Will glasses make my child’s eyes worse?
There is a lot of unfortunate information out there in internet-land, telling the unsuspecting person, or parent, that glasses will make their vision worse. Even more concerning — websites advocating the ‘throw away your glasses’ message like endmyopia.org paint the picture of a bunch of sneaky, money hungry optometrists who willingly prescribe stronger glasses year after year, knowing that they make a child’s or adult’s vision worse. Well it’s time for me to tell you the full story based on scientific evidence.
The issue with a lot of the information on a consumer website like endmyopia.org is that there are nuggets of truth in it, but the message isn’t balanced. This website is popular and its author, Jake Steiner, is a clever cookie, and I agree with some of the things he says, but take issue with the conspiracy-theory tone — it’s more about what’s the standard versus cutting edge knowledge and clinical practice.
Now I spend my days translating science into practice, from nerd language into normal person language, finding the best solutions and management options for my patients in my practice in the Brisbane, Australia. I have a PhD in myopia and spend much of my time educating my peers across the world, both at conferences and online through our practitioner website. I know the science and also how to explain it accessibly to my peers, my patients and their parents. So let’s get down to it.
This blog is focussed on the issue of childhood myopia, or shortsightedness -where a child can’t see long distance things but can see up close. This is a growing issue as the incidence of myopia is growing around the world at an alarming rate, with half of world’s population predicted to be myopic by 2050.
It’s fairly safe to say that for children with astigmatism (distorted vision), hyperopia (longsightedness), strabismus (turned eyes) or amblyopia (lazy eyes), there’s unlikely to be a situation where glasses make things worse, unless they’re incorrect. And it would rarely be the case for adults that glasses make things worse — more commonly we notice that once we get our first pair of over-45 reading glasses (sigh, it’ll happen to all of us, even optometrists!), we need them more with time anyway. It’s not the glasses that have done it, it’s the number of birthdays!
But the reality and the scientific evidence for children with progressive, or worsening myopia, is that prescribing straight long distance (called single vision distance) spectacle lenses, in most cases, isn’t the best, evidence based choice any longer.
There have been a wealth of research studies investigating better options, including progressive addition (multifocal) and bifocal spectacles; overnight orthokeratology and multifocal contact lenses; and atropine eye drops. In almost all of these studies, single vision distance glasses (or sometimes single vision distance contact lenses) are used as the control group — the group who progresses, or worsens, the fastest. This scientific domain is called ‘myopia control’ — attempting to slow down, or stop, the progression of childhood myopia.
Unfortunately, it can take some time for research to translate into early-adopter and then to widespread, standard clinical practice — a task I dedicate my time to, educating my peers around the world. A 2015 a survey showed optometrists who are concerned about myopia progression are still prescribing single vision glasses or contact lenses to more than half of their young patients with progressing myopia. Why is this? It can often be because of a lack of options available to them — especially contact lens options like overnight orthokeratology or multifocal contact lenses. There are also regulatory barriers — in the USA, for example, despite a wealth of research nothing has been officially approved by the FDA for a ‘myopia control’, so American optometrists aren’t even allowed to say these magic words to you. But you can ask them, and every optometrist has some evidence based options to offer your child if you are concerned about progressive myopia, wherever they are in the world.
So in conclusion, it ain’t a big conspiracy against you, your wallet or your child’s eye health. It’s just a lag between cutting edge research and widespread clinical uptake, examples of which would be easy to find in any profession. But there are very good, lifelong eye health reasons to control myopia — to attempt to slow the progression — and so if your child’s vision is getting worse and you’ve just been offered the same single vision distance glasses again (but stronger this time), ask what else could be done to manage their myopia.
