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Ocular morbidity in myopia
... [1][2][3][4] This is concerning because it carries a lifelong risk of visual impairment due to associated ocular comorbidities such as retinal detachment, choroidal neovascularisation and macular atrophy. [5][6][7] To address this, active interventions are necessary to prevent the onset and progression of myopia. ...
Objective The objective of this study was to assess the efficacy of low-dose atropine 0.01% in controlling myopia progression among Indian children over a 2-year period.
Methods This retrospective study, conducted across 20 centres in India, monitored the progression of myopia over 2 years after initiating treatment with 0.01% atropine eye drops. This included children between 6 and 14 years with baseline myopia ranging from −0.5 D to −6 D, astigmatism≤−1.5 D, anisometropia ≤ −1 D and documented myopia progression of ≥0.5 D in the year prior to starting atropine. Subjects with any other ocular pathologies were excluded.
Results A total of 732 children were included in the data analysis. The mean age of the subjects was 9.3±2.7 years. The mean myopia progression at baseline (1 year before starting atropine) was −0.75±0.31 D. The rate of myopia progression was higher in younger subjects and those with higher baseline myopic error. After initiating atropine, myopia progression significantly decreased to −0.27±0.14 D at the end of the first year and −0.24±0.15 D at the end of the second year (p<0.001). Younger children (p<0.001) and higher baseline myopia (p<0.001) was associated with greater myopia progression and poor treatment response (p<0.001 for both).
Conclusion Low-dose atropine (0.01%) effectively reduces myopia progression over 2 years in Indian children.
... Progression of myopia can lead to significant irreversible changes in the eyeball resulting in loss of vision. Complicated myopia is one of the main causes of invalidation as a result of ocular pathologies [1][2][3][4][5]. The frequency of myopia in developed countries of the world is 19-42%, reaching in some eastern countries 70% [6,7]. ...
Background: Myopia is labeled as one of the most common eye disorders, one of the most effective methods of its treatment being orthokeratological treatment. Anisometropic amblyopia continues to be treated by optical correction applied separately or in combination with occlusion or other therapies. Material and methods: The study included 32 patients (64 eyes), who were divided by 8 patients (16 eyes) into 4 groups (2 primary and 2 control), depending on the presence or absence of amblyopia and the degree of myopia (small and medium). Subjects in the baseline group underwent combined treatment between orthokeratology and physiotherapy. Results: The combined treatment resulted in the decrease of myopia according to the spherical equivalent by 60% in patients with amblyopia and mild myopia and from 90% in those without amblyopia. The values of the antero-posterior axis had a similar dynamic (p <0.001). In patients with moderate myopia its evolution decreased by 95% compared to patients with amblyopia – by 60%. The degree of anisometropia decreased by 10% (p > 0.05). Corrected visual acuity depending on the degree of amblyopia increased by 50% in cases with mild amblyopia and 150% in cases with moderate amblyopia (p < 0.001). The absolute volume of accommodation increased by 70% in patients with mild amblyopia and by 300% in patients with moderate amblyopia (p <0.001). Conclusions: It is rational to apply refractive therapy in the treatment and prevention of acquired uncomplicated myopia, with an average index of quality of life of 93.1%, versus 39.3% for optical correction.
... Myopia has emerged as one of the major public health issues worldwide, particularly affecting up to 80-90% of young adults in East Asia [1][2][3][4][5][6][7]. Although myopia can be corrected using spectacles, contact lenses, or refractive surgery, pathologic myopia is associated with sightthreatening complications, such as myopic macular degeneration, retinal detachment, glaucoma, and choroidal neovascularization [8][9][10]. ...
Background/objectives:
Myopia progression is of great concern because of its association with an increased risk of sight-threatening conditions. This study aims to determine whether certain clinical and optic disc features are associated with the rate of myopia progression.
Subjects/methods:
In this retrospective longitudinal observational study, we reviewed the medical records of 95 patients aged 6-11 years with myopia (spherical equivalent refractive error (SER) at baseline ≤ -0.5 D) and collected data regarding medical history, comprehensive ophthalmologic examination, and fundus photography. Using fundus photographs, we measured the ratio of horizontal to vertical disc diameter (HVDR), ratio of maximum β-zone peripapillary atrophy (β-PPA) width to vertical disc diameter (PVDR), and optic disc torsion. Outcome measurements included 2-year myopia progression (D/year) and overall myopia progression during the entire follow-up with a mean of 51 months.
Results:
Mean age at initial visit was 7.67 ± 1.50 years and mean SER at baseline was -2.91 ± 1.68 D (range, -5.75 to -0.50 D). In the univariate analysis, age, parental myopia, SER at baseline, HVDR, and PVDR were significantly associated with myopia progression (P < 0.05). In the multivariate analysis, however, only age at initial visit and PVDR were significant factors associated with both 2-year and overall myopia progression.
Conclusions:
Children with younger age and smaller β-PPA at baseline showed a faster myopia progression. This study suggests that the width of β-PPA, regardless of SER, might be used as a quantitative parameter to predict the potential for further myopia progression associated with scleral stretching.
... The prevalence of myopia has been increasing throughout the world, reaching more than 90% in some populations in eastern Asia. 1 It is a predisposing factor for retinal detachment, macular degeneration, and glaucoma, which can lead to loss of vision and, ultimately, blindness. [2][3][4][5] The associated risk for these complications increases with the severity of myopia and axial length. 5 The World Health Organization identified myopia as one of the five leading causes of blindness and visual impairment worldwide. ...
Purpose:
To compare the progression of myopia in eyes that underwent unilateral refractive surgery with non-operated eyes.
Methods:
Three patients who underwent refractive myopic correction in one eye are described. The collected preoperative and postoperative data included age, gender, subjective refraction, best corrected visual acuity, and uncorrected visual acuity.
Results:
The first patient (19-year-old woman) had photorefractive keratectomy in her left eye and the myopic progression was 1.20 diopters (D) (3 years postoperatively) compared to -2.50 D in her non-operated eye. The second patient (30-year-old man) had laser-assisted in situ keratomileusis in his left eye with a myopic progression of 0.25 D compared to 0.75 D in his non-operated eye (10 years postoperatively). The third patient (22-year-old man) underwent photorefractive keratectomy in his right eye with no myopic progression compared to -1.50 D in his non-operated eye (3 years postoperatively).
Conclusions:
These three cases suggest that refractive surgery for myopia correction may be associated with a slower progression of myopia postoperatively. [J Pediatr Ophthalmol Strabismus. 2019;56(2):78-82.].
... 14 Myopia progression is associated with an increased risk of vision-threatening eye abnormalities, such as glaucoma, macular degeneration, retinal detachment, and chorioretinal degeneration. [15][16][17][18] Additionally, patients diagnosed with myopia at a younger age are more likely to develop severe visual impairment and blindness later in life than patients diagnosed with myopia at an older age. 12,19,20 It should also be noted that myopia is associated with a considerable socioeconomic burden. ...
Purpose
To compare rates of myopia progression and adverse events between orthokeratology (OK) and soft contact lens (SCL) wearers over a 10‐year period in schoolchildren.
Methods
Medical records of consecutive patients (≤16 years of age at baseline) who started OK for myopia correction and continued the treatment for 10 years were retrospectively reviewed. For the control group, patients who started using soft contact lenses (SCLs) for myopia correction and continued to use them for 10 years were also reviewed. Clinical data, including sex, age, manifest refraction, visual acuity, prescription lens power, and adverse events during the 10‐year period, were recorded. Estimated myopia progression was calculated as the sum of ‘changes in prescription lens power during 10 years’ and ‘residual refractive errors at the 10‐year visit,’ and was compared between groups. We also compared the incidence of adverse events between groups over the 10‐year study period.
Results
A total of 104 eyes of 53 patients who underwent OK treatment and 78 eyes of 39 patients who wore SCLs fulfilled the criteria. The estimated myopia progression over the 10‐year period found in the OK and SCL groups were −1.26 ± 0.98 and −1.79 ± 1.24 days, respectively; this difference was statistically significant (p = 0.001). Additionally, lower myopia progression was found in the OK in comparison to the SCL group at all baseline ages (p = 0.003 to p = 0.049) except at 16 years old (p = 0.41). No significant difference was found in the number of adverse events found between the OK (119) and SCL (103) groups (p = 0.72).
Conclusions
The results of this study supports the long‐term efficacy and safety of OK lens wear in reducing myopia progression in schoolchildren.
... 12 Yüksek miyopi olarak kabul gören değer en az -6 diyoptri miyopinin olmasıdır. 13 Daha önceki çalışmalar, yüksek miyopinin, yırtıklı retina dekolmanında en önemli risk faktörü olduğunu göstermiştir. 14 Çalışmamıza aldığımız hastaların tümünde en az bir retina yırtığı ve minimum -6 diyoptrilik bir miyopi mevcuttu. ...
... Myopia and, above all, elevated myopia (>6 D) presents a high risk of ocular morbidity. It is an inherited condition characterized by a degenerative chorioretinal atrophy linked to an excessive lengthening of the eye ball [1]. Among the various alterations, myopia is associated with a greater risk of problems such as macular holes, lacquer cracks, and choroidal neovascularization (CNV). ...
Aim of the present work has been to evaluate the effects in both the treated
and the contra lateral eye of mono-lateral intra vitreal treatment with Ranibizumab
(LUCENTIS®) in a 46-year-old woman affected by bilateral myopic choroidal
neovascularization.
A 46-year-old woman presented a best-corrected visual acuity of 8/10 in the
right eye, and 1/20 in the left eye. Fundus examination revealed a bilateral myopic
choroiditis and a foveal neovascularization in the left eye that was confirmed by OCT
analysis. The flicker ERG response was also altered in both eyes.
The subretinal neovascularization in the left eye was treated by an intravitreal
injection of ranibizumab. After 8 days the OCT and the flicker ERG showed no
improvement, and a second injection of ranibizumab was given one month after the
first. Twenty days later OCT and flicker ERG showed a significant improvement both in
the left, treated eye, but also in the right, untreated eye.
In conclusion, ranibizumab apparently inhibited VEGF induction of new vessel
formation and the following edema due to the leakiness of these new vessels and the
rupture of the blood-retinal barrier in the treated eye. Evidently, it also diffused via
the hematic and/or neuronal route to the contralateral eye where it also exerted a
detectable improvement of the local conditions.
... High myopia or myopia with increased risks of ocular morbidity can be defined as a spherical equivalent of at least-6 OD. The resulting ocular pathology is usually due to excessive elongation of the eyeball and associated with pathological changes in the fundus [2]. ...
Myopia has become a big public health problem in certain parts of the world. Sight-threatening complications like choroidal neovascularisation membranes occur in up to 10% of pathological myopia, and natural history studies show a trend towards progressive visual loss. There are long-term financial and quality-of-life implications in this group of patients, and treatment strategies should aim for long-term preservation of vision.
A 56-year-old Caucasian woman presented with a best-corrected visual acuity of 6/6-1 in her right eye and 6/24 in her left. Fundal examination revealed pathological myopia in both eyes and an elevated lesion associated with pre-retinal haemorrhage in the left macula. Ocular coherence tomography and fundus fluorescein angiogram confirmed a subfoveal classic choroidal neovascularisation membrane. The patient decided to proceed with intravitreal ranibizumab (0.5 mg) therapy. One month after treatment, best-corrected visual acuity improved to 6/12 in her left eye, with complete resolution subretinal fluid on ocular coherence tomography. After three months, best-corrected visual acuity further improved to 6/9, which was maintained up to 16 months post-treatment.
We suggest intravitreal ranibizumab as an alternative treatment for long-term remission of myopic choroidal neovascular membrane. It also suggests that myopic choroidal neovascularisation membranes may require fewer treatments to achieve sustained remission. Furthermore, this could serve as a feasible long-term management option if used in conjunction with ocular coherence tomography.
... Common definitions of high myopia or myopia with increased risks of ocular morbidity, include spherical equivalent (SphE) of at least -6.0 D, SphE at least -8.0 D, or SphE at least -10.0 D. Ocular pathology is usually due to excessive elongation of the eyeball and associated with pathological changes in the fundus (Goldschmidt, 1988;Tokoro, 1988). The terms Ômalignant myopiaÕ, Ôdegenerative myopiaÕ and Ôpathological myopiaÕ have also variously been used to describe myopia accompanied by degenerative changes in the sclera, choroid, retinal pigment epithelium and associated compromises in visual function (Duke-Elder, 1970;Daubs, 1982). ...
Besides the direct economic and social burden of myopia, associated ocular complications may lead to substantial visual loss. In several population and clinic-based cohorts, case-control and cross-sectional studies, higher risks of posterior subcapsular cataract, cortical and nuclear cataract in myopic patients were reported. Patients with high myopia (spherical equivalent at least -6.0 D) are more susceptible to ocular abnormalities. The prevalent risks of glaucoma were higher in myopic adults, and risks of chorioretinal abnormalities such as retinal detachment, chorioretinal atrophy and lacquer cracks increased with severity of myopia and greater axial length. Myopic adults were more likely to have tilted, rotated, and larger discs as well as other optic disc abnormalities. Often, these studies support possible associations between myopia and specific ocular complications, but we cannot infer causality because of limitations in study methodology. The detection and treatment of possible pathological ocular complications is essential in the management of high myopia. The ocular risks associated with myopia should not be underestimated and there is a public health need to prevent the onset or progression of myopia.
Given the opportunity of presenting a review on oculometry, my title for theTokyo 1992 abstract book was as given above. Coming down to facts, however,it proved impossible within a single lecture to cover the full subject:The amount of ultrasound work in the field is far too voluminous and varied.
Our prospective study was conducted to compare axial length elongation in myopic children receiving long-term overnight orthokeratology (OK) treatment to those wearing spectacles as controls.
There were 59 subjects enrolled in this study. The OK group comprised 29 subjects who matched the inclusion criteria for OK. The control group comprised 30 subjects who also matched the inclusion criteria for OK, but preferred spectacles for myopia correction. Axial length was measured periodically for 5 years using an IOLMaster device, and the time course of changes was evaluated and compared between the groups.
A total of 43 subjects (22 and 21 in the OK and control groups, respectively) completed the 5-year follow-up examinations. At baseline, the mean age ± SD was 10.04 ± 1.43 and 9.95 ± 1.59 years, the spherical equivalent refractive error was -1.89 ± 0.82 and -1.83 ± 1.06 diopters (D), and the axial length was 24.09 ± 0.77 and 24.22 ± 0.71 mm in the OK and control groups, respectively, with no significant differences between the groups. The increase in axial length during the 5-year study period was 0.99 ± 0.47 and 1.41 ± 0.68 mm for the OK and control groups, respectively, and the difference was statistically significant (P = 0.0236, unpaired t-test). The annual increases in axial length were significantly different between the groups for the first (P = 0.0002), second (P = 0.0476), and third years (P = 0.0385), but not for the fourth (P = 0.0938) and fifth (P = 0.8633) years. There were no severe complications throughout the study period.
The current 5-year follow-up study indicated that OK can suppress axial length elongation in childhood myopia.
Choroidal neovascularization (CNV) secondary to pathological myopia (PM) occurs in up to 10 % of PM and the natural course often leads to a considerable deterioration of visual acuity. Treatment options like laser or PDT can stabilize visual acuity. Alternatives like ranibizumab are new treatment options that show very promising results. It was the aim of this analysis to evaluate the development of visual acuity and the number of injections needed in patients with myopia-associated secondary CNVs.
We retrospectively analysed 10 eyes of 9 patients (7 women, 2 men, mean age: 66 years, SD 8.3; range: 54 - 78 years) treated with ranibizumab because of CNV secondary to PM. All eyes were treatment naïve. Criteria for re-treatment were loss of visual acuity and/ or activity in OCT or fluorescence angiography.
During the mean follow-up of 10 months (SD 6.1; range: 6 to 26 months) a mean of 2.5 (SD 1.6, range: 1 to 5) injections of ranibizumab was applied. The spherical equivalent was - 12 D (SD 4.8, range - 7,5 D to - 20.5 D). Previous to the first injection mean visual acuity was logMAR 0,64 (SD 0.20) (ETDRS: 52.8; SD: 11.4) and during the follow-up a mean of 3.4 lines (ETDRS: 16.5 letters) was gained (p = 0.008). After one month visual acuity improved to log MAR 0.47 (SD 0.1, p = 0.0012) (ETDRS: 61.7; SD: 6.5), after 3 months log MAR 0.38 (SD 0.1, p = 0.012) (ETDRS: 65.8; SD: 5.6) and after 6 months up to log MAR 0.35 (SD 0.1, p = 0.008) (ETDRS 67.3; SD 5.6). At the end of the follow-up visual acuity was log MAR 0.30 (SD 0.1) (ETDRS: 69.3; SD: 6.7).No patient experienced a loss of visual acuity. No ocular or systemic side effects were observed.
According to our results treatment of CNV secondary to PM with ranibizumab leads to a substantial improvement of visual acuity. It seems that successful treatment of CNV secondary to PM needs less anti-VEGF injections than the treatment of neovascularizations due to age-related macular degeneration. Anti-VEGF seems to be a promising alternative to PDT and laser photocoagulation in myopia-related CNV.
This prospective study was conducted to assess the influence of overnight orthokeratology (OK) on axial elongation in children, with those wearing spectacles as controls.
One hundred five subjects (210 eyes) were enrolled in the study. The OK group comprised 45 patients (90 eyes, age 12.1 ± 2.5 years, mean ± SD; OK group) who matched the inclusion criteria for OK. The control group comprised 60 patients (120 eyes, 11.9 ± 2.0 years) who also matched the inclusion criteria for OK but preferred spectacles for myopia correction. Axial length was measured at baseline and after 2 years using ocular biometry, and the changes were evaluated and compared between the groups.
Ninety-two subjects (42 and 50 in the OK and control groups, respectively) completed the 2-year follow-up examinations. At baseline, the spherical equivalent refractive error was -2.55 ± 1.82 and -2.59 ± 1.66 D, and the axial length was 24.66 ± 1.11 and 24.79 ± 0.80 mm in the OK and control groups, respectively, with no significant differences between the groups. The increase in axial length during the 2-year study period was 0.39 ± 0.27 and 0.61 ± 0.24 mm, respectively, and the difference was significant (P < 0.0001, unpaired t-test).
OK suppressed axial elongation in myopic children, suggesting that this treatment can slow the progression of myopia to a certain extent.
To assess the longitudinal changes in biometric parameters and associated factors in young myopic children aged 7--9 years followed prospectively in Singapore.
Children aged 7--9 years from three Singapore schools were invited to participate in the SCORM (Singapore Cohort study Of the Risk factors for Myopia) study. Yearly eye examinations involving biometry measures were performed in the schools. Only myopic children (n=543) with 3 year follow up data were included in this analysis.
The 3 year increases in axial length, anterior chamber depth, lens thickness, vitreous chamber depth, and corneal curvature were 0.89 mm, -0.02 mm, -0.01 mm, 0.92 mm, and 0.01 mm, respectively. Children who were younger, female, and who had a parental history of myopia were more likely to have greater increases in axial length. After adjustment for school, age, sex, race, parental myopia and reading in books per week, the age (p<0.001), sex (p=0.012), and parental myopia (p=0.027) remained significantly associated with the 3 year change in axial length. Reading in books per week, however, was not associated with axial length change. Children with faster rates of progression of myopia had greater increases in axial length (Pearson correlation coefficient (r)=-0.69) and vitreous chamber depth (r=-0.83).
The 3 year change in axial length of Singapore children aged 7--9 years at baseline was high and greater in younger children, females, and children with a parental history of myopia. Myopia progression was driven largely by vitreous chamber depth increase.
To evaluate the efficacy and safety of topical atropine, a nonselective muscarinic antagonist, in slowing the progression of myopia and ocular axial elongation in Asian children.
Parallel-group, placebo-controlled, randomized, double-masked study.
Four hundred children aged 6 to 12 years with refractive error of spherical equivalent -1.00 to -6.00 diopters (D) and astigmatism of -1.50 D or less.
Participants were assigned with equal probability to receive either 1% atropine or vehicle eye drops once nightly for 2 years. Only 1 eye of each subject was chosen through randomization for treatment.
The main efficacy outcome measures were change in spherical equivalent refraction as measured by cycloplegic autorefraction and change in ocular axial length as measured by ultrasonography. The primary safety outcome measure was the occurrence of adverse events.
Three hundred forty-six (86.5%) children completed the 2-year study. After 2 years, the mean progression of myopia and of axial elongation in the placebo-treated control eyes was -1.20+/-0.69 D and 0.38+/-0.38 mm, respectively. In the atropine-treated eyes, myopia progression was only -0.28+/-0.92 D, whereas the axial length remained essentially unchanged compared with baseline (-0.02+/-0.35 mm). The differences in myopia progression and axial elongation between the 2 groups were -0.92 D (95% confidence interval, -1.10 to -0.77 D; P<0.001) and 0.40 mm (95% confidence interval, 0.35-0.45 mm; P<0.001), respectively. No serious adverse events related to atropine were reported.
Topical atropine was well tolerated and effective in slowing the progression of low and moderate myopia and ocular axial elongation in Asian children.