The need for glasses to see distance (myopia) ordinarily manifests itself in elementary school, when a child reports problems seeing the board in the front of class. The refraction may continue to change as the child grows; however, once the child is fully grown the refraction should remain stable for decades. Some children may be hyperopic (hyperopia), in their early years, causing difficulty with convergence and drift in the eyes, and difficulty in learning to read. However, as the hyperopic child grows, the eye also grows, and vision can improve as the distance from the front to the back of the eye becomes longer and vision is then focused on the macula.
When a child first needs glasses for distance vision or astigmatism as a teenager or young adult, and thereafter the refraction continues to change frequently, i.e. every one to two years; or contact lenses are needed for best vision—it is a sign of a corneal thinning disease. Refractive surgery should NEVER be done on a patient with a corneal thinning disease! In patients with corneal thinning diseases, refractive surgery weakens the cornea, can cause rapid development of “iatrogenic” corneal ectasia (thinning and bulging), and can accelerate a decline in eye health by many decades.
No refractive surgery has ever withstood the test of time! In some patients, refractive surgery can be devastating more quickly, but no refractive patient is ever safe from a return to glasses or from developing new complications.
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