Diagnosis of subtle refractive errors

Nearsightedness also called myopia is a condition where objects up close appear clearly, while objects far away appear blurred. In nearsightedness, light comes to concentrate before the retina after passing through the eye lens instead of on the retina. Clinically evaluated this common eyesight problem makes distant objects appear blurry, while close objects still appear sharp. Nearsightedness affects about 25 percent of all individuals in the United States, according to the National Eye Institute.

Farsightedness, likewise called hyperopia is also a common type of refractive error where distant objects might be seen much more clearly than objects that are near. However, people experience Farsightedness differently. Some people may not notice any type of problems with their near vision, especially when they are young. For people with significant farsightedness, vision can be blurry for objects at any type of distance, near or far.

Causes of Nearsightedness

The majority of nearsightedness cases result from an eyeball that's too long which prevents light from focusing directly on the retina (the "screen" at the back of the eye). Nearsightedness can be caused by a cornea (clear layer at the front of the eye) that's not shaped correctly. In fact, these two problems intercept light from focusing directly on the retina. Rather, light focuses in front of the retina, which makes distant objects appear blurry. Although researchers still don't know exactly why some people develop nearsightedness while others don't, it's possible that the problem may be genetic. If one or both of our parents is/are myopic, our chances of having the problem is higher those of a person whose parents aren't nearsighted.

Nearsightedness: Signs and symptoms

Nearsightedness might develop gradually or quickly. It usually initially occurs during childhood, and also can intensify as time goes on. Signs and symptoms of nearsightedness might consist of:

• Distant objects appearing blurry.

• The need to squint to see objects clearly.

• Headaches.

• Difficulty driving because of poor eyesight, especially at night during the night.

Identifying Nearsightedness

A complete eye examination by an optometrist can quickly detect nearsightedness. Commonly, eye-clinic vision tests will certainly be the first time a parent learns about a child’s nearsightedness. Sometimes parents or teachers will find nearsightedness after seeing a child squint in order to see distant objects. Grownups may start to realize that they have the problem when they have trouble watching movies, can't see distant objects clearly while driving, or participate in other activities that involve looking at far-away objects. If someone is having trouble seeing things that are far away, it's an excellent idea to get an eye examination. Even if he/she has no symptoms of nearsightedness, it's a good idea to get an eye examination around the time you turn 40.

Then, after that experts recommend getting an eye examination:

• Every 2 to 4 years between ages 40 and 54.

• Every 1 to 3 years between ages 55 and 64.

• Every 1 to 2 years beginning at age 65.


John who is a 10-year-old shy kid came to our clinic for a consultation reporting ‘blurry vision in one eye’. His mother searched online and learned about myopia, also known as nearsightedness. She had been told by a previous ophthalmologist that her son did not need to wear glasses since the kid had said he was ‘seeing well’ last year. However, in early February, John had started complaining his right eye was getting tired very easily and he could not concentrate well when he was reading or doing near work. John enjoys playing robotic games on the computer in his leisure time, and he said that he could no longer play as much as he used to without complaining of eye strain. His mom got concerned about the rapid change in his vision and the discomfort he experiences. As she did more in-depth research about myopia or nearsightedness, she found out about the unique ‘myopia control service’ offered by Khanna institute on Google.

Interestingly, neither parent has vision issues or need for glasses. Upon further evaluation, Dr. Khanna found that John had myopia in the right eye while his left eye displayed mild hyperopia and astigmatism. This condition is generally known as ‘anisometropia’ in which the shape and prescription is distinctively different in each eye. Given the fact that he was not prescribed with glasses last year, when they were checked, it was assumed that the level of myopia at that time might have been miniscule or considered ‘asymptomatic’. The onset of myopia often begins with a low amount of nearsightedness which can often go undetected. If left untreated for long, however, myopia can suddenly spike up and result in noticeable blurry vision for long distance vision. The case of John also raised the suspicion of ‘lazy eye’ or amblyopia due to the distinct anatomical and optical differences between the two eyes. Fortunately, he can be corrected to 20/20 perfect vision with no indication of lazy eye.

 Upon extensive educational talk and discussions with John and his mother, Dr. Khanna recommended an individualized myopia control treatment for him using K.I.D.S. (Keratometric Induced Dioptric Steepening) or overnight contact lens for the right eye to slow or halt myopia progression at that time. The untreated left eye would be monitored closely to ensure that it would not develop myopia in the long run.

 After the first day of overnight lens wear, John’s unaided vision in the right eye was 20/20 or perfect vision. He noticed that not only had his distance vision improved significantly after just one night of wearing the corrective contact lens in one eye, he also reported that he could read more comfortably with little stress or strain. His mother was amazed about the great result in such a short period of time, and the mother and kid were grateful to witness the shy kid who initially hid behind his mother’s back finally showing a grin and becoming more relaxed after knowing that he could see much better than before.

If you are concerned about your child’s myopia, please visit our website www.khannainstitute.com and schedule a complimentary evaluation with Dr. James Giraldi at our Westlake Village office..

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About the Author Rajesh Khanna, MD

Los Angeles Lasik Surgeon Rajesh Khanna MD is a recognized pioneer in Presbyopic Implants for correction of aging eyes. He has popularized Cornea Cross Linking and Intacs forKeratoconus. He is an Expert Cataract, Pterygium Eye Surgeon, A Cornea Specialist he performs Laser Corneal Transplants, DMEK, DSEK and DALK. Rajesh Khanna MD is a well known medical writer. He has published the bestseller "The miracle of Pi in Eye".He is also a columnist for the newspaper Acorn. Dr.Khanna also hosts "Medical Magic". In his spare time he hikes with his family and German Shepard or does yoga. He also plays field hockey and loves swimming.

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