🎙️ Episode Summary

In this episode, Dr. Laby dives into one of the most overlooked yet impactful factors in athletic performance: myopia, or nearsightedness. For athletes who depend on split-second visual precision—whether tracking a fastball, spotting a teammate, or reading subtle movement cues—nearsightedness can quietly erode competitive performance. The discussion begins by breaking down what myopia is: the ability to see near objects clearly but with blurred distance vision. While glasses and contacts can correct it temporarily, the real concern lies in progression—the gradual worsening of myopia over time.

The episode explores two critical consequences of progressive myopia. The first is the immediate impact on sports performance. Even small prescription changes can degrade visual acuity from elite levels like 20/12 or 20/15 down to 20/20, which for most people seems “perfect,” but for professional athletes can mean the difference between success and failure. The second consequence is more serious: long-term eye health. As the eye elongates, it physically stretches the retina, increasing the risk of irreversible damage such as retinal tears, detachment, maculopathy, and early cataracts.

Listeners then learn how managing myopia isn’t just about sharper sight—it’s about protecting the structure and longevity of the eye itself. Research shows that slowing myopia progression by just one diopter (one unit in prescription strength) can reduce future vision-threatening risks by approximately 40%. That’s a profound, quantifiable benefit that highlights the importance of early intervention, especially for young athletes and those still developing visually through their teens and early twenties.

Dr. Laby also outlines the key risk factors that increase susceptibility to progressive myopia: early age of onset, genetics, excessive near work (especially screen time), and ethnic background (with higher prevalence in individuals of Asian descent). These insights are paired with actionable recommendations, including regular, specialized sports vision evaluations that go beyond the standard “20/20” eye exam.

Finally, the episode introduces three modern, evidence-based strategies proven to slow or control myopia progression: orthokeratology (Ortho-K)—nighttime lenses that reshape the cornea; multifocal soft contact lenses that alter peripheral focus; and low-dose atropine eye drops, which biochemically signal the eye to slow elongation. Together, these tools empower athletes and parents alike to make informed, proactive decisions about visual health—ensuring not just peak performance today, but lifelong visual stability and safety.

🧠 Learning Points

• Myopia (nearsightedness) affects both athletic performance and long-term eye health.
• Even a slight increase in prescription (e.g., 0.50–1.00 diopter) can lower visual performance from elite to average levels.
• Progressive myopia causes the eye to elongate, increasing risks of retinal damage, maculopathy, and cataracts.
• Slowing myopia by just 1 diopter reduces future vision risks by roughly 40%.
• Major risk factors: young age of onset, genetics, prolonged near work, and Asian ethnicity.
• Three proven treatments for controlling progression:

1. Orthokeratology (Ortho-K): Nighttime corneal reshaping lenses.
2. Multifocal soft contacts: Adjust peripheral light focus to limit eye growth.
3. Low-dose atropine drops: Biochemical signal that halts elongation.

• Regular sports vision evaluations are crucial — 20/20 isn’t necessarily “good enough” for elite performance.
• The goal: Correct for performance today, control for vision health tomorrow.

⏱️ Episode Timestamps

• 00:00 – Introduction: Why nearsightedness is an overlooked barrier to peak athletic vision and what this episode will uncover.
• 01:00 – Understanding Myopia: What it is, how it develops, and why squinting isn’t a long-term solution.
• 02:10 – The Dual Threat: How myopia impacts both short-term sports performance and long-term eye health.
• 03:25 – The Competitive Edge: Why elite athletes often have 20/12 or better vision — and why 20/20 isn’t “good enough.”
• 05:00 – Eye Structure and Risk: How myopia physically stretches the eye, increasing risks of retinal damage and cataracts.
• 06:30 – Quantifying the Danger: Why slowing progression by just one diopter can reduce lifetime vision risk by 40%.
• 07:45 – Who’s at Risk: The four main risk factors — age, genetics, near work, and ethnicity.
• 09:00 – When Progression Stops: Typical age ranges for stabilization and why elite athletes must stay vigilant.
• 10:15 – The Three Control Methods:
• Orthokeratology (night lenses)
• Multifocal soft contact lenses
• Low-dose atropine eye drops
• 12:30 – Choosing the Right Approach: How specialists tailor solutions based on sport, lifestyle, and compliance.
• 13:30 – The Takeaway: Correct for today’s performance; control for lifelong visual health.
• 14:44 – Closing Message: A call to athletes and parents — take small, informed steps now to protect sight for the long game.

Transcript

 Let's talk about something that might be secretly holding back peak athletic performance: nearsightedness. If you rely on absolutely perfect vision for what you do, maybe tracking a fastball, maybe spotting someone out of the corner of your eye, well, you really need to tune in. Definitely our mission today is, uh, a deep dive into mastering myopia.

That's the clinical term nearsightedness, and we're bringing insights here from, you know, literally decades working with pro athletes, elite performers, in pretty much every sport. We wanna show you not just how to correct it, but how to actually control its progression. Progression, that's the keyword.

Exactly. If your prescription keeps going up, that's like a ticking clock. We need strategies to slow it down or, ideally, stop it. Okay, so let's nail down the basics. First. Myopia, what is it again? Simply, it just means you see things fine up close, you know, reading the script, looking at your phone. Mm-hmm.

But the minute you look further away, square board teammate across the field, things get blurry, fuzzy. And the classic sign the giveaway is squinting. Right? If squinting helps sharpen things up even a little, then you're fundamentally nearsighted. Yeah. And while, okay. Squinting gives you that split second of clarity, it's obviously not a real strategy when you're competing at a high level.

No, definitely not. And this isn't some rare thing. We're talking nearly a quarter, maybe 23% of the world population is myopic, and the rates are significantly higher in people of Asian descent. It's a huge issue. Right. And catching it early. Recognizing it. Yeah. Is critical. You mentioned it's kind of a dual threat.

Two big problems rolled into one. Exactly. Two distinct issues. And the first one, well, it hits your performance, your competitive edge, maybe even your wallet eventually. Okay. Let's talk about that competitive impact. Do you call it the bottom of the sports vision pyramid? That's right. Vision is absolutely fundamental.

It's the base. Everything else is built on in sports. And look for the pros for the elite athletes 2020 vision, what most people think of as perfect often isn't actually good enough, really. So 2020 is just average or even below average for them? Yeah, for many, yes. When we test top athletes, especially in visually demanding sports like baseball, the average vision we see is often better than 2020.

Think 2015 or sometimes even 2012, it's quite common. Okay. Let's unpack that 2012 thing. Yeah. That means you're seeing detail clearly from 20 feet away that someone with normal 2020 vision would only see clearly if they moved up to 12 feet. Right. Precisely that slight edge, that ability maybe to pick up the spin on a pitch, just a fraction of a second sooner, or see a defender shift.

That's what separates good from truly elite. Wow. So even a tiny change, like you said, maybe half a number going up in your nearsightedness prescription, that can be enough. It can knock you down from that elite 20/12 edge back to 20/20. And the problem is a regular eye doctor might check you, see 20/20, and say You're fine.

Yeah. Vision's great. But a sports vision specialist, someone who understands these demands, sees that drop from 20/12 to 20/20 and knows functionally your performance potential has been compromised. It could mean the difference between making the play and not okay. So performance is the immediate problem, today's problem.

But you mentioned a second threat, something, uh. More insidious long-term health? Yes, and this is the bigger picture, honestly, it's the more critical one. Long-term. As the eye becomes more nearsighted, it physically changes shape. It actually elongates. It gets longer from front to back. It stretches. It stretches, and that stretching puts strain on the delicate structures inside the eye.

This significantly increases the risk of serious. Potentially permanent eye problems down the road. Okay. Can you give us an analogy? Yeah. How does that physical stretching cause damage? Make it stick for us. Okay. Uh, think about stretching a really thin piece of fabric, maybe like sheer pantyhose, over a balloon while you keep inflating it.

Right? It gets thinner and weaker. Exactly. That fabric gets pulled, taut, it gets weaker, more vulnerable to tearing. Well, that thin fabric is like your retina, especially the macula, that vital spot for your sharp central vision. When it's stretched by eye elongation, it's much more prone to physical damage, like tears, detachment, or a condition called maculopathy and cataracts, too, right?

Where the lens gets cloudy. That risk increases as well. Yes, and what's absolutely crucial for people to understand is that these issues, retinal tears, maculopathy, and advanced cataracts, these aren't things you can just fix later with a stronger pair of glasses or contacts. So these are actual physical injuries to the eye structure, precisely.

A retinal tear usually needs surgery. Vision loss from something like maculopathy often can't be fully corrected. The damage can be permanent. That's why managing myopia progression early isn't just about sports today. It's about protecting your actual site for, you know, the next 50 years. Got it. So, okay.

We can correct the vision day to day with glasses or contacts. You mentioned most athletes prefer contacts, better peripheral vision, less risk of glasses breaking. Right. That makes sense in most sports, but just correcting it isn't the whole story because the nearsightedness itself tends to get worse, especially in younger people.

That's the progression we need to control. That is the vital distinction we have to make. Correction is temporary. Just managing the symptom controls about managing the underlying cause, aiming for lifelong stability. If we only correct the vision each year, we're essentially just chasing the problem, putting a stronger lens on an eye that's still physically getting longer, still increasing those long-term health risks we just talked about.

So why is focusing on controlling the progression so incredibly important? You mentioned a payoff. It's huge and it's quantifiable. Research really backs this up. If we can slow down or stop the progression of nearsightedness by just one diopter, that's one unit, one number in your prescription. Okay?

Doing just that reduces the risk of those serious future eye problems. The physical damage by about 40%. Whoa. Hang on, 40% risk reduction from preventing just one diopter of change. Help us visualize what one diopter is. Is that a big jump, or, huh? It's a very practical, common amount of change. Think of it like the difference between needing your very first mild pair of glasses, say a Magus 1.0, and then needing a stronger pair, maybe a negative 2.0 a year or two later.

If we can intervene and keep someone from going from minus 1.00 to minus 2.0, we've potentially achieved that 40% risk reduction for their future eye health. It's often just stopping one or two years worth of typical progression. It's a really achievable goal with the right approach. That completely reframes it.

Yeah. It's not just about convenience, it's serious prevention. Yeah. So who's most at risk for this progression? Who should be most concerned? Well, we typically look for four main risk factors. Number one is age of onset. The younger you are when myopia starts, the more years it has to progress and usually the faster it progresses.

Okay. Younger start equals higher risk. Make sense. Number two is genetics. Simple as that. If both your parents are nearsighted, your risk is significantly higher. Right? And number three, this is the tough one in today's world, isn't it? Mm. Close work screens. Exactly. Spending a lot of time doing closeup tasks, reading phones, tablets, any intense near focus, especially for long stretches, say 45 minutes or more without taking a break to look far away.

That seems to contribute. Hell. What's the mechanism there? The thinking is your eye accommodates. It strains a bit to maintain that close focus and that constant accommodative effort might send signals telling the eye, Hey, we need to be longer to make this easier. Reinforcing that elongation process, huh?

And the fourth risk factor ethnicity? Uh. Individuals of Asian descent have a statistically higher prevalence and often faster progression of myopia. Okay, so this leads to the timeline question. Does this progression, this eye stretching. Ever actually stop. Is there an age where someone can breathe? Easy for many people, yes.

The data suggests about half the population stops progressing by around age 15, that number jumps up significantly. Maybe 77% are stable by age 18 and by age 20, about 90% have stopped changing. 90% sounds pretty good. It does. But here's the catch, especially for elite athletes, that leaves 10% of individuals, people who are maybe 21, often just starting their pro careers or playing high-level college sports.

They are still experiencing changes in their prescription. And like we talked about for them, even a small change, half a diop. Exactly. It can be enough to take away that critical performance edge. Dropping them from 20/12 or 20/15 down towards 20/20, performance suffers, which underscores the need for constant vigilance.

Right. Not just a standard eye check. Absolutely. That's why we push for a yearly. Really thorough sports vision evaluation, not just a basic health check. A general eye doctor might see 20/20 in that 21-year-old athlete, and again, say You're fine. Yeah. But a specialist, someone who's worked with pros for, you know, 30 years like Dr. Laby, he sees that change from a previous 20/12 baseline and knows action is needed. We have to maintain that peak competitive clarity. Okay. The stakes are clear. Let's shift from the why this is so critical to the how. Mm-hmm. You mentioned three modern research-backed ways to actually control this progression to limit the eye growth.

What are they? Right. We have three main tools in the toolbox. The first one is called orthokeratology. We often shorten it to ortho K. Think of it like braces for your eyes, braces you wear at night. Exactly. These are specially designed rigid contact lenses. You put them in before you go to sleep. While you sleep, they gently, temporarily reshape the front surface of your eye, the cornea.

Then you take them out in the morning and boom. You typically have clear 20/20 vision all day long, no need for glasses or contacts during the day. Wow, that sounds amazing. For athletes, especially in non contact sports or swimming where daytime lenses are a hassle or impossible, what are the downsides? Any risks.

The main things to consider are, um, a slightly increased risk of corneal infection compared to not wearing lenses, but that's managed with really good hygiene and costs can be a factor. These are custom lenses. They need careful fitting and periodic replacement, but that freedom from daytime correction is a huge plus for many athletes.

Okay. That's mentioned one. Ortho K night lenses. Method two involves contacts you wear during the day. Yes. These are specialized multifocal soft contact lenses. They look and feel mostly like regular soft contacts you wear daily, but their design is the clever part. They have a central zone that provides clear distance vision, just like a standard lens, but the outer part.

The periphery of the lens has a different power, a different prescription. And that peripheral part isn't really foreseeing clearly, is it? It's doing something else exactly right. It's designed to manipulate how light focuses on the sides of the retina, the peripheral retina, we call it creating peripheral defocus.

Okay. So the lens is basically sending a signal to the eye, like, Hey, the focus out here on the edges looks good. Maybe even a bit too far forward. So you don't need to keep growing longer to catch up. That's the theory and it works. Myopia happens partly because peripheral light ray tend to focus behind the retina, which is thought to be a signal for the eye to elongate these multifocal lenses, pull that peripheral focus forward, landing it on or even slightly in front of the peripheral retina.

This seems to cancel out that growth signal. And there's specific lenses approved for this, right? Mm-hmm. Based on studies. Absolutely. A good example is the MiSight lens from CooperVision. It was specifically studied and gained FDA approval for its effectiveness in slowing myopia progression in children when worn consistently.

But yeah, consistency is key. You generally need to wear 'em daily for several years to get the full benefit. Okay, ortho K at night, special multifocals during the day. That leaves method three. Which is an eye drop. Correct. This involves using low dose atropine, eyedrops. Now, atropine itself isn't new. It's been used for a long time in medicine, even for the heart, and ophthalmologists use it at full strength, 1% to dilate pupils for eye exams, right?

Those drops that make everything blurry and light sensitive for hours. How can that possibly help control myopia without those side effects? Oh, that's the crucial part, right? The dose. The concentration we use for myopia control is incredibly weak. It's typically 0.01%. That's literally one 100th of the strength used for dilation. One 100th.that seems negligible. How does such a tiny amount even work? It's fascinating, isn't it? It's so low that it generally doesn't cause noticeable pupil dilation or blurred near vision, which are the common side effects of the full strength drop. Yeah. Yet research shows that this minuscule amount is somehow enough to interact with.

Specific receptors. We think primarily in the sclera, the white. Outer part of the eye and essentially signal the eye to slow down or stop its elongation process. So it's not directly changing the focus of light like the lenses do. It's more like a biochemical signal to stop growing precisely. It seems to interrupt the growth cascade itself.

This makes it a great option, especially maybe for younger kids who might have trouble handling contact lenses safely, or for...