Disease Description (Causes and Symptoms)
- Definition: Pseudomyopia (accommodative myopia) is a temporary myopic state in which the focus of distant objects falls in front of the retina due to increased lens thickness and persistent contraction of the ciliary muscle (accommodative spasm).
- Pathophysiology: When the accommodative muscles become excessively tense or go into spasm due to prolonged near work, they do not fully relax even at rest, adding refractive power and making it appear as though the actual refraction has changed.
- Main symptoms: Decreased distance vision, eye fatigue (ocular fatigue), headache, and dry or gritty eyes. It is common mainly among older elementary school students to middle school students and others who engage in extensive near work.
Treatment Methods and Precautions
- Diagnostic approach: A cycloplegic refraction test using cycloplegic agents (cycloplegic eye drops) is used to distinguish pseudomyopia from true myopia (in which the structural refraction has changed).
- Medication treatment: Use of cycloplegic medications to relax the accommodative muscles (e.g., atropine and cyclopentolate). The ophthalmologist determines the medication, dosage, and duration of use based on age and symptoms.
- Note: Stronger medications (e.g., atropine) may cause pupil dilation, blurred near vision, photophobia, and, rarely, systemic side effects; use them as directed by a doctor.
- Nonmedication treatment (lifestyle management): Limit near-work time, maintain an appropriate reading distance (approximately 30–40 cm recommended), improve lighting, rest by looking into the distance for about 10 minutes after every hour of work (the 20-20-20 rule may be applied), and correct posture.
- Principles of eyeglass prescription: In pseudomyopia, temporarily unnecessary myopia correction (full minus prescription) may affect the long-term progression of true myopia, so the decision should be based on the results of a cycloplegic examination before prescribing. If necessary, a light plus correction for near work or partial correction (bifocal/ADD) may be considered.
- Follow-up: Reexamination (cycloplegic refraction) and treatment adjustments are needed while monitoring whether symptoms resolve and whether the refractive status changes.
- Complications and side effects: If not appropriately treated, there may be an increased risk that recurrent accommodative spasms will progress to true myopia. Cycloplegic medications may cause temporary reduced near vision, photophobia due to pupil dilation, drug allergies, or rare systemic reactions.
Checklist Before an Outpatient Visit (Including Items to Bring and Information to Record)
- Items to bring: Currently used glasses/contact lenses (and prescription), previous refraction and ophthalmic examination records (if available), and school vision screening results (if available, submit them).
- Information to record: When symptoms began, daily and hourly symptom patterns (such as worsening after near work), types and amount of near work per day (reading, smartphones, games, etc.), presence of eye fatigue or headaches, and accompanying symptoms such as itching, redness, or tearing.
- Medications and allergies: Medications currently being taken (including oral medications and eye drops) and any drug allergies.
- Precautions before examination: Remove contact lenses before the eye examination if you wear them (follow the doctor's instructions); cycloplegic eye drops for diagnosis are administered at the outpatient clinic, so do not instill them yourself. Plans for driving or going out: Cycloplegic medications may affect activities because of pupil dilation, photophobia, and reduced near vision, so arranging transportation home is recommended.
Examples of General Questions to Ask the Doctor
- What are the expected effects and side effects of this medication (or eye drops)?
- What is the recommended treatment duration and interval for reexamination (follow-up)?
- Is my child's (or my) current condition at risk of progressing to true myopia?
- What should be adjusted in daily life (studying, sports, and smart-device use)?
Examples of Condition-Specific Questions
- How many weeks or months should cycloplegic eye drops (e.g., atropine) be used? When should the reexamination be performed?
- Do the glasses currently being worn (or the myopia prescription obtained from self-testing) need to be changed immediately, or should this be decided after reviewing the results of the cycloplegic examination?