To ask if not wearing glasses when you need makes you eyes worse

[User40407]

I’ve always told my ds1 who wears glasses that he should always wear to prevent his eyes getting worse. I’ve just read something that says wearing glasses only corrects your sight when you are wearing them and not wearing them has no impact on your eye sight either way. Aibu to ask if this is true?

Many myopia will get this shift in the latter part of their 30s/40s.
Mine were getting a diopter worse on each optician visit. Then they got better on stopping wearing my stronger, more recent prescriptions, in my 20s. Then worse again on wearing a new prescription. Then better again on wearing older weaker prescriptions again.

Many myopia will get this shift in the latter part of their 30s/40s.

I was around 24 when I first got glasses, about 4 + years after I started with all day screen work and long hours - the companies policies were yearly eye tests - so just 30 when they said I didn't need any - and early 40s still don't.

As far as I have read there is correlation between a lot of time spent doing close work and screen time along with less time spent outdoors and myopia too. So I don't know what your optician was talking about.

Me either but couple it's come up with have been adamant lifestyle changes had no impact and previous prescriptions must have been wrong – I’ve remembered as it struck me as as such an odd attitude especially as we've stuck with the same company for eye tests.

I expect I'll need some at some point as most of my family have them by middle age but I'm just glad it's not yet.

bigKite

Me either but couple it's come up with have been adamant lifestyle changes had no impact and previous prescriptions must have been wrong – I’ve remembered as it struck me as as such an odd attitude especially as we've stuck with the same company for eye tests.

I've learnt not to discuss lifestyle changes in relation to improved eyesight with opticians. Once I made the mistake of saying I was experimenting with eye exercises and my last prescription had improved. Well, I got a right lecture from him! Then the highest prescription I have ever had! (Which I never really wore!). So I now cheerfully give out only the information they ask for but no more discussion of attempts to improve my eyesight. Last time I went to the opticians I went to a new place, so they didn't have my history, with glasses I had personally selected as giving me the best visual acuity (not my strongest ever). I have my own Snellen chart. The new prescription was only slightly stronger than the ones I walked in wearing. Except (again) I prefer my old ones in terms of visual acuity. Incidentally they are both significantly weaker than the strongest prescription I've had!

Well my anecdotal evidence this week is about seven days ago I started reading a book that had very small bold writing, to my son every evening. I wasn’t convinced my eyes were up to it abd said to my partner whether I should wear his old reading glasses that he had knocking about in s drawer. He said no, work your eyes and read it. So I’ve been reading it for a eeek, and tonight I noticed i had no issue with reading it at all. So I’m starting to think he might be right, we need to use our eyes and they will adapt (assuming there’s not some serious issue aside from age).

I don't have solid proof per say but do agree with your partner somewhat @sheshootssheimplores.

The majority of the evidence points to undercorrection of myopia causing greater deterioration than full correction, which is why most optometrists fully correct.

I have found this report analyses several recent studies in controlling myopia.

https://iovs.arvojournals.org/article.aspx?articleid=2727315

This, in particular I thought pertinent:

"An early nonrandomized trial of undercorrection, conducted in 1960s,9 found this treatment to slow the progression of myopia. More recently (since 2000), well-designed, randomized controlled trials (RCTs) examining undercorrection for distance (by +0.50 to +0.75 diopters [D]) over 1.5 to 2.0 years found this treatment to either increase myopia progression or have no benefit, when compared with myopia progression in fully corrected SV spectacle wearers (Table 1).10−12 Although all trials involved relatively young children at an age when progression is common, the trials were only small to moderate in size. However, the latter weakness does not explain the consistent trend of faster progression in undercorrected eyes observed in some studies. Nonetheless, although another larger, albeit nonrandomized trial also found no significant difference between comparable treatment groups, curiously, myopia progression significantly decreased with increasing undercorrection.13 The latter trend is also consistent with results from a recent study comparing myopia progression in uncorrected and fully corrected 12-year-old children; this study found slower progression in the former group, the latter effect increasing with the amount of undercorrection.14 The possibility that the lack of sharp distance vision with undercorrection strategies may lead to behavioral changes, such as reduced outdoor activities in some children, thereby favoring myopia progression, warrants investigation, although the contrasting study outcomes suggest additional factors are at play."

And this:

"a relatively recent RCT involving two high-set executive bifocal lens designs (+1.50 D add alone and +1.50 D add with 3Δ base-in prism), both of which significantly reduced myopia progression in children older than 3 years compared with SV spectacles (−1.25 D [bifocals] versus −1.01 D, [prismatic bifocals] versus −2.06 D [SV]), in children with progressing myopia)"

And this:

"The association between increased time spent outdoors and protection against myopia in children and adolescents has been summarized in a recent meta-analysis,162 which linked every additional 1 hour of outdoor time per week with a reduction in the risk of myopia by 2% (odds ratio 0.98; P < 0.001)."

All of which seems to, anecdotally at least, conflict with the advice people posting here have received from their optometrists/opticians.

I got my first glasses at about 14/15, am now 39. At first, I wore them just in class for looking at the whiteboard and for watching TV etc. I'm.short sighted and I think I have a micro squint in one eye. As I've got older, I'd wear them for computer work and noticed I'd get headaches if I didn't. It got to the point where I'd wear them more and more. I was told at one point I should be wearing them all the time, which I didn't immediately adhere too but I do now. I can see without them but wouldn't last 5 minutes at my work computer without them. Funnily enough, my prescription has never altered dramatically, I dont think and at my last eye 2 months ago, there was no change. I do wear mine all the time now though.

I had myopic creep growing up. I worsened 2 diopter per year. It significantly slowed down, almost stopped worsening when they prescribed me hard contact lenses.

crans, yes, I've heard they act like a jelly mould shaping the front of the eyeball! From what I've read, though, the effects are temporary and last only as long as they are regularly worn.

I wore my lenses till in my thirties, now I have glasses and it didn't become worse. Maybe adulthood plays a role too, I don't know.

crans, well it is believed that axial growth occurs mainly in childhood and adolescence. However, this research shows that axial lengthening (and reduction!) can still occur in early adulthood, even after only a short time of an induced positive or minus defocus (like what could be induced with different spectacle strengths).

iovs.arvojournals.org/article.aspx?articleid=2126435

It could be that you have experienced some degree of presbyopia which can make a person more long sighted as it can get more difficult to tense the eye muscles to focus on near distances during accommodation. This is often believed to reduce myopia to a small degree.

There is quite a lot of evidence that hard lenses worn in childhood, either daytime or night time ortho K slows down progression or even stops progression of myopia in children. My daughter was -1.25 at age 11, she still is -1.25, 6 years later, and I'm sure it's because we went down the Ortho-k route. All her peers who have been wearing glasses from the same age for short sightedness have ever stronger lenses after every eye test!

Fantastic, mushroom! It's great that your daughter's myopia has remained stable.

Ortho-K is expensive and requires quite a bit of commitment in terms of eye care, though, versus undercorrection or not wearing a full negative lens correction all the time or a wearing multi focus lens including some addition to use for close work for myopic patients. It would not surprise me if the optical industry were more in favour of recommending Ortho-K over these more inexpensive methods. Although the benefits are, undoubtedly, uninhibited visual acuity all day.

If you were emmetropic - perfect vision in the distance- you would be accommodating at near.If you are myopic wearing your glasses effectively makes you emmetropic at distance and your eyes are then accommodating for near vision in the same way that the eyes of someone with perfect vision would.

And I wonder why optometrists correct to 'greater' visual acuity that 20/20 vision? (On most Snellen charts there are lines below the 20/20 and I know people who can see them at the requisite distance wearing their recent negative lens prescriptions for myopia). 20/20 is what considered normal vision. If someone can see further, surely that would make them hyperopic and they would have to (almost continually) accommodate to focus on the nearer distances. More than someone who is emmetropic would.

However, this research shows that axial lengthening (and reduction!) can still occur in early adulthood,

In my case it would explain it. I wore lenses till I was 36 or 37, so past the early adult stage. Interesting though.

Yes, I thought that research interesting too, cranston. I would love to see similar research conducted involving older test subjects. I think it is quite possible the same biological functions could be at play.

High - that study you linked to isn’t an RCT, there is a hierarchy of evidence base. All the recent RCTs have shown that myopia increased more when undercorrected. The other major flaw with the study that you’ve linked is that the undercorrected patients were significantly more myopic at baseline. Which could point to undercorrection leading to higher levels of myopia or to those individuals having had their period of rapid deterioration already.
If you google RCT in conjunction with undercorrection and myopia you’ll see all the current evidence.

We also don’t correct to a certain acuity level, the point of spectacles is to move the abnormal focus (either behind or in front of the retina) on to the retina at the macula which is what would happen if you were emmetropic. Different individuals achieve different levels of acuity so whilst 20/20 (6/6 or 0.0 Logmar) is normal for one person, another may only achieve 6/7.5 or could get 6/4.

There’s also no evidence that glasses for presbyopia (older-age reading glasses) make vision worse. But vision will be better/worse under certain conditions - depending on the lighting, how tired you are, your pupil size.

Thanks for your response, under. Granted that trial was not randomised, however, the findings are consistent in terms of a model for myopia development and progression with animal studies and also the phenomenon of addition lenses decreasing axial growth and slowing myopia progression. Here:

"a relatively recent RCT involving two high-set executive bifocal lens designs (+1.50 D add alone and +1.50 D add with 3Δ base-in prism), both of which significantly reduced myopia progression in children older than 3 years compared with SV spectacles (−1.25 D [bifocals] versus −1.01 D, [prismatic bifocals] versus −2.06 D [SV]), in children with progressing myopia)"
iovs.arvojournals.org/article.aspx?articleid=2727315

"Significant changes in optical axial length occurred in human subjects after 60 minutes of monocular defocus. The bidirectional optical axial length changes observed in response to defocus implied the human visual system is capable of detecting the presence and sign of defocus and altering optical axial length to move the retina toward the image plane."

iovs.arvojournals.org/article.aspx?articleid=2126435

We also don’t correct to a certain acuity level, the point of spectacles is to move the abnormal focus (either behind or in front of the retina) on to the retina at the macula which is what would happen if you were emmetropic.

So by which tests is it ascertained that the focus has moved onto the retina?

Considering that, whilst the results are repeatable, I have read that autorefractors are said to often over correct in terms person's myopia. To my understanding, it's why subjective eye tests are done.

Because a autorefraction is often carried out without cycloplegia.

Autorefractors do over correct, so we’d usually do a subjective and a ret (retinoscopy - which is a subjective measurement of refractive error). We generally only do a cycloplegic refraction on children and those we suspect are over focusing (pseudomyopes/latent hypermetropes).

Yes, current thinking on myopia control is due to peripheral defocus, so not defocus on the macula, but on the area around it. Its’s quite difficult to describe without drawing what happens and it clearly can’t be the whole story as the reverse doesn’t occur. (So you can stop hyperopia deterioration with a central blur).
There is also atropine treatment which has been shown to reduced myopic deterioration the most and of course bifocals as you’ve mentioned. Both have reduced accomodative demand on the eye, but neither blur distance vision.

I had glasses for a few years when I was 6 with weekly eyes excercises because I saw double, chose not to wear glasses for a year and half an notice I struggled to see stuff that were written in red and green on the whiteboard at school if I was sitting far away from the board, and then I couldn't see it even if written in black and then if I wasn't sat at the very first row. I got back into wearing glasses because it freaked me out. I do think not wearing them if you need them make it worse for your eyes but I also think wearing your glasses more than necessary and spending a lot of time on screen also damage your vision are you aren't training your eyes to work on their own.

Now if I take my glasses off, all I see is a massive blur. I can't read, regardless of the size of the billboard or anything and I can last about an hour before developping massive nauseas and headache.

Even though now I don't mind my glasses, if I could have my time back I would have sticked to using them when my vision was still really good because I broke my glasses a few months back and the week I had to survive before them was rough.

We generally only do a cycloplegic refraction on children and those we suspect are over focusing (pseudomyopes/latent hypermetropes).

So, in theory, someone could, quite easily, be 'overcorrected' and so their prescription for myopia might be too strong and in effect make them hyperopic with their glasses. Having to accommodate far more than an emmetrope would, as I suggested in my earlier post. Which could, in theory, induce a biofeedback response (in terms of axial growth as per the research I mentioned) and advance their myopia further.