Interesting case studies

Just a few interesting case studies I’ve observed over the years. Some are mysterious and unexplained. Others, I know what happened. It’s sort of like watching a magic show, if anyone is into magic tricks and illusions. In some of these stories, you won’t know what happened and neither do I to this day, but in others, I’ll spill the facts because I know them.

  1. A man who was pretty nearsighted, around -8 I’d guess. He wore glasses and sometimes bifocal contacts. After not seeing him for a bunch of years, I noticed he was wearing relatively weak glasses compared to what he used to use, and was taking them off a lot. Best guess: around -2.5. I still don’t know how or why. He since moved to another state, I think.

  2. A good friend of mine. When I met him in college, he was wearing -1.75, -2.25. I told him about improving vision, and he said that made sense. He stopped using glasses almost all at once (over a period of several months). Today you never see him with glasses. Why? Because he has low myopia now and never uses them. It took a year or two for his vision to improve to that point. He still technically has myopia, but not much…likely under 1D. And to be honest, the -2 glasses he used to wear were a huge overcorrection…he was only ever actually a bit over -1.

  3. A kid I went to high school with. He wore glasses for nearsightedness. Then all of a sudden one year he didn’t. I asked him about it. He said, “I guess my eyes improved.” Turns out that wasn’t the case…he was wearing contacts, and I found out. He also said he was distantly related to a well-known celebrity who is a household name. That one turned out to be true.

  4. An optometrist I met and ran into a few times who was a friend of someone I knew. He mentioned “being blessed with perfect vision” and not needing glasses…I overheard it in a conversation he was having. On another occasion, I was asking him some technical questions, and he mentioned to me how he had laser eye surgery. I asked for what, and he said he had been nearsighted. I asked how long ago, and he said about 5 years before! Now, weirdness of this story doesn’t end there…this guy has a book on vision improvement hidden (well, not hidden, but most people would never look in that direction and the light in the exam rooms are dim) in his bookshelf at work.

  5. A 98-year-old-man who has medium to high myopia and wears bifocals. Why is this story interesting? Because it’s possible evidence that he might never have had cataract surgery, since most people opt to be fully or near fully corrected for distance and doctors tend to push it when people have the procedure.

  6. A former teacher of mine. I assumed he just wore contacts, because I saw him in glasses once. Clearly, he was nearsighted. Turns out he had low myopia and almost never wore them. I wouldn’t be surprised if he was almost no longer myopic today.

  7. Someone else I knew who I hadn’t seen in a long time. I suspected he didn’t wear glasses or contacts, unlike the one above. When I knew him he was around late 30s I believe. I saw him more recently when he was around 50, and he was wearing minus glasses. I could not believe it. Turns out, he developed the myopia at middle age (along with a ton of complicating factors, because it’s not easy to adapt into myopia at that age…he said his eyes basically felt like they were exploding, and the doctors didn’t have answers, but kept increasing the power until it hit around -2).

  8. A guy who never wore any lenses, and then all of a sudden was around -10, wearing thick glasses at one point. I asked him what happened. He said corneal transplant after an injury, and that he needed the glasses after that. I thought, wow…I had no idea that could happen. That is crazy.

  9. A relative, who I guess wore contacts, but I never knew it. I thought he just didn’t need glasses (I later saw pictures of him wearing glasses). Anyway, I remember had refractive surgery at one point in the 1990s, for myopia. About 5 years ago, I noticed him in glasses. But he wasn’t nearsighted again…he was hyperopic…just slightly. I assume they overcorrected him by a good amount, and then when he started needing reading glasses, they just gave him progressives.

  10. A long-time newsman at a local TV station. Never saw him in glasses until the mid 2000s. For about 2 months in the Summer, he wore glasses every broadcast. Never saw him wearing them again since…except for reading glasses once or twice during the past year or two as he got older.

I hope you found these stories interesting like I did!
*Gender may or may not have been changed in one or more of these stories, to protect the innocent! The rest of the details are accurate.

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This reminds me of my mum, whom I’ll simply add to this list:

  1. My mum told me she developed myopia very late. She must’ve been over 30 or so. Almost certainly from a weird CRT monitor combined with stressful programming work on it. I suppose anyone who could have progressive myopia can also get myopia with a late onset. Just a matter of stimulus.

Two more come to mind:

  1. A friend of mine improved his myopia while wearing optometrist prescribed glasses. His job changed to include more meetings and walking about, and less programming and analysis.

  2. Another friend wore glasses around age seven or so, which he remembers were for myopia – looked like a typical myopia onset. He says he wore them all the time. But now, he’s an emmetrope. I tested him: natural 20/20. He can have very intense and near-work intensive interests, like creating ultra-detailed 3D models of buildings or lens systems, so I always wonder how he avoids myopia. One possible explanation I noticed is that he intuitively takes breaks or loosens things up when he works, and doesn’t like doing one thing nonstop for a very long time, but rather does things in little chunks of time that add up in the end.

Not sure if I unconsciously selected these stories to tell a narrative, but they all emphasize the nonstop aspect of near work. This has been observed in chicken studies too: it looks like there’s a minimum duration of near focus required to cause myopic progression. This would be consistent with what Jake says about “dynamic” near work not worsening your eyes. That type of work usually includes many moments where you look around or further away, resetting the timer, so to speak.

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@Varakari, very interesting!

I will say I’ve met several others who developed myopia at or near middle age, when most people start developing presbyopia. It was, in all cases, concurrent with development of presbyopia. I have some ideas on how this might happen…maybe we’ll talk in messages about it someday. I would love to be involved in a clinical study on some related ideas one day. The interesting thing is that all of these late-onset individuals (tell me if it’s true for yours as well) seem to stay under -3. I’m sure there must be exceptions, but I don’t know how common they are. -3 is like a magic threshold though…my experience is that -3 is the balancing point between weak and strong glasses. There’s just something about lenses above about -2.5…the objects get smaller faster, distances seem compressed more…and of course, -3 basically corresponds with most people’s habitual near working distance…12-14 inches. I think you’re on to something about dynamic versus static near work. Every optometrist who is forward thinking I’ve read stuff by, heck, even Bates, stressed all of these ideas, too.

The guy who developed myopia later used to sometimes squint slightly and seemed to have trouble changing focus before he ever wore glasses, but nothing blatant. I just noticed it once in a while, very subtle. The myopia developed during a period of extreme stress, and after he had started using smartphones for a few years as well. he also told me one of his parents needed glasses starting at middle age, but that his vision improved as he got older, to the point where he no longer needs them today.

It seems that everyone has a tendency toward either myopia or hyperopia based on the way their focusing responds to stimuli…under accommodation at near versus over accommodation at near. It seems to roughly run in families. I don’t believe any of my grandparents are/were myopic (until now…my grandfather is slightly myopic in his older years, post cataract surgery, but was pretty close to emmetropia before that)…he wore glasses starting around age 45, but I don’t know if the distance correction was more like a plus or minus. All I know is it was minor, and he really didn’t need them for distance…mostly just presbyopia. He probably could have just used reading glasses instead of bifocals. but I still believe he had a tendency toward myopia, because two of his sons are myopic, and one is hyperopic/astigmatic. My grandmother on that side was fairly hyperopic (several diopters).

On the other side of the family, I have an uncle who is not a blood relative, who is hyperopic. He’s been wearing glasses ever since I can remember. He said when he was in college, he only wore a “rest lens” on occasion (mild plus, like a differential in a way, for anyone reading this) for sustained near work. but he had perfect distance vision. As he got older, accommodation got worse as expected, but the hyperopia also increased…I believe he is up around +3 for distance today, and uses over +5 for near. Both of his siblings are hyperopic, too, and I believe his parents were as well.

That’s pretty amazing that some people can hold out so long when it comes to developing myopia. I thought the handful of friends I knew who didn’t need glasses until high school or college were late-onset, but clearly it goes far beyond that age range.

I have a feeling that most true emmetropes (very rare in my experience…lots of people who aren’t myopic are slightly hyperopic, like +0.5 or +0.75) are probably people who are more prone to myopia if things get out of hand badly enough. After all, emmetropization had to occur. It seems more of the population is prone to myopia than hyperopia…more than half it seems.

I believe ciliary spasm is also possibly a protective response to prevent substantial true myopia from occurring. It seems to be the next best scenario after correct accommodation, if one can’t accommodate correctly. I’ve read that myopes have faulty accommodation during the period when the vision is worsening, but then it often becomes normal or nearly so after they adapt to the new lenses. Of course, the process then starts again in many cases due to peripheral hyperopic defocus, etc. I suppose if you never do sustained near work with glasses, and get enough distance viewing, you can stay stable indefinitely.

Yeah, there are always a decent number of people whose minus powers decrease while wearing prescribed lenses. it often coincides with wearing progressives with a mild add power for new presbyopia, I’ve noticed.

And of course, there are always people with hyperopia that increase over time. We have to remember that decreasing myopia and increasing hyperopia are essentially the same process.

@Blake, thanks for the fix…I hadn’t even noticed the typo.

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