Treating myopia as a lasting injury: the higher the prescription, the greater the future risk of retinal detachment, macular degeneration, and glaucoma

6. Treating myopia as a lasting injury: the higher the prescription, the greater the future risk of retinal detachment, macular degeneration, and glaucoma

Cost: No cost involved. There is nothing specific to do here; the necessary actions are outlined in items 4 and 5 (spending two hours outdoors and managing screen time based on age).

In plain terms: Myopia does not go away on its own, nor does the prescription level decrease. It is far more than simply “wearing glasses.” Compared to people without myopia, those with mild myopia face a risk of myopic macular degeneration roughly 10–15 times higher; for individuals with a prescription of 600 degrees or more, this risk rises by several hundred times. The likelihood of retinal detachment is about three times higher for mild myopia and roughly 13 times higher for severe myopia. Therefore, the earlier a child develops myopia and the faster it progresses, the greater the long-term risks they must face.

Benefit: A systematic review and meta-analysis compiled studies published up to June 2019, grouping participants into three prescription categories: mild (−0.5 to −3.00 D), moderate (−3.00 to −6.00 D), and high (≤−6.00 D, i.e., 600 degrees or more). Compared to people without myopia, the odds ratios for myopic macular degeneration were 13.57 (95% CI 6.18–29.79) for mild myopia, 72.74 (33.18–159.48) for moderate myopia, and 845.08 (230.05–3104.34) for high myopia. For retinal detachment, these odds ratios were 3.15 (1.92–5.17), 8.74 (7.28–10.50), and 12.62 (6.65–23.94) respectively. The odds ratios for posterior subcapsular cataract were 1.56 (1.32–1.84), 2.55 (1.98–3.28), and 4.55 (2.66–7.75) respectively. For open-angle glaucoma, the odds ratio for mild myopia was 1.59 (1.33–1.91), while for moderate and high myopia combined it was 2.92 (1.89–4.52). Among individuals over 60, the odds ratios for visual impairment were 1.71 (1.07–2.74), 5.54 (3.12–9.85), and 87.63 (34.50–222.58) respectively. This aligns with the “Ten Core Principles for Preventing and Controlling Myopia in Children and Adolescents,” which defines high myopia as a prescription of 600 degrees or more; such individuals face significantly higher rates of cataracts, open-angle glaucoma, myopic macular degeneration, retinal detachment, and other vision-threatening conditions. Importantly, “myopia can be prevented and controlled, but not reversed.”

Evidence grade: A

Sources: Haarman AEG, Enthoven CA, Tideman JWL, Tedja MS, Verhoeven VJM, Klaver CCW (2020). The complications of myopia: a review and meta-analysis. Investigative Ophthalmology & Visual Science, 61(4), 49. <https://doi.org/10.1167/iovs.61.4.49>; National Health Commission of China (NHC) General Office (2023). Ten core knowledge for preventing and controlling myopia in children and adolescents (National Health Office Maternity and Childhood Letter [2023] No. 278). <https://www.gov.cn/zhengce/zhengceku/202307/content_6894284.htm>

Notes: All studies included in this analysis were observational studies, and the reported odds ratios are unusually large. For instance, the confidence interval for high myopia and myopic macular degeneration spans from 230 to 3104, indicating considerable variation among individual studies; thus these figures should be viewed as rough estimates rather than precise values. Most of these complications tend to appear only in middle or old age, so this is not a situation where immediate harm occurs; rather, it represents a long-term risk that accumulates over decades. Myopia itself is not a disability, and the vast majority of people achieve normal vision after wearing corrective lenses. The purpose of this item is to shift the common perception that “once you have myopia, glasses are all you need” to recognizing that it is worthwhile to delay and control its progression. Information on follow-up examinations after diagnosis can be found in item 12 (pupil dilation and refraction testing). Be wary of products claiming to cure myopia; refer to item 9 (myopia cannot be cured) for further details.