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by gdebel 1496 days ago
Ophthalmologist here. The myopia epidemic is real thing. The advice given in this post is not a dangerous thing to try. However, I doubt that the theory is true, and I doubt that following this method will really help myopic patients. Let's try to justify this point :

"The long-term use of over-correcting glasses induces myopia" This is quite true. But it induces a myopia which is reversible. Overcorrection (which we try to avoid) leads to ciliary spasm. When the patient gets older, the lens gets less flexible (for everyone, this is what leads to presbyopia) and the myopia, if it was overcorrected, diminishes. It is common to reduce the correction for patients around 40.

We have a good, natural model in nature for over-corrected myopic eyes: hyperopic patients. They don't become myopic with time. Around 40-45 years, their hyperopia becomes clinically significant (they didn't need glasses before and they progressively need to have their hyperopia corrected at 45, or a little bit later if the hyperopia is slight).

"Repair is fast at first as you clear the ciliary spasm, and then slows down as you work on shortening the eyeball itself." No. Clearing the ciliary spasm (which is not present in every myopic patient, only the overcorrected ones) will indeed reduce the amount of myopia (the eye will return to its normal state: less myopia). However, we happen to have a very precise way to mesure the axial length of the eyeball (interferometry). While we commonly observe a lengthening of the eyeball in high, pathological myopia, I've never heard of an eyeball which shortened, nor read any paper which related this phenomenon. We don't know why the eyeball elongates in high myopia. But, as far as I know, eyeball never shorten.

"If you are considering laser eye surgery, please skim Lasik Complications." Yes, please do. You must be informed and your surgeon must inform you. However, you could also look at the number of refractive surgeons who underwent themselves this surgery, or operated their family. It is a common thing to operate our residents at the end of their internship because they saw the outcomes and want the procedure. Please note that any serious refractive surgeon will perform a refraction after cycloplegia, to remove any ciliary spasm and correct only the "real" myopia.

https://theophthalmologist.com/business-profession/do-ophtha...

12 comments

My understanding was dopamine has the effect of stopping the eyeball from growing longer, which is released during exercise in the presence of bright sunlight. Hence a sedentary and indoor setting make you more prone to Myopia.

I don't have time to find a reference, but I have read research which shows that our eyes tend to grow longer when we are having any sort of trouble focusing, which is often the case with a weakened prescription or in dim light. As a result I stopped ordering slightly weaker glasses for myself and moved my office to a brighter room in the house.

Despite all that, my Myopia seems to be getting worse, wearing the appropriate glasses that ensure sharp focus for distance vision and ones that are less straining with a negative SPH value for computer work (hobby/weak reading glasses etc). I also have some astigmatism which my glasses are completely correcting now.

I would love for medical science to discover the means to reverse myopia, it seems like a solvable problem involving signalling/conditions which causes the eye morphology to change.

> dopamine has the effect of stopping the eyeball from growing longer, w Bilberry has been proven for this. If dopamine prevented myopia ADHD people on Adderall would not develop myopia. I'm aware that medical prescription correlates with symptoms are not public nor analysed but still that's a big if
Not sure if dopamine build-up in the striatum (or whatever the specific effect of dopaminergic amphetamines is) would be of any relevance. Could be a separate area of the brain, e.g. only specific to the visual system. Dopamine agonists reviewed in this journal article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653403/
I have had myopia since age 18 and it constantly worsened. I got diagnosed with glaucoma in my 30s as a result of high IOP, but only because I started to have bad vision because my right optic nerve is already damaged. I started taking medication to reduce IOP then (a few years ago) and since then my myopia stopped worsening.

I have this image of my eyeball in my head, being basically a skin sack full of water enclosed in the skull in all dimensions but one. My theory is my eyeballs lengthened because of the high IOP. My ophthalmologist says this is impossible. Unfortunately I am not scientifically literate enough to check that and I am not sure who to talk to.

What I am trying to say is, if your myopia is constantly worsening get your IOP tested - just in case.

Bilberry prevents myopia progression. Also, how do you diagnose IOP?https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296196/
There are devices to measure IOP, most used but kind of inaccurate with a small „air burst“ on your eye. There seem to be more accurate measurement methods but they involve „touching“ the eye.
Can an amateur buy them online?
No definitely not. Your doctor has it. See https://en.wikipedia.org/wiki/Intraocular_pressure
> Berberine prevents myopia progression

Any sources about that?

I edited ly comment, it's not Berberine it's Bilberry https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296196/
Thank you for the very interesting breakdown.

Regarding LASIK, I got my surgery in 2009, at 21 years of age. At the time I only did enough research to know to find a reputable surgeon in my area, and no more. Nowadays I would probably Google for more side effects and dangers. I'd likely hesitate at the risk of getting it so early and wonder if it'll be a waste as my eyes change, but at the time I just trusted what the doctor told me.

I still consider it to be one of the best things I've ever spent money on. I think the surgeon mentioned he over-corrected somehow, accounting for eyesight changes over the years. There's been some degradation. If I close one eye I can see that my right one is slightly less sharp and slower to focus than the left. But overall my eyesight is still excellent over ten years later, with none of the scary persistent complications I'd read about since the surgery.

Nowadays, I hear of newer methods of laser eye surgery that involve putting in lenses that you can replace with new ones when needed as opposed to resurfacing the eye itself. It makes me think about how much advancement there must be in the techniques since I'd gotten it done. If I'm still happy with my decade-old result, I imagine people getting it done today might find their procedures to be even better.

What I like about this theory is we can test whether or not it’s true for ourselves by simply wearing slightly weaker glasses and seeing if our vision improves. The cost is relatively low and it would be fun to do.

Interestingly enough, it does seem like eyeballs can shorten in many species, including chicks, shrews, and some primates. It only took a few seconds to Google.[1]

I’d be curious whether humans share a similar mechanism. I would be surprised if they didn’t, considering how this mechanism is common amongst such a diverse range of species.

Cheers.

[1] https://iovs.arvojournals.org/article.aspx?articleid=2189093

> hyperopic patients. They don't become myopic with time

As a farsighted person who didn't get glasses until I was 30... I only wish it was as easy as sitting and waiting a few years.

Most of the advice in tech circles is about myopia, so whenever I see something like this I like to imagine the opposite advice to see if it would cure me in the opposite direction. Should I stare at something less than 20cm away for 20 seconds every 20 minutes? I don't think either near or far-sighted people are going to heal themselves with internet advice

Yes, hyperopia is a very ungrateful condition... The usual situation is patients which had a perfect vision all their life, and, around 40, lose their near vision, and their far vision a few years later. This is always a little bit depressing. My only advice for hyperopia would be (I'm sorry for that) to not wait too long to wear a correction for near vision. Sadly you won't heal hyperopia by training your eyes to look closer, but you will certainly be very tired at the end of the day if you need convex glasses and don't have them.
You're completely right. Although I could see just fine, my eyes were extremely fatigued after every workday and I just never realized it. Glasses changed my life. In fact I'm about to go in again for a second stronger pair of reading glasses for computer work. I might as well embrace getting old!
> But, as far as I know, eyeball never shorten.

There are many anecdotal reports about people seeing shorter eyeballs as measured by an autorefractor while doing the reduced lens method, one example that I recall is this one from cliffgnu[1].

For LASIK the real thing that isn't communicated is that it doesn't address the root of the problem which is that the eyeball gets longer, it only works as if someone carved glasses on your cornea.

[1] : https://www.youtube.com/watch?v=efsgkBHaTlI

The problem is that you can't measure axial length with an autorefractometer. You need a biometer. The autoref will tell you the objective refraction of the patient (which is quite imprecise).

The eyeball gets longer with time in high (pathological) myopia. Serious surgeons will check that the myopia is stable (1-2 years) before doing a surgery. The eye doesn't, usually, gets longer in patients with moderated myopia. All the work, in refractive surgery, is in good patients selection. It is very unusual to observe a significant myopic regression in patients with a stabilized myopia after 21 years. Of course the eye is an organ, there is no absolute rule in the human body. However, patients which were correctly selected for surgery don't, usually, see their myopia coming back with time.

Even for pathological patients, the solution is to reset their eye with e.g LASIK and to prevent growth via bilberry. It's non-prescription is one instance of the universal established deep mediocrity https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296196/
Does it help to eat bilberries rather than the extract?
I don't know but you have to understand that in general, extracts achieve effective concentrations that are impossible to achieve naturally. Moreover, a pill is easy to take consistently in the morning, while eating a bunch of billberries every morning is a chore. Consistency is key for the goal. I guess eating bilberries is better than nothing, you'd have to study the extract to infer how many bilberries per pill it represent.
Can't find it right now, but there was a retweet by longevity scientist David Sinclair about a study in mice that exposure to UV-C could potentially reverse aging (and myopia) of the eyes.

I'll edit if I find the reference.

What I do is regularly go for a walk in the sun for up to half an hour without wearing glasses or contacts. If it doesn't work, I'll be getting a good dose of vitamin D in any case.

As far as I understand it, David Sinclair lost all credibility when he was invited to debate scientists in real life and refuse. The rate at which he spins up companies is also a bit alarming. This is as someone who would love for what he is preaching to turn out to be true.
He was retweeting a study that was not his own. I'll look it up.

edit :

here's the study : https://www.pnas.org/doi/10.1073/pnas.2018840118

here's DS's retweet : https://twitter.com/davidasinclair/status/145775319654643712...

I misrepresented DS's retweet comment and it is not as spectacular as I made it seem. In any case, intresting.

The site alleges that there are a number of positive self-treating anecdotes found on the internet. Is there a medically justified explanation for these? (It's ok if not -- an alternative is that they're cranks or lying, both of which are very plausible). What is the minimum vision improvement from behavioural adjustment that would be medically surprising to you?
They might just have a wrong prescription initially

When they spend more time on getting prescriptions and multiple opinions, they get better prescriptions.

I have severe dry eyes from unfortunately taking accutane in my teens. Will LASIK cause more dryness? I already tried restasis which did not improve the ability of ‘rewetting’ my eyes when the optometrist was testing for this towards the end of treatment.

Worsened dryness as an outcome from LASIK is the only thing holding me back from it. Would love some feedback!

Is it recommended to get two different pairs of glasses for both near sightedness and far sightedness? I have a -3.5D with astigmatism as well. I get the feeling I'd require only less powered glasses for screen time as opposed to using my regular glasses for it. What is your professional opinion about this?
I am not the expert you are replying to, and I have only anecdotal evidence. But for what it is worth, I have been using "computer glasses", which are midway between my reading- and distance vision prescriptions, for more than 10 years. I find that this prescription reduces eyestrain very significantly, and I can easily spend a whole day in front of the screen without fatigue.
> However, we happen to have a very precise way to mesure the axial length of the eyeball (interferometry).

Does this measure the length at the center only? Even if the eye cannot shrink there, it could possibly grow outside of the center or by inreasing its diameter causing a change of the shape.

Do they ever perform lasik under general anesthesia? My eyes react so strongly to overstimulation like bright light or being touched that I couldn't even get the pre-tests done.
No you can't do that, because the patient must look at a target. There is an eye tracker in the laser but you have to look in the right direction. The surgery is much less impressive that you can imagine. Take an advice with a reputable, trained surgeon which will carefully look for any contraindication !
Theoretically, could you fix the eyeballs in place somehow?
Opinion on Lasik vs smile and others?