Myopiekontrolle: aktuelle Strategien

Purpose. The prevalence of myopia is increasing worldwide and its long-term effects can have major impacts on eye health. Paediatric onset of myopia leads to a higher risk for developing high levels of myopia in adulthood. Slowing down or stopping myopia progression is an important task for the future. Material and Methods. Based on a literature review, the latest developments in the field of myopia control for children were summarized. The current study situation for orthokeratology, soft contact lenses, atropine therapy and spectacle lenses for the management of myopia is discussed in detail. Results. Results on the safety and effectiveness of orthokeratology and modified soft contact lenses are exceedingly consistent. Soft multifocal contact lenses, as well as newer spectacle lenses, recently received regulatory approval for myopia control. Studies on the administration of atropine recommend a dosage of 0.01 - 0.05 %. All methods slow down myopia progression and decrease axial length growth of the eye. Side effects, adverse events or discontinuation of treatment only occur in the rarest of cases. Orthokeratology and atropine continue to deliver the best results. Conclusion. From today’s perspective, carrying out myopia control can be recommended with great certainty. The choice of method depends on the individual requirements of each patient, with all methods offering success in reducing myopia progression. In the future, even more advanced contact lens geometries, more precise atropine dosages or improved optics of spectacle lenses will further increase the success of the treatment. Keywords. Progressive myopia, myopia control, children, contact lenses, atropine, spectacle lenses

Assessment of cerebral blood flow in children with myopia in combination with undifferentiated connective tissue dysplasia

Background. In practice, patients with numerous undifferentiated forms of connective tissue dysplasia are more common. With regard to the combination of myopia and undifferentiated connective tissue dysplasia, one of the links in the mechanism of origin of this refractive anomaly is decreased thickness of the sclera and a change in its elastic parameters. Myopia in children often occurs against the background of impaired blood supply to the visual analyzer associated with circulatory pathology in the vertebral vessels. The purpose was to evaluate cerebral blood flow in patients with myopia in combination with undifferentiated connective tissue dysplasia. Materials and methods. The study involved 86 children (170 eyes) diagnosed with progressive myopia. All patients were consulted by related specialists to detect undifferentiated connective tissue dysplasia and underwent a complete ophthalmological exa-mination. The diagnostic coefficient of expression of phenotypic and clinical signs of undifferentiated connective tissue dysplasia was also determined using the expert table of T. Kadurina. Results. Phenotypic and clinical signs of undifferentiated connective tissue dysplasia were noted in 41 (100 %) cases when evaluating according to the criteria of T. Mil-kovskaya-Dimitrova and T. Kadurina, and in 34 (83.0 %) children du-ring screening for joint hypermobility on Beighton score. As for increased axial length of the eye in the examined patients with myopia and undifferentiated connective tissue dysplasia, it was noted that an increase had a direct correlation with the severity of undifferentiated connective tissue dysplasia, with the greatest correlation obtained in children with pronounced phenotypic manifestations in the musculoskeletal system (correlation coefficient was 0.83). Chemical regulation of carotid artery tone (respiratory failure test) is altered in the vast majority of patients with myopia. Conclusions. All children with progressive myopia are re-commended to be examined by related specialists to identify undif-ferentiated connective tissue dysplasia and hemodynamic disorders. Only a comprehensive approach to this refractive anomaly can be effective in combating its progression.

TUDY OF THE ROLE OF VITAMIN D IN CHILDREN WITH PROGRESSIVE MYOPIA

There is controversy in ophthalmic research as to whether vitamin D deficiency is an independent factor in the progression of myopia.

Influence of Chronic Ocular Hypertension on Emmetropia: Refractive, Structural and Functional Study in Two Rat Models

Chronic ocular hypertension (OHT) influences on refraction in youth and causes glaucoma in adulthood. However, the origin of the responsible mechanism is unclear. This study analyzes the effect of mild-moderate chronic OHT on refraction and neuroretina (structure and function) in young-adult Long-Evans rats using optical coherence tomography and electroretinography over 24 weeks. Data from 260 eyes were retrospectively analyzed in two cohorts: an ocular normotension (ONT) cohort (<20 mmHg) and an OHT cohort (>20 mmHg), in which OHT was induced either by sclerosing the episcleral veins (ES group) or by injecting microspheres into the anterior chamber. A trend toward emmetropia was found in both cohorts over time, though it was more pronounced in the OHT cohort (p < 0.001), especially in the ES group (p = 0.001) and males. IOP and refraction were negatively correlated at week 24 (p = 0.010). The OHT cohort showed early thickening in outer retinal sectors (p < 0.050) and the retinal nerve fiber layer, which later thinned. Electroretinography demonstrated early supranormal amplitudes and faster latencies that later declined. Chronic OHT accelerates emmetropia in Long–Evans rat eyes towards slowly progressive myopia, with an initial increase in structure and function that reversed over time.

Shaping Eyeballs by Scleral Collagen Cross-Linking: A Hypothesis for Myopia Treatment

The global prevalence of myopia has brought to the attention of the different eye and vision specialists, who make way to control its progression. Evidence have shown that a proactive reshaping of the eyeball is the core point of myopia developing process, which particularly includes the weakening, thinning, and expanding of the sclera. Thus, the sclera is considered to be a prime target for therapeutic manipulation in halting progressive myopia. In the past decades, corneal collagen cross-linking has been applied in clinical practice for treating aberrant corneal remodeling diseases. In this article, we hypothesize that scleral collagen cross-linking (SXL) has a huge potential in stabilizing myopic process by shaping the eyeball and preventing the aberrant scleral remodeling. In contrast with the current methods of optometry correction, such as physiotherapy, pharmacotherapy, spectacles, contact lenses, refractive surgeries, etc., eyeball-shaping method using SXL is a fundamental intervention which aims at the pathogenesis of progressive visual loss of myopia. Compared with the current posterior scleral reinforcement, the most advantage of SXL is that there is no allotransplant into the myopic eye, which means less expenditure, lower risk, and easier to handle in operating.

Our Experience of Using Soft Bifocal Contact Lenses in Children with Progressive Myopia

Introduction. According to the studies, one out of three myopic patients with refraction greater than –6.00 D and an axial length greater than 26 mm is at high risk of facing low vision and loss of sight in the future. According to the results of medical examinations and screenings in carried out in Ivanovo, the prevalence of myopia in primary school children has increased three times during the past twenty years. Myopic children under 7 years old are six times more likely to have myopia progressed to higher degrees than children in which myopia onset took place later (at the age of 11–12 years). Optical interventions for myopia control such as orthokeratology and soft bifocal contact lenses have a strong body of evidence and are well accepted by ophthalmologists.Purpose. The purpose of the present study was to investigate the effect of soft bifocal contact lenses on refraction, accommodation and axial length in children with progressive myopia.Materials and methods. We observed 30 children aged 8–15 years with myopia progression rate of 0.82 D/year and accommodative weakness and instability. We prescribed OKVision PrimaBio Bi-focal design soft bifocal contact lenses (OKVision, Russia) that feature +4.00 D addition power on periphery. The effectiveness was estimated by monitoring refraction, accommodation and axial length every three months within a year.Results. After 12 months of wearing soft bifocal contact lenses, the annual myopia progression rate decreased 4.3 times on average. We were able to stabilize myopia in 50% of the children during the period of monitoring. The use of this intervention had a strong effect on accommodation resulting in an increase of its amplitude and reserve.Conclusion. The use of soft bifocal contact lenses has been proven to have a strong inhibitory effect on myopia progression rate. Myopia stabilization manifested itself as the absence of increase in myopic refraction and axial length as well as normalization of accommodative function.

A novel variant in the TSPAN12 gene-presenting as unilateral myopia, pediatric cataract, and heterochromia in a patient with familial exudative vitreoretinopathy

Purpose: To report a case of 16-month-old boy with a novel variant TSPAN12 gene-presenting as unilateral myopia, pediatric cataract, and heterochromia in a patient with familial exudative vitreoretinopathy. Observation: A 16-month-old otherwise healthy boy was referred to Boston Children’s Hospital for evaluation of strabismus. Ocular examination revealed intermittent esotropia, left hypotropia, and limited left eye elevation in both adduction and abduction. Full cycloplegic hyperopic correction of +3.50 diopters (D) over both eyes was given to the patient. Over several months, refraction of the right eye showed progressive myopia (−6.00 D) with new onset iris heterochromia. Fundus examination showed there was a large area of chorioretinal atrophy with abrupt ending of the blood vessels; anterior to the ora serrata there were diffuse vitreous bands and veils that reached the lens anteriorly in direct contact with the lenticular opacity. A novel heterozygous nonsense likely pathogenic variant was identified in the TSPAN12 gene (NM_012338.3) c.315T>A (p.Cys105Ter) confirming the diagnosis of FEVR. Conclusion and importance: Asymmetric FEVR rarely present with unilateral axial myopia however association with acquired heterochromia and cataract has never been reported. We report a case of FEVR caused by a novel TSPAN12 likely pathogenic nonsense variant presenting as unilateral progressive myopia, acquired heterochromia, and pediatric cataract.

Results of treatment of myopia progression by the method of cryogenic scleroplasty

AIM: To evaluate the results of the effectiveness of cryogenic scleroplasty. MATERIALS AND METHODS: 184 children (313 eyes) (mean age 11,72 3,76 years) with moderate and high progressive myopia were examined before and after cryogenic scleroplasty (main group) and Pivovarovs scleroplasty (control group). RESULTS: A smaller average annual difference in the spherical equivalent of refraction (∆SEav) and the average annual gradient of the axial length (∆ALav) were recorded in the group of patients after cryogenic scleroplasty according to the data obtained during the two-year follow-up. ∆SEav was 0,48 0,45 diopters in the main group and 0,51 0,34 diopters in the control group in children of the younger age subgroup (up to 9 years old); 0,35 0,31 diopters in the main group and 0,69 0,61 diopters in the control group (p = 0,047) in the older age subgroup (9 years and older). ∆ALav in the main group was 0,15 0,11 mm in children under 9 years of age, 0,31 0,14 mm (p = 0,016) in the control group; 0,29 0,18 mm and 0,34 0,32 mm in children 9 years old and older, respectively. CONCLUSIONS: The proposed technology of cryogenic scleroplasty has two surgical approaches in the lower-internal and upper-external parts of the eyeball; the scleroplastic material adheres evenly to the sclera, covers all four quadrants of the eyeball; it is fixed under the rectus muscles of the eye; at a 24-months follow-up period showed a good stabilizing effect.

Еffects of optical correction methods on accomodation in children with progressive myopia (literature review)

Accommodation disorders in young people are more common than diagnosed. This review is based on the data of domestic and foreign literature and studies the effect of contact lenses of various designs on accommodation. Particular attention has been given to bifocal soft contact lenses as one of the recognized interventions for treating juvenile progressive myopia and their ability to slow axial elongation. Key words: accommodation, myopia control, bifocal contact lenses, orthokeratology.

Features of choroidal blood flow and their influence on formation of peripheral retinal degenerations in school-age children with undifferentiated connective tissue dysplasia

Purpose. To study choroidal thickness (CT) and assess its effect on frequency of occurrence dangerous types of peripheral retinal degenerations (PRD) in school-age children with myopia associated with undifferentiated connective tissue dysplasia (UCTD). Material and methods. The object of study was 62 children (124 eyes) aged 10–15 years (mean age 12.3±0.8 years) with progressive myopia associated with moderate (48 people, 77.4%) and pronounced (14 people, 22.6%) degree of UCTD. Special ophthalmologic examination included macular imaging by optical coherence tomography (RTVue 100, «Optovue», USA) to measure CT. Diagnostic criteria by T.M. Milkovskaya-Dimitrova et al (1987) were used to identify phenotypic characters of UCTD. Results. Comparative characteristic of CT in macula showed high (p <0.05) relationship between the blood-filled of choroidal vessels and degree of UCTD. Analysis frequency of occurrence of PRD depending on CT demonstrated that against the background accumulation of phenotypic characters of UCTD increase in frequency of occurrence of PRD was observed. Statistical analysis confirmed presence of significant negative correlation between decrease CT and increase in incidence of prognostically dangerous forms of PRD. Conclusion. It was found that in school-age children with myopia with increase degree of UCTD, CT decreases. With choroidal thinning in children with myopia associated with UCTD, the frequency of occurrence dangerous forms of PRD increases. The research results are of clinical importance for the development of rational approaches to clinical examination and treatment children with school myopia with clinical signs of UCTD. Key words: progressive myopia, undifferentiated connective tissue dysplasia, choroidal thickness, peripheral retinal degeneration, rhegmatogenous retinal detachment.