What is Myopia?
A recent study published in the Archives of Ophthalmology found that more Americans now are nearsighted than in years past. Nearsighted people rarely have headaches or eye strain except as related to squinting to see clearly.
No-one knows with certainty what causes myopia, but in general the eyeball of the nearsighted person is physically longer than that of the normal, or farsighted person. As a result, entering light rays come to a focus in front of the retina (the film of nerve tissue inside the eye that receives light rays and transmits them to the brain) rather than directly on it. The rays cross and by the time they reach the retina the person perceives a blur.
In some families myopia has been found to be genetic, but there is no uniformity to this finding. Nearsightedness usually appears in childhood but there are plenty of cases in which it does not show up until the late 20’s. Myopia typically stabilizes when a person is finished growing and may start to worsen again later in life as cataracts develop.
There is no real treatment for myopia but the vision problems associated with it can be corrected with eyeglasses, contacts, or surgery.
Glasses and contact lenses do not cure myopia and when they are removed, the eye is still nearsighted. Surgical methods to correct nearsightedness first started to appear in society over 100 years ago with some crude early attempts that probably created more blindness than they solved. Another spurt of activity in this regard occurred around 1950 in Japan with similar dismal results. It was not until the mid-1970’s in Russia when Radial Keratotomy for nearsightedness was discovered, that the modern day of refractive surgery was born. Dr. Fyodorov discovered accidentally that the cornea (the clear window at the front of the eye) could be made flatter or less steeply curved with surgical incisions resulting in dramatically reducing nearsightedness. Within the next few years, Dr. Stephan Trokel in New York developed a laser technique to accomplish the same purpose and this is the technology in widespread use worldwide today in the form of LASIK, PRK, and Epi-LASIK.
The first procedure approved by the FDA in 1995 was PRK in which no incision is made, but the surface cells of the cornea are removed, the second layer down is then reshaped (flattened) with the excimer laser causing the entering light rays to be focused precisely on the retina for clear distance vision in eyes that were previously near-sighted.
The next procedure which appeared just a couple of years after PRK had been approved was LASIK in which either a stainless steel blade in a special device, or a different kind of laser (femtosecond) is used to cut a “flap” in the cornea. The flap is then folded back to expose the inner part of the third layer down of the cornea which is then flattened by the excimer laser to produce the vision change.
Many ophthalmic surgeons worldwide believe that it is much safer in the short and long term to correct the myopia without cutting into the tissue of the cornea. However, both types of procedure are safe, millions of procedures having been done worldwide over the past few decades with minimal complications having occurred. I have performed over 10,000 LASIK procedures with only one significant complication and over 1000 Epi-LASIK and PRK procedures with no significant complications.
The Doctor’s Doctor