High myopia is out to prove that it is more than just a strong glasses prescription. Also it brings about structural changes in the eye which is the reason for the need of regular monitoring and proper long term treatment.
Most people think of myopia as a distance vision issue. What they may not know is that very high prescriptions also play a role in increasing risk of retinal problems, glaucoma and early cataracts. That is why high myopia often requires a greater level of care than routine vision correction.
What Is High Myopia?
Myopia is a condition that occurs when the eye is too long or the cornea is too steep causing light to focus in front of the retina instead of on it. High myopia is also a term used for a refractive error of about –6.00 dioptres or greater and also includes an axial length which is often over 26 mm.
In practice what that means is not only is the vision blurred at a distance but also the eye is put under more structural stress over time. This is the reason high myopia also known as severe myopia or pathological myopia when it comes to present complications.
Causes and Risk Factors
High myopia usually develops from a mix of genetics and environment. Children with one or both myopic parents are at greater risk, and early-onset myopia is more likely to progress to severe levels.
Several lifestyle factors may contribute to progression, including:
- Excessive near work and prolonged screen use.
- Limited outdoor time during childhood.
- Urban, indoor-heavy routines.
- East and South Asian ancestry, where prevalence is higher.
Health Risks
The main concern with high myopia is not just blurred vision; it is the complications that can follow. The stretched eye can place stress on the retina, optic nerve, and central macula.
Important risks include:
- Retinal detachment, which can be a surgical emergency.
- Myopic macular degeneration, which can reduce central vision permanently.
- Glaucoma, especially open-angle glaucoma.
- Cataracts, which may develop earlier.
- Vitreous changes that cause floaters and flashes.
- Choroidal neovascularisation in some advanced cases.
Symptoms to Watch
High myopia usually shows up as blurred distance vision, but warning signs can go beyond that. If any of these happen, the eye should be checked promptly.
- Blurred distance vision even with glasses or contacts.
- Sudden increase in floaters or flashes of light.
- A curtain or shadow in part of the visual field.
- Distortion of straight lines.
- Difficulty driving at night.
Diagnosis
A full eye exam is required to determine the level of myopia and the risk of complications. We use cycloplegic refraction, dilated fundus exam, OCT imaging, visual field testing, and axial length measurement which in turn we use to study the retina, macula and optic nerve and to also determine if the patient requires myopia management, refractive surgery or close retinal follow up.
Treatment and Management
Treatment depends on age, stability of the prescription, and whether the eye already shows structural changes. Glasses and contact lenses can correct blur, but they do not change the elongated shape of the eye.
For children and young adults, myopia management may include:
- Low-dose atropine eye drops.
- Orthokeratology overnight lenses.
- Multifocal contact lenses.
- Increased outdoor time, which may help slow progression.
For stable adult myopia, surgical options may include:
- LASIK and LASIK eye surgery for selected cases.
- SMILE, a minimally invasive corneal procedure.
- Implantable Collamer Lens (ICL), often preferred for very high myopia.
- Refractive lens exchange in carefully selected patients.
When To See a Doctor
It is recommended that you get an eye exam if you are seeing that your prescription is going up yearly or if you notice new floaters, flashes, or a shadow in your vision. Also if you have a family history of retinal detachment or glaucoma which in turn may lead to you developing it also do it out for regular check ups.
If you are a candidate for refractive surgery we advise you to have a full suitability assessment which in turn will help determine what option between LASIK, ICL or another is the best for you.
Vasan Eye Care
Vasan Eye Care has a large network of specialists in high myopia which we also see as myopic maculopathy. We also at Vasan provide Myope control programs for children and a full range of surgical options from LASIK to ICL. We find that early intervention which is tailored to the degree of myopia is the best way to protect long term vision.
Key Takeaways
- High myopia is usually defined as −6.00
- −6.00 dioptres or more is linked to physical elongation of the eye.
- It raises the risk of retinal detachment, macular degeneration, glaucoma, and early cataracts.
- Annual dilated retinal examination is important for anyone with high myopia.
- Myopia control therapies in childhood can reduce progression before it becomes severe.
- LASIK, ICL, and refractive lens exchange are options for eligible adults.
- Sudden floaters, flashes, or a visual shadow need same-day assessment.
Frequently Asked Questions
Regular myopia mainly causes blurry distance vision that can be corrected with glasses, while high myopia usually means −6.00 dioptres or worse and involves eye elongation with higher complication risk.
There is no cure that reverses existing elongation, but surgical options such as LASIK, ICL, and refractive lens exchange can reduce dependence on glasses in suitable adults. Myopia control therapies in childhood can slow progression before it becomes severe.
High myopia itself is not always classified as a disability, but severe complications such as macular degeneration can cause significant and lasting vision impairment. Regular follow-up is essential.
Myopia often stabilises in the early to mid twenties, though some highly myopic eyes may continue to change later. Ongoing monitoring remains important even after the prescription settles.
References
- StatPearls: Myopia – https://www.ncbi.nlm.nih.gov/books/NBK580529/
- Cleveland Clinic: Myopia (Nearsightedness) -https://my.clevelandclinic.org/health/diseases/8579-myopia-nearsightedness
- ICR: High myopia, causes, symptoms and treatment – https://icrcat.com/en/eye-conditions/high-myopia/