BY:
ACHIN PANT
3RD YEAR MBBS
MYOPIA
t is a refractive state of eye in which parallel rays of
light coming from infinity are focused in front of
retina, when accommodation is at rest
t is otherwise known as “short-sightedness”
GENERAL EYE MEASUREMENTS
IN MYOPIA
ean corneal power is 1D>emmetropes & hypermetropes
ean chamber depth is 3.67mm(2.8-4.55)
ean lens power is 17-35D
ange of axial length: 21.62-26.37mm(low
myopia)
21.88-34.77mm(high
myopia)
CLASSIFICATION
ETIOLOGICAL
XIAL MYOPIA
URVATURAL MYOPIA
OSITIONAL MYOPIA
NDEX MYOPIA
UE TO EXCESSIVE ACCOMODATION
AXIAL MYOPIA Results from increase in AP length
of the globe
CURVATURE MYOPIA Increased curvature of cornea
POSITIONAL MYOPIA Anterior displacement of crystalline
lens in the eye
INDEX MYOPIA Increase in the refractive index of
crystalline lens
DUE TO EXCESSIVE Inpatients with spasm of
ACCOMMODATION accommodation
CLINICAL
ONGENITAL MYOPIA
IMPLE(LOW MYOPIA)
NTERMEDIATE (MEDIUM, MODERATE MYOPIA)
ATHOLOGICAL MYOPIA
HILDHOOD(SCHOOL MYOPIA)
CQUIRED MYOPIA
CONGENITAL MYOPIA
resent since birth
sually diagnosed at the age of 2-3 yrs
ostly unilateral, manifests as ANISOMETROPIA
hild may develop convergent squint
rror is about 8-10D remains constant
t may be associated with congenital anamolies like cataract, aniridia,
micropthalmos, megalocornea etc.
SIMPLE MYOPIA
evelopment of eye is normal
t occurs because there is a correction failure between total
refractive power(of lens and cornea)& normal axial length
ost eyes have around <3D, some have around 3-5D
rescent formation is absent in the fundus
xial length is about 22mm-25.5mm
ETIOLOGY
hysiological variation in the length of the globe
ole of diet
edigree analysis
xcessive near work
SYMPTOMS SIGNS
Clinical features
Poor distant vision Prominent eyeballs
Asthenopic symptoms Anterior chamber deeper than normal
Half shutting of eyes in children Pupils large and sluggishly reacting
Fundus is normal
INTERMIDDIATE MYOPIA
erm given by “OTSUKA”
n these cases posterior segment expansion is greater than
normal
robably an exaggerated enlargement of the normal
postnatal distension of the oro equitorial zone
eredity and environmental factors interact to produce this
abnormality
xial length of globe is 25.5-32.5mm
ost commonly found in the eye with 3-8D of myopia
ncidence of glaucoma & retinal detachment are
increased in these cases
nlike pathological myopia, here eyes however do not
have posterior staphyloma
PATHOLOGICAL MYOPIA
t is defined as occular disease in which a number of serious
complication are associated with excessive axial elongation of the eye
t is an autosomal recessive trait
ost cases of myopia related blindness & it is essentially hereditary
disease
sine-qua-non” of this disease is presence of posterior staphyloma……
or k/s SCARPA’s staphyloma
ecreased scleral resistance & increased expansion forces results in
staphyloma formation
efractive error usually above 6-8D & it’s a
degenerative change
xial length is over 32.5mm in almost all cases
t starts at childhood at 5-10 yrs of age and results in
high myopia in early adult life
ETIOLOGY
MAINLY TWO MAIN THEORIES ARE GIVEN
1) Role of heredity
2)Role of growth process
ROLE OF HEREDITY
t is now confirmed that genetic factors play a major
role in the etiology
t is believed that heredity linked growth of retina is
the determinant in the development of myopia
ROLE OF GENERAL GROWTH
PROCESS
he factors such as nutritional deficiency, debiliating
diseases and indifferent general health which effect
the general process will also influence the progress of
myopia
Genetic factors
More growth of retina
Stretching of sclera
Increased axial length
Degeneration of choroid
Degeneration of retina
Degeneration of vitreous
Symptoms
efective vision
uscae volitantes
ight blindness
signs
rominent eye balls
orneal thinning, anterior iris insertion
nterior chamber is deep, scleral fibers are of small
dimension
horoidal vascular occlusion
upils is slightly large and react sluggishly to light
FUNDAL CHANGES
ptic disc appears large and pale and at its temporal edge
a characteristic myopic crescent is present
egeneration changes in retina & choroid are common
in progressive myopia
n peripheral retina there is attenuated cystoid changes
with formation of “BLESSIG-IWANHOFFS CYSTS”
OSTER-FUCHS’ spot may be present at the macula
amina vitrea shows thinning splitting & rupture
osterior staphyloma due to ectasia of sclera at posterior pole may
be apparent as an excavation with the vessels bending backward
over its margins
ptic nerve is oval & cup-disc ratio is increased
egenrative changes in vitreous include liquefaction, vitreous
opacities & posterior vitreous detachment appears as WEISS’ reflex
isual fields show contraction and in some cases ring scotoma is
present
RG reveals subnormal electroretinogram due to chorioretinal
atrophy
COMPLICATIONS
etinal detachment
omplicated cataract
itreous hemorrhage
trabismus fixus convergence
CHILDHOOD MYOPIA
ts is otherwise k/s school myopia
ccurs at 5-12 yrs of age
ends to demonstrate earlier and may continue upto 3rd decade
ONDERS recognised two types of childhood myopia
1) stationary type
2) progressive type
AQUIRED MYOPIA
ost- traumatic
ost-keratitic
rug induced
seudomyopia
pace myopia
ight myopia
onsecutive myopia
INVESTIGATIONS
isual acuity
undus examination
etinoscopy
ntraocular pressure
nvestigations to rule out any systemic disorder like DM, TB
etc..
TREATMENT
IM:
revention of myopia from development
revention of myopia progression, management of
complications & visual rehabilitation
PTICAL TREATMENT
URGICAL TECHNIQUES
OW VISION AIDS
ENETIC COUNSELLING
1. OPTICAL TREATMENT
t constitutes prescription of appropriate concave
lenses, so that clear image is formed on retina
t the same time
orrected by concave lenses
2. SURGICAL TECHNIQUES
hotorefractive keractectomy
aser in-situ keratomileusis
xtraction of clear crystalline lens
hakic intraocular lens
ntercorneal ring transplantation
rthokeratology
PHOTOREFRACTIVE
KERATECTOMY
n this technique a central optical zone of anterior
corneal stroma is photoablated by using excimer
laser(193nm UV flash) to cause flattening of central
cornea
t provides good correction for -2 to -6D of myopia
LASER IN-SITU KERATOMILEUSIS
t is widely accepted treatment modality among all
choices
t can correct myopia upto -12D
PATIENT SELECTION
atient above 21 years of age
ho have suitable refractive error above 12 months
ho have had unsatisfactory results with non-surgical
treatment
n whom corneal thinning disorders that lead to curvature
myopia such as keratoconus have been ruled out
ADVANCES IN LASIK
USTOMIZED LASIK: C-LASIK is based on the wave
front technology
It corrects abberations present in the eye
alongwith spherical & cylindrical corrections
-LASIK: in this technique instead of corneal stromal
flap only the epithelial sheet is separated
mechanically with the use of a customized device
ADVANTAGES
inimal or no postoperative pain
ecovery of vision early
o risk of perforation of globe
o residual haze
ffective in correcting myopia of abt -12D
DISADVANTAGES
xpensive
equires greater surgical skill
lap related complications more
EXTRACTION OF CRYSTALLINE
LENS
FUCALA’S OPERATION”
mployed for myopia upto -16 to -18D mostly in
unilateral cases
ecently extraction o lens and implantation of IOL is
done to correct myopia> 12D
PHAKIC IOL
n this technique a special type of intraocular lens is
implanted in anterior or posterior chamber anterior
to the natural crystalline lens
orrection can be done for myopia>12D
INTRACORNEAL RING
IMPLANTATION
nto the peripheral cornea at 2/3rd stromal depth
t has a vaulting effect which flattens the central
cornea decreasing myopia
t’s a reversible process
ORTHOKERATOLOGY
t’s a non surgical procedure in which moulding of
cornea takes place by overnight wear unique rigid gas
permeable lenses are used
t can correct myopia upto -5D
3. LOW VISION AIDS
sed for progressive degenerative myopia where vision
cant be corrected by lens and spectacles
4. GENETIC COUNSELLING
enetic counselling regarding heredity of myopia
should be explained to the patients
BIBLIOGRAPHY
PHTHALMOLOGY-SHORT
TEXTBOOK(GERHALD.K.LANG)
LINICAL METHODS IN
OPHTHALMOLOGY(SANDEEP SAXENA)
ARSONS’ DISEASES OF EYE
. K. KHURANA
