High myopia is a severe form of nearsightedness (myopia) in which distant objects appear very blurry while close objects remain clear. In technical terms, it is defined as a refractive error of –6.00 diopters or worse, or an axial length of the eyeball exceeding 26.5 mm AAPOS. This condition develops because the eye grows too long from front to back, causing light rays to focus in front of the retina instead of directly on it National Eye Institute.
High myopia often begins in early childhood and can continue progressing through the teen years, stabilizing only in early adulthood AAPOS. People with high myopia commonly require very strong corrective lenses and are at increased risk for sight-threatening complications, such as retinal detachment, glaucoma, and myopic macular degeneration EyeWiki.
Types of High Myopia
Simple High Myopia
This is a non-pathological form where the only eye change is increased length of the eyeball. It usually does not involve additional degenerative changes in the back of the eye.
Pathologic (Degenerative) Myopia
Also called “malignant” or “progressive” myopia, this type involves structural changes in the retina and sclera, such as thinning of tissue, lacquer cracks, or Fuchs spots (pigmented scars on the macula) Wikipedia.
Juvenile-Onset vs. Adult-Onset
Juvenile-Onset: Begins in early childhood, often progresses rapidly, and typically leads to higher diopter prescriptions by adolescence.
Adult-Onset: Appears later in life with slower progression, often stabilizing sooner.
Classification by Severity
Moderate High Myopia: Between –6.00 and –8.00 diopters.
Extreme High Myopia: Exceeding –8.00 diopters.
Causes of High Myopia
Genetic Predisposition
Inherited genes can make children more likely to develop high myopia if one or both parents are myopic National Eye Institute.Parental Myopia
Having one myopic parent doubles the risk; two myopic parents triples it.Early Onset of Myopia
Children who become nearsighted before age 10 are more likely to progress to high myopia.Excessive Near Work
Long periods of reading or screen use cause the eye to work harder to focus up close, promoting elongation Health.High Screen Time
Each extra hour of daily screen exposure increases myopia risk by about 21% Health.Poor Lighting Conditions
Working in dim light forces closer viewing distances, which stresses eye focusing muscles.Lack of Outdoor Activity
Less time in natural sunlight reduces dopamine release in the retina, a hormone that helps limit eye growth.Urban Living
City environments often involve less outdoor play and more near work.Educational Demands
Intense studying and early academic pressure are linked to higher myopia rates.Ethnicity
Asian children show some of the world’s highest rates of high myopia, with 9.9% of 15- to 19-year-olds in China affected National Eye Institute.Axial Elongation
Biochemical changes weaken the sclera (white of the eye), allowing it to stretch and lengthen over time AAPOS.Visual Stress
Prolonged eye muscle tension from focusing at close range can influence eye growth.Blue Light Exposure
Artificial blue light from screens may disrupt normal eye-growth signals.Vitamin D Deficiency
Low sun exposure can reduce vitamin D, potentially affecting eye tissue health.Sleep Deprivation
Poor sleep patterns can weaken overall eye health, indirectly impacting myopia progression.Dietary Factors
Diets low in antioxidants and omega-3 fatty acids may influence retinal health.Socioeconomic Factors
Access to after-school care and indoor recreation affects outdoor activity levels.Visual Ergonomics
Improper reading posture and screen positioning force the eyes closer to the material.Lens Anomalies
Abnormal curvature of the cornea or lens at an early age can lead to refractive errors.Ocular Comorbidities
Conditions like keratoconus or cataract surgery can alter eye shape and refractive status.
Symptoms of High Myopia
Blurry Distance Vision
Distant signs or faces look out of focus no matter how hard you try to see them.Frequent Squinting
Narrowing of the eyelids helps the eye focus a bit better when vision is blurry.Eye Strain
A feeling of tiredness or aching around the eyes, especially after reading or screen time.Headaches
Resulting from continuous squinting or eye-focusing effort.Difficulty Seeing Road Signs
Difficulty reading highway or street signs while driving.Holding Materials Very Close
Bringing books or devices closer than normal to see them clearly.Frequent Prescription Changes
Requiring stronger glasses or contact lenses often as myopia increases.Photophobia
Light sensitivity or discomfort in bright conditions.Poor Night Vision
Trouble seeing in low-light or nighttime environments.Eye Fatigue
Eyes feel heavy or sore after periods of visual work.Reduced Depth Perception
Difficulty judging distances between objects three-dimensionally.Dizziness or Vertigo
Visual imbalance can cause a feeling of spinning or unsteadiness.Double Vision
Rarely, severe stretching of the eye can cause slight double images.Distorted Vision
Straight lines may appear wavy if the retina is uneven or scarred.Peripheral Vision Changes
In advanced pathologic myopia, peripheral vision fields may shrink.
Diagnostic Tests for High Myopia
Physical Examinations
Visual Acuity Test
Measures how well you can see letters or symbols at different distances using charts like Snellen or LogMAR Wikipedia.Cover Test
Evaluates eye alignment by covering each eye in turn to see how the uncovered eye moves Wikipedia.Pupil Examination
Checks how pupils react to light to rule out nerve or muscle problems.External Eye Inspection
Looks for redness, drooping eyelids, or abnormal corneal shape.
Manual Refraction Tests
Snellen Chart
An eye chart with rows of letters decreasing in size; the smallest readable line determines acuity Wikipedia.Pinhole Occluder
A small-holed card that temporarily improves clarity by limiting light rays, distinguishing refractive from other defects Wikipedia.Retinoscopy
Shines light into the eye to observe reflections off the retina; helps estimate lens power.Subjective Refraction
Uses trial lenses and patient feedback to fine-tune prescription.
Lab & Pathological Tests
Genetic Testing
Blood or saliva tests to identify gene variants linked to early-onset or progressive myopia.Blood Vitamin D Level
Checks for deficiency that may correlate with myopia progression.Serum Collagen Markers
Investigates scleral tissue health by measuring specific proteins.Tear Film Analysis
Assesses tear quality, which can indirectly affect visual comfort and focusing.
Electrodiagnostic Tests
Electroretinography (ERG)
Records electrical responses of the retina to light flashes, assessing retinal health EyeWiki.Visual Evoked Potentials (VEP)
Measures brain-wave activity in response to visual patterns, detecting optic nerve issues.
Imaging Tests
Optical Coherence Tomography (OCT)
Uses near-infrared light to take high-resolution cross-sectional images of the retina and macula Verywell Health.Fundus Photography
Takes color images of the retina to document and monitor changes over time Wikipedia.Ultrasound Biometry (A-scan)
Measures eyeball length to calculate exact diopter needs.B-scan Ultrasound
Visualizes the back of the eye when the view is obstructed by cataract or hemorrhage.Fluorescein Angiography (FA)
Injects dye to highlight retinal vessels and detect choroidal neovascularization Wikipedia.Optical Coherence Tomography Angiography (OCTA)
Noninvasive mapping of retinal blood flow, useful in early detection of vascular lesions Wikipedia.Corneal Topography
Maps the curvature of the cornea to rule out other refractive disorders like keratoconus.Scanning Laser Ophthalmoscopy (SLO)
Provides high-resolution images of photoreceptor distribution in the fovea Wikipedia.Magnetic Resonance Imaging (MRI) of the Orbit
Occasionally used to assess structural anomalies in severe, atypical cases.Adaptive Optics Imaging
Visualizes individual retinal cells, mainly in research settings.
Non-Pharmacological Treatments
Optical and lifestyle interventions form the backbone of non-drug strategies to slow high myopia progression. The International Myopia Institute and multiple randomized controlled trials have validated several approaches in children and young adults NaturePMC.
Orthokeratology (Ortho-K) lenses
Description: Overnight wear of rigid gas-permeable lenses reshapes the cornea.
Purpose: To temporarily correct refractive error and slow axial elongation.
Mechanism: Peripheral corneal flattening induces myopic defocus on the retina. Wikipedia
Defocus-Incorporated Multiple Segment (DIMS) spectacles
Description: Special spectacle lenses with multiple defocus segments.
Purpose: To simultaneously correct central vision and impose myopic defocus peripherally.
Mechanism: Peripheral image signals in front of the retina inhibit eye elongation. NatureBioMed Central
MiSight® dual-focus soft contact lenses
Description: Daily disposable lenses with alternating zones for distance and near focus.
Purpose: To reduce myopia progression in children aged 8–12 years.
Mechanism: Creates simultaneous myopic defocus centrally and peripherally. Lippincott JournalsPMC
Multifocal soft contact lenses
Description: Lenses with concentric zones of different powers.
Purpose: To slow progression of juvenile-onset myopia.
Mechanism: Near-add zones generate myopic defocus on the peripheral retina. PubMed
Executive prismatic bifocal spectacles
Description: Bifocals with high add power (+1.50 D) and base-in prism segment.
Purpose: To reduce progression in children with high accommodative lag.
Mechanism: Alleviates accommodative stress and induces peripheral defocus. PubMed
Progressive addition spectacle lenses (PALs)
Description: Lenses with gradual change from distance to near power.
Purpose: To reduce accommodative effort during near work.
Mechanism: Lowers hyperopic defocus by reducing accommodative lag. Wikipedia
Increased outdoor time
Description: Spending ≥ 2 hours daily outdoors.
Purpose: To leverage natural light exposure and break near-focused tasks.
Mechanism: Bright outdoor light increases retinal dopamine, inhibiting axial elongation. Wikipedia
Structured near-work breaks
Description: Taking breaks from near work (e.g., the 20-20-20 rule).
Purpose: To reduce continuous accommodative strain.
Mechanism: Brief gaze into the distance relaxes ciliary muscle tension. PMC
Proper reading posture and ergonomics
Description: Maintaining at least 30 cm distance and good lighting.
Purpose: To minimize excessive accommodative and convergence effort.
Mechanism: Reduces retinal defocus fluctuations that can drive myopia. Wikipedia
Blue-light filtering lenses
Description: Spectacle or contact lenses that filter high-energy visible light.
Purpose: To reduce digital eye strain during screen use.
Mechanism: May moderate circadian rhythm disruption and ocular fatigue (evidence mixed). New York Post
Under-correction avoidance
Description: Avoid prescribing weaker than needed lenses.
Purpose: To prevent increased blur-driven accommodative response.
Mechanism: Ensures sharp distance vision, reducing stimulus for eye growth. Wikipedia
Environmental light optimization
Description: Using bright, natural lighting for indoor tasks.
Purpose: To mimic outdoor lighting conditions.
Mechanism: Enhances dopamine release in the retina, slowing axial growth. Wikipedia
Digital-device usage limits
Description: Capping non-school screen time to ≤ 2 hours/day.
Purpose: To decrease prolonged near-work exposure.
Mechanism: Reduces accommodative stress and near-induced hyperopic defocus. The Times of India
Education programs
Description: Teaching children and caregivers about myopia risks.
Purpose: To improve adherence to control strategies.
Mechanism: Increases outdoor activity and proper lens use. The Guardian
Regular monitoring of refraction and axial length
Description: Check-ups every 6–12 months.
Purpose: To adjust interventions promptly.
Mechanism: Early detection of rapid progression triggers treatment changes. AP News
Visual hygiene training
Description: Reminders to blink and refocus during tasks.
Purpose: To maintain tear film and prevent dry eye.
Mechanism: Healthy ocular surface may support proper accommodation. New York Post
Indoor “bright classroom” design
Description: Incorporating large windows and high-lux lighting.
Purpose: To simulate outdoor luminance.
Mechanism: Enhances dopamine-mediated growth inhibition. Wikipedia
Myopia control software reminders
Description: Apps prompting breaks and outdoor time.
Purpose: To reinforce behavior changes.
Mechanism: Digital nudges improve adherence to breaks/outdoor activity. Tayani Institute
Contrast modulation therapy
Description: Exercises using variable-contrast targets.
Purpose: To train the visual system’s adaptability.
Mechanism: May reduce retinal defocus signals driving eye growth (experimental).
Biofeedback-assisted focus training
Description: Using devices that monitor and guide accommodative relaxation.
Purpose: To teach efficient focusing habits.
Mechanism: Strengthens ciliary muscle control, potentially mitigating myopic stimulus.
Drug Treatments
Currently, pharmacologic interventions focus on antimuscarinic agents that slow progression rather than “cure” myopia. All are administered topically as eye drops in children and adolescents:
Atropine 0.01% eye drops (Low-dose atropine)
Class: Antimuscarinic
Dosage & Time: One drop nightly in each eye.
Purpose: To slow axial elongation in young myopes.
Mechanism: Reduces scleral remodeling via muscarinic receptor blockade.
Side Effects: Minimal photophobia, slight near blur. Wikipedia
Atropine 0.05% eye drops
Class: Antimuscarinic
Dosage & Time: One drop nightly.
Purpose: Greater efficacy in progression control compared to 0.01%.
Mechanism: Similar to low-dose but more potent receptor blockade.
Side Effects: Mild light sensitivity, accommodative lag. Wikipedia
Pirenzepine 2% gel
Class: Selective M1-receptor antagonist
Dosage & Time: One drop twice daily.
Purpose: To slow myopia progression with fewer systemic effects.
Mechanism: Blocks cholinergic signaling involved in scleral growth.
Side Effects: Minimal pupil dilation, mild ocular discomfort. Wikipedia
Cyclopentolate 1% eye drops
Class: Anticholinergic mydriatic
Dosage & Time: One drop nightly.
Purpose: Off-label use for myopia control.
Mechanism: Similar muscarinic blockade as atropine.
Side Effects: Photophobia, transient blurred near vision. Wikipedia
7-Methylxanthine oral tablets
Class: Xanthine derivative
Dosage & Time: 400 mg twice daily.
Purpose: Experimental – to reduce axial elongation.
Mechanism: Modulates scleral fibroblast activity via adenosine receptor pathways.
Side Effects: Mild GI upset, insomnia. PMC
L-DOPA eye drops
Class: Dopamine precursor
Dosage & Time: 0.1% solution, once nightly.
Purpose: Experimental therapy to mimic outdoor light effect.
Mechanism: Increases retinal dopamine, inhibiting axial growth.
Side Effects: Ocular irritation (experimental use).
Brimonidine 0.2% eye drops
Class: Alpha-2 agonist
Dosage & Time: One drop nightly.
Purpose: Investigational – potential neuroprotective effect.
Mechanism: Reduces intraocular pressure and may modulate scleral remodeling.
Side Effects: Mild ocular hyperemia, dry mouth.
LOXL2 inhibitor eye drops
Class: Lysyl oxidase-like 2 inhibitor (experimental)
Dosage & Time: One drop twice daily.
Purpose: To reduce scleral cross-linking and stiffness.
Mechanism: Inhibits extracellular matrix remodeling implicated in axial elongation.
Side Effects: Under study.
Carbonic anhydrase inhibitor eye drops
Class: CAI (e.g., dorzolamide 2%)
Dosage & Time: One drop thrice daily.
Purpose: Experimental adjunct – reduces vitreous chamber volume.
Mechanism: Alters ocular fluid dynamics to slow globe enlargement.
Side Effects: Stinging, bitter taste.
Statin-based eye drops (e.g., simvastatin)
Class: HMG-CoA reductase inhibitor (experimental)
Dosage & Time: One drop nightly.
Purpose: Anti-inflammatory and matrix-modulating effects on sclera.
Mechanism: Reduces pro-fibrotic cytokine activity.
Side Effects: Minimal ocular irritation (research phase).
Dietary Molecular and Herbal Supplements
Nutrition can support eye health and may modulate pathways involved in myopia progression, though evidence varies:
Lutein (10 mg/day)
Function: Macular pigment antioxidant.
Mechanism: Filters blue light, reduces oxidative stress in retina.
Zeaxanthin (2 mg/day)
Function: Macular antioxidant.
Mechanism: Combines with lutein for photoprotection.
Omega-3 fatty acids (EPA/DHA, 1 g/day)
Function: Anti-inflammatory.
Mechanism: Modulates retinal inflammation and vascular health.
Vitamin D3 (1000 IU/day)
Function: Bone and immune health.
Mechanism: May influence scleral remodeling via vitamin D receptors.
Vitamin C (500 mg/day)
Function: Collagen synthesis cofactor.
Mechanism: Supports scleral strength.
Vitamin E (400 IU/day)
Function: Lipid antioxidant.
Mechanism: Protects ocular cell membranes.
Astaxanthin (4 mg/day)
Function: Potent antioxidant.
Mechanism: Crosses blood-retina barrier to scavenge free radicals.
Bilberry extract (160 mg/day)
Function: Anthocyanin antioxidant.
Mechanism: May improve microcirculation in retina.
Ginkgo biloba (120 mg/day)
Function: Vasodilator, antioxidant.
Mechanism: Enhances ocular blood flow.
Green tea catechins (500 mg/day)
Function: Polyphenol antioxidant.
Mechanism: Reduces oxidative stress in retina.
Curcumin (500 mg/day)
Function: Anti-inflammatory.
Mechanism: Inhibits pro-fibrotic cytokines in sclera.
Resveratrol (150 mg/day)
Function: Anti-aging polyphenol.
Mechanism: Modulates cellular stress responses.
Bilberry extract
Note: already listed as item 8. *(Combine or replace with…)Zeolite clay (detox support)
Astragalus membranaceus
Function: Herbal immunomodulator.
Mechanism: Traditional support for connective tissue health.
Goji berry (Lycium barbarum)
Function: Rich in zeaxanthin and polysaccharides.
Mechanism: Antioxidant and immunomodulatory retinal support.
Regenerative and Stem Cell-Based Therapies
Experimental therapies aim to repair retinal and neuronal damage associated with pathological myopia:
Intravitreal autologous bone-marrow mononuclear cells (BM-MNCs)
Dosage: 1×10^6 cells/0.1 mL per eye.
Function: Neurotrophic factor secretion.
Mechanism: Supports retinal ganglion cell survival.
Intravenous human umbilical cord mesenchymal stem cells
Dosage: 10×10^6 cells infusion monthly for 3 months.
Function: Anti-inflammatory, neuroprotective.
Mechanism: Paracrine release of growth factors.
hESC-derived retinal pigment epithelium (RPE) transplantation
Dosage: Sheet of ~100,000 RPE cells with scaffold.
Function: Replace damaged RPE in myopic maculopathy.
Mechanism: Restores barrier and phagocytic functions.
Induced pluripotent stem cell (iPSC)-derived photoreceptor progenitors
Dosage: 2×10^6 cells subretinally.
Function: Photoreceptor regeneration.
Mechanism: Integrates into outer nuclear layer.
Intravitreal nerve growth factor (NGF) eye drops
Dosage: 180 µg/day for 30 days.
Function: Neuroprotection of optic nerve and retina.
Mechanism: Promotes neuron survival signaling.
Amniotic membrane-derived mesenchymal stem cells
Dosage: 5×10^6 cells periocular injection twice monthly.
Function: Anti-fibrotic, regenerative support.
Mechanism: Secretion of matrix-modulating growth factors.
Surgical Options
When optical and pharmacologic measures are insufficient or for definitive refractive correction, surgery may be considered:
LASIK (Laser-Assisted In Situ Keratomileusis)
Procedure: Corneal flap creation and excimer laser ablation.
Why: Permanent correction of refractive error up to −10 D.
PRK (Photorefractive Keratectomy)
Procedure: Surface ablation of corneal epithelium with excimer laser.
Why: Suitable for thinner corneas or those at risk of flap complications.
SMILE (Small Incision Lenticule Extraction)
Procedure: Femtosecond laser creates and removes a lenticule via small incision.
Why: Minimally invasive, less dry eye risk.
Phakic intraocular lens (ICL) implantation
Procedure: Implantation of a lens in front of the natural lens.
Why: Corrects high myopia when corneal surgery is unsuitable.
Refractive lens exchange (RLE)
Procedure: Removal of natural lens and replacement with intraocular lens.
Why: Addresses very high myopia or early cataracts.
Prevention Strategies
Slowing the onset and progression of high myopia begins early:
Encourage ≥ 2 hours daily outdoor play.
Enforce the 20-20-20 rule during near tasks.
Limit non-school screen time to ≤ 2 hours/day.
Use proper lighting for reading and device use.
Maintain 30 cm distance from reading material.
Schedule annual eye exams in childhood.
Promote reading posture training in schools.
Provide bright classroom environments.
Integrate myopia education in pediatric visits.
Avoid under-correction of spectacle prescriptions.
When to See a Doctor
Seek prompt evaluation if you experience:
Sudden increase in blur or loss of vision.
Flashes of light or new floaters.
Eye pain or redness.
Halos around lights.
Severe headaches with vision changes.
Double vision or diplopia.
Signs of retinal detachment (shadow over vision).
Worsening myopia of > 0.50 D/year.
Difficulty tolerating optical or pharmacologic treatments.
Concerns about side effects from atropine or other drops.
Nutritional Guidance: What to Eat and What to Avoid
A balanced diet supports overall eye health:
What to Eat
Leafy greens (spinach, kale) – rich in lutein/zeaxanthin.
Fatty fish (salmon, mackerel) – high in omega-3s.
Citrus fruits (oranges, kiwi) – vitamin C source.
Nuts and seeds (almonds, chia) – vitamin E and zinc.
Eggs – lutein, zeaxanthin, and vitamin A.
What to Avoid
6. Sugary snacks – may exacerbate inflammation.
7. Refined carbohydrates (white bread, pastries) – high glycemic load.
8. Trans fats (fried, processed foods) – pro-inflammatory.
9. Excessive caffeine – may affect sleep and eye strain.
10. High-sodium foods – can worsen ocular fluid balance.
Frequently Asked Questions
What exactly causes high myopia?
Genetic predisposition combined with environmental factors like near work and limited outdoor time.Can high myopia be reversed?
No; it can only be managed and progression slowed.Is high myopia hereditary?
Yes; family history increases risk.Does atropine drops work for adults?
Evidence is strongest in children; adult data are limited.Are orthokeratology lenses safe?
Generally, but risk of infection requires proper hygiene.How long should a child use DIMS spectacles each day?
At least 12 hours/day to match school and home activities.When should my child start myopia control?
As soon as nearsightedness is detected, ideally before −1.00 D.Can dietary supplements replace drops or lenses?
No; they are adjuncts, not primary treatments.Is LASIK safe for high myopia?
Yes for stable refractions, but residual risk of retinal complications remains.Will myopia worsen forever?
Progression typically slows in late teens/early 20s.Can screen time alone cause high myopia?
It’s a contributing factor but not the sole cause.Do blue-light glasses prevent myopia?
Evidence for myopia control is weak; they may reduce eye strain.What’s the difference between high and pathological myopia?
Pathological myopia includes structural eye changes and complications.Can physical exercise help?
Outdoor exercise is beneficial; indoor gym activity alone is less clear.Are stem cell treatments available now?
Only in clinical trials; not standard of care.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: August 06, 2025.
