Scientific Myopia Prevention: Break the Misconceptions — Reading Harms Eyes, Cycloplegic Refraction Is Safe, Glasses Do Not Worsen Myopia

Introduction Parents' Confusion and the Doctor's Concern

"My child has good habits, hardly watches TV or plays with phones, so why is he nearsighted? He just loves reading."

"My child says he can see the blackboard clearly. After cycloplegic refraction at the hospital, I didn't expect his vision to be so poor."

"Wearing glasses will make myopia worse and make the eyes deformed and lifeless. If all else fails, he can just have myopia surgery when he grows up."

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I have worked on the clinical frontline of myopia prevention and control for children and adolescents for over 20 years and have conducted eye health public welfare lectures at more than 300 schools. After meeting a large number of parents and children, I found that they lack eye health knowledge and also hold many misconceptions about myopia prevention and control, which worries me deeply.

Misconception 1 Reading Does Not Harm Eyes

A heavy near-work burden is a major risk factor for the onset and progression of myopia. Reading books, looking at phones, looking at smartwatches, using tablets, drawing, doing bead puzzles, and similar activities are all essentially near work. The longer the time and the closer the distance, the heavier the eye burden. At this stage, parents can well control children's time using electronic products, but they often do not realize that poor reading habits can also increase the eye burden. Avoid reading while tilted, lying down, or in dim light, and pay attention to balancing work and rest.

Misconception 2 Cycloplegic Refraction Harms the Eyes

Children and adolescents are young, cooperate poorly during examinations, and their eyes' accommodation is often in a tense state. The purpose of cycloplegic refraction is to relax the eyes by paralyzing the ciliary muscle, thereby examining the most real and objective refractive status. Cycloplegia can accurately assess the hyperopia reserve, help predict future myopia risk, and help obtain a prescription that allows clear, comfortable, and lasting vision.

Cycloplegic refraction does no harm to normal human eyes. Symptoms such as difficulty seeing near objects and photophobia outdoors after cycloplegia are only temporary and quickly disappear as the drug effect fades. Human pupils also naturally dilate in dark environments and at night. After cycloplegic refraction for myopia, the eyes return to normal within a relatively short time.

Misconception 3 Wearing Glasses Makes Myopia Worse

Glasses should not take the blame. If myopia is not corrected, the eyes remain in a blurred and fatigued state, which is more likely to lead to myopia progression. Scientific and standardized optometry and glasses fitting not only help patients see clearly but also reduce visual fatigue, improve binocular visual function, and help delay myopia progression. If myopia still progresses after wearing glasses, it is not the glasses' fault; rather, the environmental factors causing myopia progression are still continuously affecting the eyes. If glasses are worn only sometimes, or only for distance vision and not for near vision, it is easy to cause binocular coordination dysfunction, more likely leading to visual fatigue and myopia progression. Only about 10% of children with low myopia, due to special eye position and accommodation conditions, may not need to wear glasses when reading and writing, but this needs to be determined by a professional setting and follow medical advice.

Misconception 4 Glasses Are Unsafe; Eyes Easily Deformed and Lifeless

In hospital ophthalmology emergency departments for eye trauma (fireworks and firecracker injuries, cuts from scissors and pencils, chemical splashes), almost all patients do not wear glasses. Today's lenses are mostly resin lenses, which are tough and not easy to break. Even if they break, the fragments are more likely to be block-shaped or sheet-shaped, relatively blunt, and have a very low probability of injuring people. At the same time, most lenses now have varying degrees of protection against ultraviolet radiation damage. To some extent, wearing glasses can prevent most eye trauma. In recent years, some new specially designed frame glasses have been proven to have good myopia control effects and can effectively delay myopia progression, so they need to be worn regularly. The so-called feeling that eyes are "deformed" or "lifeless" after removing glasses is an illusion. Looking at eyes through the concave lenses of myopia glasses makes them appear smaller, and the higher the prescription, the more obvious this is. At the same time, some high myopia may have a slight protrusion due to long axial length.

Misconception 5 Myopia Surgery Can Cure Myopia

Many parents turn a blind eye to myopia, thinking it is nothing more than wearing a pair of glasses. When the child is only eight or nine years old, they ask whether laser surgery can be done when the child grows up, believing that surgery will solve everything and cure myopia. The essence of myopia in children and adolescents is excessive axial elongation and corresponding changes in eye structure. At this stage, there is no "magic device" or "magic drug" that can truly and effectively reverse the above conditions.

Myopia surgery targets adults with basically stable myopia and suitable eye conditions. The principle is like implanting a "contact lens" that never needs to be removed on or inside the eye surface, so after surgery, daily frame glasses or contact lenses can be dispensed with. However, the axial elongation caused by myopia and the risk of fundus lesions that may accompany myopia cannot be changed or reduced. Therefore, myopia surgery is only a special optical correction and cannot truly and completely cure myopia.

Adults, especially those with high myopia, who have undergone myopia surgery still need regular annual examinations of the fundus and intraocular pressure. Children and adolescents in the stage of myopia progression are contraindicated for myopia surgery.

Four Goods Achieve the "Four Goods" for Eye Care

Myopia prevention and control should adhere to the concept of prevention, move the threshold forward, and start early and small. Achieve the "Four Goods," emphasize behavioral intervention, and integrate them into daily life.

Play Well Outdoor Activities Prevent Myopia

In early childhood, maintain more than 3 hours of effective outdoor activity every day. In primary school, more than 2 hours of outdoor activity every day or a cumulative 14 hours per week can effectively prevent the onset of myopia. Implement one physical education class every day so that children can walk out of the classroom during every break, go to the corridor or playground to bathe in sunlight and look into the distance. Even on cloudy and rainy days, the natural outdoor light intensity is significantly higher than the indoor environment, so go out and play during the daytime. It can be half an hour each time, multiple times, walking, running, cycling, playing ball, swinging, etc., all effective. If there is a certain intensity of activity, the eye care effect is even better.

Read Well 20-20-20 Eye Care Method

In early childhood, read as little and as late as possible. Reading should balance work and rest, maintain an upright sitting posture, and keep books at a distance of one foot from the eyes. Advocate the 20-20-20 eye care method: every 20 minutes of near work such as reading and writing, look up and gaze at a distance of 20 feet, that is, 6 meters, for more than 20 seconds. Stay away from or strictly control the use of mobile phones, smartwatches, and other electronic products.

Sleep Well Ensure 10 Hours of Sleep

Less sleep time often means long nighttime reading, writing, or phone use, which is more likely to rapidly consume the hyperopia reserve and lead to the onset and progression of myopia. In early childhood and primary school, try to ensure 10 hours of sleep every day and strive to fall asleep before 9 p.m. In addition, after the child falls asleep, keep the room as dark as possible, draw the blackout curtains tightly, and do not turn on a night light.

Eat Well Balanced Diet, Less Sweets

Eat a balanced diet without partiality. Fresh vegetables and fruits are rich in various substances beneficial to visual health. In addition, eat more high-quality protein foods such as fish, soy products, and eggs. Eat less sweets, fried foods, etc., and drink fewer sugary beverages. Do not blindly follow trends and buy various so-called "eye care" health products. At the same time, try to avoid watching electronic products or reading and writing immediately after meals.

Conclusion Prevention Is the Most Cost-Effective and Effective Health Strategy

The main factors affecting our health are lifestyle, behavioral habits, and environmental factors. Prevention is the most cost-effective and effective health strategy. This is especially true for myopia. May more children play, run, and raise their heads outdoors, and have a pair of bright, clear, healthy, and beautiful eyes.

(Author: Ni Hailong, Director of the Optometry Center, Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine [Zhejiang University Eye Hospital])