correcting high astigmatism and keratoconus. Their disadvantage is poor breathability, unable to permeate oxygen, carbon dioxide, moisture, and metabolic substances, making them uncomfortable to wear. Soft contact lenses are made of materials such as hydroxyacrylic acid or silicone rubber, are soft, have good breathability, and can absorb moisture, making them comfortable to wear and can be used to treat corneal diseases, but they are easily deformed and not suitable for astigmatism. They are divided into long-wear and daily-wear types based on wearing methods. Contact lenses worn overnight for two or more consecutive days are classified as long-wear, including weekly, monthly, or even disposable types. Long-wear lenses are removed and cleaned only once after being worn for multiple days, with proteins and other substances from tears depositing on the lens, eventually forming permanent cloudy spots that affect the clarity of the lens. More seriously, bacteria can accumulate and grow, making it easy to develop infectious keratitis. For this reason, long-wear methods are no longer recommended. Daily-wear lenses are worn for no more than 14 hours continuously, and must be removed each night for necessary cleaning, disinfection, and proper storage, to be worn again the next day. Due to the daily cleaning and disinfection of the lenses, permanent cloudy spots will not form on the lenses. Daily cleaning and disinfection greatly reduce the likelihood of developing infectious keratitis. Therefore, it is necessary to the daily-wear method and avoid the long-wear method. Contact lenses have advantages that ordinary glasses do not have and solve problems that ordinary glasses cannot. Since contact lenses are closely attached to the cornea and can rotate with the movement of the eye, light always enters the eye through the center of the lens, regardless of the direction the eye turns, eliminating the prismatic effect and oblique astigmatism defects caused by the edges of ordinary glasses. Contact lenses are ground based on the curvature of the patient's corneal surface and refractive power, fitting tightly against the cornea, forming a new refractive medium with the lens and tear layer, contributing to a complete optical unit. The curvature of the lens surface can be ground arbitrarily according to refractive requirements. Replacing the irregular curvature of the corneal surface effectively eliminates irregular corneal astigmatism and reduces the difference in object size between the two eyes. Due to the close contact of the contact lens with the cornea, the distance to the center of the eye is shortened, and the image formed on the retina after passing through the lens is similar to that without wearing a lens, making objects appear neither magnified nor reduced. Avoiding the disadvantages of ordinary glasses, it is most suitable for significant refractive differences between the two eyes or monocular aphakia. Contact lenses are thin and light, attached to the corneal surface, making them much more convenient than thick and heavy myopia glasses. Additionally, they bring great convenience to people with special needs (such as actors and athletes). Due to the many advantages that contact lenses have over ordinary glasses, their scope of application is much broader. They are more suitable for the following situations: (1) High myopia, with a refractive difference between the two eyes exceeding 3.00D, corneal mixed astigmatism or irregular astigmatism. Especially for some cultural or sports professionals, wearing ordinary glasses may affect their work or performance, making them suitable for contact lenses. (2) Some people have had cataract surgery in one eye, due to the significant refractive difference, they cannot wear ordinary glasses and can only wear contact lenses. (3) Soft contact lenses can be used to treat corneal edema, exposure keratitis, and dry keratoconjunctivitis. By painting the lens circumference with a color similar to the iris and keeping the center transparent, it can eliminate the photophobia symptoms of albinism patients and those with iris defects. In recent years, there have also been specialized corneal contact lenses made for treatment purposes, with lenses immersed in certain drugs that can be released to the conjunctival sac at timed intervals. This not only reduces the frequency of eye drops but also saves medication while maintaining a higher concentration of medication in the conjunctival sac for better treatment effects, such as treating glaucoma or corneal ulcers. Although contact lenses have many advantages, they also have certain limitations and are not suitable for everyone. There are three main contraindications for wearing contact lenses. Physical conditions: entropion, trichiasis, incomplete eyelid closure, lacrimal sac inflammation, dry eye disease, severe trachoma and chronic conjunctivitis, keratitis, diabetes, hypertension, sinusitis, etc. Environmental conditions: wind, sand, dust, volatile chemicals, and severely polluted environments. Personal qualities: poor hygiene habits, poor self-care ability, and inability to maintain diligent care, such as middle and primary school students. Although contact lenses have been continuously improved, their chemical properties, comfort, and safety have reached a relatively ideal level and are widely used. With the popularization of their use and long-term clinical observation, some complications of varying severity have emerged, such as corneal injury, conjunctival inflammation, and corneal infection. For many years, curing myopia and removing glasses have been the urgent wish of many people with myopia, hoping for the arrival of an enemy and a blessing of myopia to realize the dream of removing glasses. Under these circumstances, some devices and drugs claiming a high effective rate of over 95% have emerged to meet the desires of parents and adolescents to remove glasses. Methods that have been tried for treating myopia include acupuncture therapy, plum blossom needle therapy, ear acupuncture, electroacupuncture, low-frequency current therapy, ultrasonic therapy, and acupoint laser irradiation. These therapies have certain effects in preventing myopia and treating pseudomyopia, but they do not have a definite and conclusive effect on true myopia. In recent years, countless medical staff and pharmaceutical experts engaged in ophthalmology have conducted beneficial research on the treatment of myopia and have developed some drugs for treating myopia, such as Sumianwu eye drops, 1% dibazol eye drops, Salvia miltiorrhiza eye drops, Carthamus tinctorius eye drops, Myopia No. 1 and No. 2 eye drops, etc. These eye drops can relieve ciliary muscle spasm to a certain extent and have a certain effect on mild myopia, especially in adolescents and pseudomyopia. Some patients' vision can improve, but the effect is not stable. In summary, the effect of treating myopia with medication is currently not satisfactory. As for magnetic therapy glasses, vision health instruments, vision health devices, vision correction instruments, physical therapy lenses, eye masks, and divine lenses, these myopia treatment devices are numerous, with advertisements frequently appearing in various media, and their advertising slogans are extremely exaggerated. Some even claim national patents, which are very tempting. Many people with a "try it" mentality have lost money and time, and in the end, they still have to wear glasses. (2) Surgical treatment of myopia Surgical treatment of myopia is suitable for the following indications: Age over 18 years old; myopia refractive power of 2.50D or higher; normal corrected vision with glasses; a desire to remove glasses; no active corneal lesions or keratoconus; no history of diabetes or collagen diseases. As mentioned earlier, myopia can be treated with acupuncture, medication, and other methods, but the most certain and reliable treatment method is still wearing myopia glasses. However, whether wearing frame glasses or contact lenses, there are still various shortcomings that are difficult to overcome. Can surgery be used to correct vision? In the 1980s, some advanced and developed countries in the world successively carried out surgical treatment for myopia—radial keratotomy, abbreviated as PRK. This surgical method originated in Japan and was later improved and refined by ophthalmologists in the Soviet Union and the United States in terms of surgical methods and equipment, greatly improving the accuracy of radial keratotomy and accumulating a large amount of clinical experience to achieve good treatment effects. Especially for young and middle-aged adults with mild to moderate myopia, the surgical success rate is over 95%. For high myopia of 6.00D-10.00D, most can no longer wear glasses, and for high myopia of over 10.00D, it can also reduce the myopia degree. It also has a certain effect on myopia astigmatism. Radial keratotomy has opened up a new approach for treating myopia. China started surgical treatment for myopia relatively late, around the mid-1980s. After radial keratotomy was introduced to China, it became popular all over the country, with small and large hospitals rushing to participate, including inviting foreigners from Russia to perform the surgery. Due to the lack of surgical instruments and insufficient clinical experience, the postoperative corrected vision was not ideal, and complications were numerous. In recent years, some large hospitals in China have purchased advanced surgical instruments from abroad—gold-diamond blades. These blades are not only sharp but also have a very thin blade edge (only 0.1 micrometers) and are marked with scales, allowing the depth of the incision to be adjusted at will. Postoperative corneal scars are fine, with uniform width and depth, and the chance of causing irregular astigmatism is reduced. Therefore, they are very popular with myopia patients, especially those with high myopia. In addition to radial keratotomy, many new surgical methods for treating myopia have emerged abroad, and some large hospitals in China have also successively carried out these surgeries. (1) Surface corneal lens surgery: Using allogeneic corneas, which are frozen and then ground into different refractive powers on special machines. Then, a layer separation is performed on the central part of the patient's cornea, and a specially made corneal lens is embedded into the corneal layer and sutured around it to achieve the purpose of correcting myopia. (2) Corneal abrasion surgery: Using the patient's own cornea, a layer is excised from the center, and the removed corneal tissue is treated at low temperatures to harden it. Then, it is ground on a precision machine to the required refractive power and sutured back in place. (3) Laser corneal incision surgery: Using excimer laser (wavelength of 193 micrometers) to perform radial keratotomy, making the incision more precise, accurate, and achieving better correction results, greatly reducing surgical complications. (4) Posterior scleral reinforcement surgery: This surgery uses medical silicone sponge, allogeneic sclera, or broad fascia as protective and reinforcing materials to reinforce and fuse the posterior sclera, support the posterior of the eyeball, prevent the progressive expansion of the posterior and the progressive elongation of the eye axis, and reduce the degree of myopia to a certain extent. At the same time, new blood vessels form postoperatively, enhancing the blood circulation of the choroid and retina, exciting visual cells, activating bioelectricity, and improving visual acuity. This surgery is particularly suitable for controlling the progressive elongation of the eye axis in high myopia, especially in adolescents with high myopia whose eye axis is longer than 26 millimeters and whose myopia degree increases by more than 1.00D per year. Surgical complications Surgical treatment of myopia has, to a certain extent, solved the problem of wearing glasses for high myopia and met the needs of people engaged in special occupations, making it popular with myopia patients. However, no matter how simple or safe surgery is, it is not without risks, and myopia surgery is still not a very mature procedure, with many aspects needing improvement and refinement. The main surgical complications at present include: (1) Corneal perforation during surgery, leading to cataracts and bacterial endophthalmitis; (2) Corneal ulcers, delayed wound healing, and corneal endothelial damage; (3) Postoperative scars and epithelial cysts, causing irregular astigmatism and severely affecting vision; (4) Residual myopia, refractive errors, astigmatism, or overcorrection