Progressive Myopia

Progressive myopia, also known as degenerative myopia or malignant myopia or pathological myopia, is a clinical type of myopia or short-sightedness associated with some typical degenerative changes in the fundus.

Associations: Pathological myopia has been associated with other ocular and systemic diseases. These conditions include Down’s Syndrome, Ocular Albinism, Infantile Glaucoma, Marfan’s Syndrome, Retinopathy of Prematurity, Ehler’s-Danlos Syndrome, low birth weight, and maternal alcoholism.

Symptoms: Impaired distant vision, eye-strain, black floaters and flashes of light, delayed dark adaptation or even night blindness, exophoria or divergent squint.

Signs: 1.prominent eyeball(pseudo-proptosis),2.larger cornea, 3.large pupil, 4.deep anterior chamber, 5.degeneration of vitreous.

Ophthalmoscopically, 1.Optic disc-large disc with mild pallor, temporal or annular crescent, posterior staphyloma. 2.Macula: dull, Foster-Fuchs fleck(spot) & degeneration. 3.General fundus: pale and tessellated appearance. Choroidal sclerosis and patches of choroidal atrophy. 4.Peripheral retina: Cystoid degeneration

Complications: 1.Retinal tear->Vitreous Haemorrhage 2.Retinal Detachment 3.Degeneration of vitreous 4.Primary Open Angle Glaucoma 5.Posterior cortical cataract.

Treatment:

1.Glasses: Appropriate concave lens with slight under-correction (Disadvantage: minification of object, image distortion, decrease in field of vision, cosmetic problem)

2.Contact lenses: (Advantage:less minification of image, no image distortion, no decrease in field of vision, no cosmetic problem)

3.Surgery: i.Radial keratotomy, ii.Keratomileusis iii.Fukala’s operation iv.Clear lens extraction(ECCE with PC-IOL) v.Minus phakic AC or PC IOL implantation vi.Intra-corneal rings insertion in paracentral area of cornea

4.LASER:1.Photo-refractive keratoplasty. 2.LASIK(Laser Assisted Stromal In Situ Keratomileusis)-more popular, but costly.

D.General Measures: Nutritious diet, proper positioning of head while reading in bright illumination, Fresh environment.