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PDF File of the Manual Myopia Manual Edition January 2021 Changes since the last update January 2020 are marked in red An impartial documentation of all the reasons, therapies and recommendations Unbiased summary of the literature, some ideas about linkages between the various published results, and recommendations for shortsighted people and people who don't want to become shortsighted at all. Dr. rer. nat. Klaus Schmid, Physicist Copyright Notice © Klaus Schmid 2002, 2003, 2004, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017, 2018, 2019, 2020, 2021. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical or oth‐ erwise, without the written permission of Klaus Schmid. Preface to the 2021 edition of the Myopia Manual Especially worth mentioning appears to be: ‐ That the neurotransmitter Dopamine has a substantial impact on the onset of myopia is already known since some years. Now more details of what has an influence on dopamine and its metabolism are appearing and first results of dopamine eye drops showed some promising results on animals. ‐ The primary systemic agent to prevent myopia, especially pathologic high myopia appears to be vita‐ min D by its positive impact on dopamine and oxidative stress in the eye. ‐ The color of the light to which the eye is exposed gets more attention, especially the color of the light emitted by smart phones and computer screens. ‐ Research being mainly focused on optical effects involving the retina, inflammation appears to play a significant role as well. Therefore means to limit the progression of myopia by limiting inflammation might be helpful. ‐ The negative effect of extensive accommodation on the onset and the progression of myopia is known since a long time. The life‐experience ophthalmologist Viikari is, however, that in many cases an existing juvenile hyperopia is the basis of this extensive and harmful accommodation, which can be avoided by using plus lenses. This is especially important, as the developing eye of children is generally hyperopic. With the research world being set to explain myopia by a retina‐image model, some practi‐ tioners explain myopia more by models based on mechanical forces and resulting degradation of con‐ nective tissue. ‐ Some unspectacular but maybe helpful result is the positive impact of making the children to go to bed early at night and to avoid long time nearwork in the evening and on weakends. ‐ "People with a certain variant of the gene ‐ called APLP2 ‐ were five times more likely to develop myo‐ pia in their teens if they read for an hour or more each day as a child. … those who carried the APLP2 risk variant but spent less time reading had no additional risk of developing myopia."1032 This means simply not myopia is inherited, but the sensitivity with respect to environmental conditions. ‐ Tables might be helpful, where the success of various interventions against the progression of myo‐ pia were evaluated (section 3.27). Disclaimer This book is intended as an informational guide to be used as a supplement, not a substitute for profes‐ sional medical advice. While the information and advice in this book is believed true and accurate, the author cannot accept any legal responsibility. Acknowledgements This book is an effort to put pieces of the myopia puzzle together. These pieces were found in numer‐ ous books and scientific publications, and therefore I am extremely grateful to all these professionals for their work and their sharing of their results. Additionally, quite a number of readers of the Internet version of this book helped with very construc‐ tive, encouraging and competent comments. Finally, thanks to my son Bernhard Schmid who was very helpful by taking care of all the data process‐ ing problems, which had to be solved to complete this book. This book is dedicated to my wife Veronica and my children Nadine and Bernhard, whose shortsightedness caused me to write this book. Hopefully it will be helpful not only for them. v Table of Contents Introduction .............................................................................................................................................. 1 1 What is Myopia? ................................................................................................................................ 4 1.1 How does it Feel being Myopic?.......................................................................................................... 4 1.2 Basic Terminology of the Anatomy of the Eye..................................................................................... 5 1.3 Accommodation .................................................................................................................................. 5 1.3.1 Myopia and Emmetropia ............................................................................................................. 5 1.3.2 Theory of Accommodation .......................................................................................................... 7 1.3.2.1 The Helmholtz Model .......................................................................................................... 7 1.3.2.2 The Schachar Model ............................................................................................................ 7 1.3.2.3 The Two‐Phase‐Model......................................................................................................... 8 1.3.2.4 Two other, Controversial Hypotheses ................................................................................. 8 1.4 Refractive Myopia................................................................................................................................ 9 1.4.1 Tonic Accommodation and Night Myopia ................................................................................. 10 1.4.2 Pseudomyopia ........................................................................................................................... 11 1.4.3 Other Types of Myopia .............................................................................................................. 12 1.5 Axial Myopia ...................................................................................................................................... 13 1.6 "What Type of Myopia Do I Have?"................................................................................................... 13 1.7 Consequences and Risks of Higher Myopia ....................................................................................... 13 1.8 Myopia and Age................................................................................................................................. 18 1.9 Accommodation and Age / Presbyopia ............................................................................................. 18 1.10 Age Related Geometrical Changes of the Eye ................................................................................... 20 1.11 The Refraction ................................................................................................................................... 21 1.11.1 Basic Procedure ......................................................................................................................... 21 1.11.2 A Method for Refraction: Fogging ............................................................................................. 25 1.11.3 The Range of Clarity................................................................................................................... 26 2 What Causes Myopia in General? ..................................................................................................... 27 2.1 Is Myopia Inherited?.......................................................................................................................... 27 2.2 Connective Tissue Disorders.............................................................................................................. 30 2.3 Active Growth by Imaging Effects...................................................................................................... 31 2.4 Mechanical Effects............................................................................................................................. 31 2.5 General Overview of the Causes of Myopia ...................................................................................... 32 3 Myopia – Observations and Experimental Results ............................................................................ 33 3.1 Distribution of Myopia by Region, Age, Gender and Ethnicity.......................................................... 33 3.2 Accommodation and Near Work ....................................................................................................... 37 3.2.1 Experiences and Results ............................................................................................................ 37 3.2.1.1 General Experiences and Results....................................................................................... 37 3.2.1.2 The Effect of Accommodation on Axial Length and Scleral Thinning ................................ 40 3.2.1.3 The Effect of Accommodation on Image Quality............................................................... 42 vi 3.2.1.4 Timing‐ and Hysteresis‐ Effects of Accommodation.......................................................... 43 3.2.1.5 Dark Focus and Accommodative Hysteresis
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