alling myopia a disease still ticks off the purists since they insist that a disease has a definite meaning which myopia does not fit. To these folks, a disease has a specific etiology, course, and can be cured. The problem with that definition is that it has too many holes. For example: Ebola is classified as a disease and yet it cannot be cured. Cardiovascular ‘disease’ has no specific etiology nor cure either. So it goes on. The main objection to classifying myopia (and its brethren hyperopia and astigmatism) as a disease comes from the insurance companies who pay for treating a disease. It's the Golden Rule in action — the guy with the gold makes the rules. ‘Twas ever thus; deal with it.

There is no doubt that myopia (except in its milder forms), and to a lesser extent — hyperopia, inflicts a grave socioeconomic burden upon the individual. This burden has not been truly appreciated by some and has been deprecated by many. We can make a beginning in our assessment of the question by considering that the cost of optical aids amounts to something in excess of $4 billion annually — that's approximately 80 cents for every man, women, and child on this planet — just for this country alone! This burden starts early and continues for a lifetime. In a survey conducted by HEW (Health, Education and Welfare) in 1974, it was found that 34% of individuals between ages 12 and 17 years were wearing correcting lenses. Myopic corrections accounted for an increasing proportion of these wearers — 72% at age 12 to 87% at age 17. In the United States alone, there are probably in excess of 150 million near-sighted individuals.

If myopia only caused a significant reliance upon optical corrections, it would be a problem of major proportions. Unfortunately it has been found to be the fifth most frequent specific cause of impaired vision in the US; the 7th most frequent cause of legal blindness and the 8th most frequent cause of severe visual impairment.

It seems somehow ironic that a condition, considered by many authorities to be one of the leading causes of visual impairment in this country, is described by some others not even to be a disease. Yet myopia meets the definition of a disease in Webster's International Dictionary, namely: “an impairment of the normal state of the living animal or plant body or any of its components that interrupts or modifies the performance of the vital ...”. Would anyone argue that vision is not one of the vital functions? Not to put too fine a point on it but I would submit that vision has survival value and any impairment of it reduces ones chance for survival.

A disease has also been described as “a cause of discomfort or harm”. Surely that description fits myopia — ask the person who has it. Or how about: “lack of ease — distress”? Can anyone state that inability to see is not a cause for distress? But please spare us the notion that the blind “do very well indeed — sightless”. Ask the blind which they would prefer — the darkness or the light?

Why belabor the point anyway since the condition can be “improved”? For the reason that for years ametropia, in particular myopia, has been a “poor relation” when it comes to its place on the list of conditions that hamper the human condition and which need effective treatment and/or eradication. The standard “treatment” has been visual aids of whatever stripe and “Thank you very much — next!”. Would we, I wonder, have the same blase’ attitude about crutches? The answer is that we would not and we do not. We see crutches as they really are — a temporary expedient, a means to an end — not a permanent solution. Since visual “aids” are nothing more than crutches why then do we feel and act so differently about ametropia?

Figure 1. Messing with nature was once considered a sin.

The reason may well have its roots in the psychology of man. It could, perhaps, be exemplified in the inscription on a 13th century tombstone:

“Here lies Salvino de'Armato of the Armati of Florence,
inventor of the spectacles.
May God pardon him for his sins.”

There is a whole mystique built up around the eyes and paranormal phenomenon attributed to them. For example — iridology is an attempt to codify this mystery by ascribing to a part of the eye — the iris — some ability to mirror disease in other parts of the body — “The eyes are the window of the soul”, and so on. Literature is replete with odes, sonnets, and passages about the eye, and what practitioner has not heard “I can take shots and other stuff but don't touch my eyes!” or “I hate putting drops or anything in my eyes!”

It is this pervasive feeling of “preciousness” and “sacro- sanctity” coupled with the conflicting emotions of fear of going blind and the desire to see better that paradoxically acts against accepting ametropia as a disease and dealing with it accordingly. Incredibly, and despite compelling evidence, myopia remains to this day not only one of the major causes of visual disability and blindness about which little is known, but also a subject that is considered to be almost “beneath” a serious scientist's efforts. That attitude is not realistic nor is it practical. Neither is it sensible, belying as it does the very essence of medical science and practice. It is a spectre of the Dark Ages and the notion that disease is God's punishment of the ungodly; furthermore it champions the status quo. As a result, myopia continues to be a problem of major proportions.

The Non-Surgical Treatment of Myopia

Basically, since myopia is an inherited trait, you either are born with the tendency to get this, or you are not. The progression of myopia is not affected by how much you use your eyes, nor is its progression affected by whether you wear glasses all the time or not at all.[1]

Recent studies have suggested that you can slow the progression of myopia in children by a combination of dilating drops and bifocals. However, this inconvenient program is not effective against larger amounts of myopia and there is serious doubt about its effectiveness in general.

The optical correction of myopia consists of either spectacle lenses or contact lenses which cause parallel light rays to again focus upon the retina rather than in front of the retina. Spectacle lenses are a relatively safe form of optical correction and are still the most common device in use. However, some patients object to wearing glasses in social situations or in athletic pursuits. Others seem to dislike wearing them in any situation. Still others have to forgo certain law enforcement, military and other careers because of their dependency upon glasses or contacts. There is no doubt that many eyes have been permanently damaged by shattered spectacles — hence the laws mandating that all such lenses be made from shatter-resistant glass or plastic.

Contact lenses offer some patients certain optical advantages over glasses. They are, however, not tolerated well by many patients and can cause corneal abrasions and infections when not used properly.

Orthokeratology: In orthokeratology, one uses hard contact lenses to progressively flatten the cornea and thus reduce its “focusing power.” Orthokeratology cannot effectively reduce large amounts of myopia. Another major drawback to orthokeratology is that it is not permanent and, therefore, if the patient does not wear a “retainer” contact lens at least part time, the corneal curvature will return to its former state.

1.   In fairness — the jury is still out on this. Some studies hint that environmental factors may play a role, but there were problems with the studies that make the data suspect; still ...