LARGER THAN NORMAL EYEBALLS
(I am not a medical professional. This is a purely anecdotal account of my own experience.)
One of the things I learnt in 2020 was that myopia (short-sightedness) and larger than normal eyeballs are related. High myopia is more than merely annoying. It is accompanied by the increased risk of conditions that may cause blindness.
So there I was, sitting in the chair, and my doctor told me that numbing drops would not suffice for my impending eye surgery as my eyes were bigger than normal. In all my decades of patiently tolerating my progressive myopia, no one had ever alerted me to this fact, but then again, I had never needed surgery before. He said local anaesthesia all around the eye was an alternative but would be “traumatic”, so general anaesthesia was the way to go.
As a pretty much lifelong myope, and then a high myope, and a non-medical person, I had never really thought WHY my myopia was progressing steadily each year. I simply went for my annual eye examinations and accepted the fact that I needed a higher script as if it was simply the result of something mystical like a bad combination of pixie dust and unicorn kisses. I never even considered why this was happening and indeed, no one ever took the trouble to tell me why until 2020. Highly myopic eyes are more oval than round, with their length extending into your head and thankfully not sideways. That length is called your axial length. The longer it is, the worse your myopia.
I ascertained that my eyes are about 3mm longer than average but in the world of the tiny architecture of the human eyeball, 3mm is enough to make a substantial difference. Attendant to this feature of having larger than normal eyeballs, comes all sort of risks. Besides the annoyance of high myopia, you are, amongst other things, at a greater risk of having early cataracts and retinal detachment following surgery. You need to make sure your retinas are in good nick before proceeding. This isn’t an entirely pleasant experience, but it is pain-free as your eyes are numbed and is certainly worth the peace of mind you get if you pass the test. If you do not pass the test, you may need retina repair surgery before you have your cataract surgery.
Larger than normal eyeballs also increase your risk of damage to your optic nerves as, due to the additional length, they take strain and may take on a somewhat frazzled appearance which tends to freak doctors out as damage to the optic nerve could lead to blindness. This puts you in the realm of being a glaucoma suspect even if your eye pressures (IOP, short for intraocular pressure) are withing the normal range. Your IOP and visual fields will then be tested regularly, and you may be advised to start glaucoma treatment such as eyedrops that lower your IOP. More pressure on those fragile optic nerves potentially means more wear and tear and you do not want that to happen. Further, due to the increased size of your eyeballs, you are a trickier eye surgery patient than average to operate on as your dimensions are of course larger than normal, and you therefore require a more experienced surgeon.
So 2020 was the year of the eye for me when I had to undergo bilateral lens extraction and implantation of prosthetic intraocular lenses, also known as cataract surgery. This all went exceedingly well and without a hitch, despite all my complications. That was pretty much that and I was left, no longer myopic at all, but obviously retaining my big eye architecture, and as happy as a pig in mud with my new eagle eye vision.
However, as an avid reader of all things ophthalmological, as far as I can keep up with my limited understanding of this highly complex field as a layperson, I subsequently read something horrifying. I was reading an article by an ophthalmologist, targeted at fellow ophthalmologists, in which it was stated that parents need to slow the growth of their children’s eyeballs in order to slow the progression of myopia and help reduce the complications as described above in my own story. (Unfortunately, I do not have a link for that exact article.) Think about that for a second … parents are now responsible for trying to reduce the rate at which their children’s eyeballs grow! Not only do we have to get them to eat their greens, drink enough water, floss their teeth, make them wear their retainers and stay off screens as much as humanly possible, we also have to somehow retard the growth of certain of their organs. Having spawned a myope myself, I was both concerned and intrigued. And yes indeed, I have been informed by specialists, there is a genetic link.
This is when I learnt about Atropine, a drug used to slow the progression of myopia. My own myopic progression had been regarded as inevitable but now this pharmaceutical intervention was available. Low dose Atropine has only been used to slow myopia in children in Western countries in recent years, whilst many more studies have been done in Asia for a much longer period (
Review Article, Published: 11 June 2018, “Update in myopia and treatment strategy of atropine use in myopia control” ). Then I ascertained that low dose Atropine is being prescribed in Australia too. Things then started getting a bit too real for me when I too was handed a script for low dose Atropine as my little myope had progressed from mild to moderate within the space of a year. This was met with mixed feelings. On the one hand I am grateful that this option is available and on the other I am wary about jumping into pharmaceutical solutions too quickly at times. Further, I can also assure you that the thought of instilling eyedrops into the eyes of a child is a daunting prospect. I once asked a nurse to help me with this incredibly difficult task as I incorrectly assumed she would do a better job of it than I would. I greatly regret asking her as she did more damage than good thanks to her awful bedside manner.
Another way to reduce the progression of myopia is to discourage too much screen time and close work and encourage more outdoor play. Good luck with that!
Then I attended a lecture about myopia and learnt about yet another possible treatment, orthokeratology. This involves making your child wear orthokeratology contact lenses at night. The lenses change the shape of the cornea temporarily and this could slow the progression of myopia (https://clinicaltrials.gov/ct2/show/NCT03465748 ). Instantly, the prospect of instilling eyedrops seemed more feasible.
And that is where my current tale ends. Only time will tell if medical interventions will work.
