Axial Length Only for High Myopia? Is it true?

Hi EndMyopia fam!

I had an interesting comment on one of my youtube videos, and I am interested to hear input from the hive mind.

The comment was that axial elongation doesn’t happen for myopia under -5.
That seems incorrect to my understanding, so I asked for a source and it was provided.
You can read in the exchange how I interpret this source, but I am also aware that I am not impartial - I want a specific answer. So rather than allow my “beliefs” to build my reason, I thought I would put it to you, my learned colleagues in myopia reversal.

Is my judgement clouded by wanting a certain outcome?

(blog post cited by Alan is: Axial Elongation Of The Eyeball: Facts & Fiction - Endmyopia® )

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Thanks for sharing this discussion! I don’t have the expertise to actually say anything useful on it, but I welcome the new perspective.
As for the article you linked, it seems like it was signed by another person. Perhaps their experience and approach was informed differently from the more commonly known current EM theory (that is, that axial elongation probably happens as soon as artificial focal planes are introduced)

Personally, I think there is value in attributing more improvement to accommodation than the initial, quick drop of -1D or so, but I certainly don’t believe it is as straightforward as the OP makes it to be. The documented last diopter experience (and mine is clearly displaying the same tendencies) is that clear flashes become more and more frequent until that state of vision becomes permanent, over a period of years. I can see perfectly clearly, a few times a day at best, but it doesn’t last and I have no idea why, and what would eventually make “good vision” my default. Basically, if this is just a problem of accommodation, why does it take years? If it’s not, what explains the more frequent clear flashes when pulling focus or clearing up double vision?

I still like their analogy, mainly because I’ve been trying to become more flexible and it is absolutely not working. :smile: It’s not as simple as starting to use underused muscles (provided you know the anatomy well enough to know which ones they are), there is a deeply complex behavioural and cognitive element to it that always eludes me.

Higher diopter myopia behaves differently and I find it easy to accept that the slow improvement is due to some reshaping of the eye. It just “makes sense” in that the speed/pattern is typical of biological adaptation (like weight loss, or muscle building)

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I totally agree with you, Alan simply misunderstands what Jake have written.

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I agree with @gemilymez too. I think Jake is saying that there are cases where people have up to 4 or 5 D of correction that’s entirely due to Accomodative Spasm or Pseudomyopia, not that Axial Elongation never happens until you test at 5D of myopia. The issue is that at high myopia of 6D or more your eye can literally be starting to fall apart and you’re at risk for a bunch of undesirable things because there’s actual physical damage to the eye (retinal detachment, etc.) He’s saying “don’t think about it” below 5D because there’s nothing in the short term to do about it that isn’t already covered by the basic EM ideas: fixing the Accomodative Spasm and getting rid of the bad habits and near work should help any Axial Elongation that exists.

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Your judgement is not clouded. According to lots of EM material, what you say makes sense. I had not seen this 2014 article and the specific idea grasped by the poster seems at odds with everything else.

At the first sentence, I read it as not to think about axial elongation. at such a low level. But then the author says he’s seen up to 6 diopters of myopia without axial elongation.

On reversing this axial elongation he says, “I have seen it more times than I can remember, and we stopped actually testing for axial elongation for many standard cases as long as 15 years ago. The result always being the same, and the test needlessly incurring cost for the client, it just made more sense to forego it.”

This is new to me. I didn’t realize there is a collection of data. I wish we had access to it.

You’re right. There’s definitely great variation in the factors that lead to you have a much stronger myopic prescription than your actual myopia level.

If someone is able to make really fast gains, more than likely it’s cause they were addressing non myopia related things, like accommodative spasms, addressing blur adaptation really quickly, getting a less overprescribed prescription, convergence issues (such as ability to track objects, improving lens elsasticity, better understanding of 3D space/distances, etc…)
His ideas of the muscles are probably inaccurate. Getting finer muscle control is the key to vision rather than using unused muscles. more likely you are getting better at accommodating at various distances and at various speeds, etc…
Because there’s more to visual acuity than just whether you see 20/20 or not, that is there’s more than just distance,. You may have 20/20 but still have a low update speed for tracking a baseball’s movement.

For myopia that can be resolved in that way^ the optometrists call it fake myopia or something like that. That is, if someone really improved by 5 diopters or whatever in a month, they wouldn’t even call it myopia. For myopia that doesn’t resolve in that way, they blame it on the cornea and/or axial length (aside from things like diabetes where they’ll blame your fluids, etc…) So for “true” myopia, there will be some mix of axial elongation and/or steeper cornea (outside of the exceptions of course like eyes that protrude/bulge out).

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