Very high myopia

[sophia35]

Hi,
   I'm a  35 year old female. Have very high myopia, -17 in left eye and -22 in right,as well as astygmatism.Use semi-rigid contacts.
   Have myopic degeneration and I think lattice too. Have had gas bubble in left eye and laser in  both  because of retinal tears/holes.Want to do whatever possible to preserve my sight. Is prophylactic scleral buckle advised?
  A cataract was now discovered in my right eye after I got laser treatment.Could laser have caused it?
  From  research, concluded its safer to consider iol only if cataracts impair my vision and at that time I should have my lens removed and replaced by a lens that also corrects myopia and I may possibly still have to use contact lenses. Do you agree? Should the io lens be placed in the anterior or posterior chamber? Should the lens also correct presbyopia ( multifocal) so I won't need glasses to see up close ( otherwise how will I put on the contact lenses i'll probably still need...)?
   I'm considering taking a multivtamin/multimineral supplement which includes luteine and zeaxantine , fish oil with omega 3 DHA and EPA  and Gingko Biloba extract. Do you advise these or anything else?

  I don't expect miracles,but please give me some useful advice or information.
Thank you very much.

Wishing everyone the very best, Sophia
  

[John C Hagan III, MD, FACS]

The use of scleral reinforcement for treatment of progressive high myopia is not a procedure universally agreed by ophthalmologists to be appropriate for the high myopia condition. Moreover there are only a few centers that do this procedure on a regular basis. This is an appropriate reference for you to read about the procedure. Cut and paste into your internet browser:  http://www.mdsupport.org/library/degenmyopia.html

The laser you had would not cause cataracts or progression of your myopia.

Cataract surgery, even successful, small incision phacoemulsification will increase the risk of a retinal detachment significantly. Thus you should not take this risk until your vision is a 'big' problem and the cataract is the main cause. Also the ophthalmologists (Physician Eye MDs) will put an intraocular lens in your eye to correct your high degree of myopia so that after the procedure you likely will not need to wear contacts and your uncorrected vision at distance and mid range will probably be better than its been for most of your life.

If you have one eye 'fixed' then your eyes will be quite optically unbalanced (high myopia in unoperated eye and near normal vision without glasses at distance). This will be to much for even contact lens to correct. So when you have one eye fixed, after it's healed and things are stable (4-8 weeks) you will need the other eye done.

The implant should be placed in the posterior chamber not the anterior chamber.

Please use the search feature on this web page to search 'multifocal intraocular implants', 'Restor implant', Resume implant and 'crystalens' implants. There are a lot of postings on the two eye forums with problems with multifocal implants. As a generalization I would advise against the use of a multifocal implant and plan on wearing no line (progressive) bifocals. An alternative would be contact lens using mono-vision or bifocal contact lens.

The AREDS study showed that takeing a multivitamin plus a special combination of extra vitamins reduced the progression of dry macular degeneration in moderate or severe cases by 23%. It did not seem to help mild macular degernation. There were few test subjects without macular degeneration and the supplements did not have lutein. The AREDS study is being repeated on patients without macular degeneration using a similiar forumula but with about 10 mgms of lutein added. This study unfortunately will not be concluded and published for several years.

Myopic macular degeneration is not the same as age related macular degeneration. There are no studies to advise you about what supplements might be helpful for your problem. All the supplements you mention are 'okay' except Gingko Biloba. It has not been helpful for eye conditions, has documented multiple side effects including bleeding tendencies.

Your retinal specialists are the best source of specific recommendations for you.

Best of luck

JCH MD

[sophia35]

Dear Doctor,

I greatly appreciate your complete and attentive reply.
I feel desperate and lost and I'm really quite scared of future prospects. I
believe there are good doctors in Portugal but the ones I've been to seem to
avoid my questions.
I have a wonderful 7 year old boy and would like to always be an able mother as  
well as to have another child but my eyesight really worries me.
Thank you,I had no idea Gingo Biloba could be harmful for eyesight.
I will try to find out about a supplement which is good for general circulation
problems ( need it for legs) as well as microcirculation and which won't  
potentially harm my eyes.
I will definitely do the research you advised.

I sincerely thank you again,
Sophia

[John C Hagan]

Sorry Sophia I do not have personal knowledge of centers in Portugal (or Europe) do that type of scleral surgery. However even in the USA I have not sent my own patients for that type of surgery as I am not convinced it's the best thing to do.'

Remember that myopic macular degeneration only affects the centeral 5% of the retina. It does not affect the peripheral vision. So it does not make an eye totally blind. Even people with macular holes can find their way around without assistance, many can read with magnification.

Most of my patients with myopic macular degeneration are not legally blind, they have reduced vision say 20/40-20/60 and function quite nicely.

JCH MD

[John C Hagan III, MD, FACS]

Hi Sophia, you have a lot of good questions so I will insert them in bold in your email.
Hi,
I'm a 35 year old female. Have very high myopia, -17 in left eye and -22 in right,as well as astygmatism.Use semi-rigid contacts.
Have myopic degeneration and I think lattice too. Have had gas bubble in left eye and laser in both because of retinal tears/holes.Want to do whatever possible to preserve my sight. Is prophylactic scleral buckle advised?

No, but regular exams and possible laser treatment of your lattice or holes may be indicated.

A cataract was now discovered in my right eye after I got laser treatment.Could laser have caused it?

No, cataracts are more common in near sighted eyes but the laser treatment did not cause it.

From research, concluded itś safer to consider iol only if cataracts impair my vision and at that time I should have my lens removed and replaced by a lens that also corrects myopia and I may possibly still have to use contact lenses. Do you agree? Should the io lens be placed in the anterior or posterior chamber? Should the lens also correct presbyopia ( multifocal) so I won't need glasses to see up close ( otherwise how will I put on the contact lenses i'll probably still need...)?

Yes wait until it significantly interferes with your vision.  The lens implant will usually be placed in the posterior chamber and the power selected will be based on measurements of your eye.  This lens will likely have a negative power because of your extreme myopia and you should end up with the best uncorrected vision you have had since you were a baby.  The main risk of the cataract surgery is that it will increase the risk of a retinal detachment, which is already high because of your high myopia. Make sure your retinal specialist evaluates you before your cataract surgery to see if any pre treatement of your retina is indicated.  You are not a good candidate for a multifocal and they are not availabe in the power you need.  I would actually suggest that the surgeon aim to leave you slightly nearsighted so you can still see up  close and read without glasses and just wear very weak, thin glasses to see far away.

I'm considering taking a multivtamin/multimineral supplement which includes luteine and zeaxantine , fish oil with omega 3 DHA and EPA and Gingko Biloba extract. Do you advise these or anything else?

It won't hurt to take these as they can reduce the risk of macular degeneration but whether they will help reduce the risk of myopic macular degeneration is unclear.  I would not recommend anything else.


I don't expect miracles,but please give me some useful advice or information.
Thank you very much.

Wishing everyone the very best, Sophia




James J. Salz, M. D,

[sophia35]

Dear Doctors,

I thank you very much for your replies. I really haven't had the chance to
access the   internet or to check out information in order to ask "informed"
questions.

I'm sure I'll have questions to ask later on but if possibe kindly answer my
immediate questions. Now that I have found this site I do hope I can continue
contacting you because it really helps me clarify issues and talking about it helps meto get get a little over  
this feeling of hopelessness.For example , although my husband knows I have bad
eyesight he doesn't realize that unless I stick my nose on the mirror my own
face is just a blur.Putting on my contacts is the very first thing I do when I
get up and I dom't know what I'd do without them.I don't see as well with my glasses and actually never use them. Should I make an effort to use the glasses sometimes? ( I get along well with the contacts).

I had actually already come across the site about degenerate myopia. That's
where  I got the notion of a prophylactic scleral buckle. The doctors I
consulted here   in Portugal said the buckle was only used in certain situatios
when the retina was actually detached. I guess it is only used prohylactically
abroad...

I was really hoping the buckle could help me. The idea I have is that I keep  
getting holes because my eyes are streched or streching and perhaps scleral
buckles would control that.

I'm also very scared that there is such a thing as too much laser because I've
had quite a lot of it. The last time I got treatment was on an "urgency basis" in the ER because my eyes were feeling funny and I have no idea how qualified the doctor was...Although laser prevents retinal detachment it also causes damage to tissue and eventually eyesight ,right?

I get horrible headaches which also affect my eyes and I work a lot in computer
programming . However, I get those horrible headaches and eyeaches even when I
don't work on the computer? What do yoo think of this? Are there any specific
exams you would advise?

Is there no way of avoiding having to have iol placed  in BOTH eyes when for example only one eye has a cataract? ( -16 in left eye and -22 in right eye which already has a cataract in inicial stage ?
Is there anything I can do to avoid progression of cataracts?

Have to sign off.
Thank you both again.

Please reply as soon as you can!

Wishing you and everyone the very best,
Sophia

[circumspect]

Sophia,

1. Your glasses should always be availabe as back-ups if you lose a contact or it is irritating your eye. You will see better with contacts but better with glasses than nothing.
2. It is not inevitable that your retina will detach or tear again. Most cases of progressive myopia stabialize.
3. Laser burns for tears are normally placed in the peripheral retina that is not used for sight or in an area with "network" of nerves that fill in the injured spot and people tend not to be aware of them. When laser is done close to the central vision ophthalmologists use different color light beams to minimize damage or use the new photodynamic process (Visudyne) or for neovascular degeration use VEGF inhibitors which are not laser at all.
4. I would not worry about too much laser. Your eye surgeons (ophthalmologists) will use only what they need to stabalize your retina. (some diabetics get over 2000-3000 laser marks on their retina and function fine.
5. Many types of headaches (sinus, tension, migraine) occur around or behind the eye and have no relation to intrinsic eye problems.
6. You could have a cataract/IOL on one eye only but the two eyes would not work well together. There are some people that elect to remove a lens that does not have a cataract (clear lens extraction) to put an IOL in to correct large degress of myopia. That is a choice that you and your surgeon must make.
7. As I said I do not refer my high myopia patients here in the USA for scleral reinforcement.

Good luck to you.

JCH MD

[sophia35]

Dear Doctor,

Once again I appreciate your response. The first question I sent was  

" Very High Myopia" dated June 28.

Have been away from computer due to serious family health issues.

I may not be able to consult this site as often as I'd like but believe me

I won't forget www.medhelp.org and will always read answers to my questions

as well as other people's whenever I can.

Firstly I'd like to say that there are simply not enough

words to praise the work you and your colleagues do.You provide yor medical

expertise promptly and clearly to countless people, many of which for one

reason  or other don't get answers to their questions and I oersonally know how

that can bring peace of mind.

If  possible kindly answer these questions:

I hate sunglasses and prefer to squint when its sunny.How important is it to

use them beacause I have a cataract in my right eye and read somewhere that

sunlight can be an aggravating factor?

If I one day use iol and still need correction for myopia theoretically is it

possible to use contacts instead of glasses?

By the way,are you notified  when readers post comments to your answers or is

it better to ask a new question?

Thank so much again. Wishing you and everyone the ene very best.

Sophia.

[HNetzer]

I have myopia, astigmatism, lattice degeneration in both eyes and PVD in one eye. Several years ago I had a retinal tear sealed with a laser more recently I was told that the PVD is more pronounced, but should be monitored at an apptmt in 6 months or if i experience any changes.

My question:
If PVD is a consequence of myopia and astigmatism, is it possible that contact lenses are better than glasses.
Also if Ortho K lenses reshape the eye to some degree, might this be beneficial?
Also there any life-style changes that might be beneficial?
Is there any vitamin supplements that moight be benefial for this condition?

[John C Hagan III, MD, FACS]

Hello HNetzer

You should follow your ophthalmologist's advice. Most of my patients with lattice and PVD and sealed holes (laser or cryotherapy) eventually are reduced to exams each year.

Lattice and retinal tears are related to myopia because the eye is longer than normal and puts the retina on stretch. Contact lens or glasses or lasik have no effect on these conditions (since they do not make the eye shorter).

Ortho-K in my opinion is worthless and the only people that benefit from ortho-k are the optometrists (non-physician, limited scope eye care providers) that continue to use this outmoded therapy.

Life style changes that will help the eye?  Don't smoke, eat a good diet, drink in moderation, protect your eyes from bright sunshine and have an annual exam by an Eye MD Ophthalmologist.

Diet/vitamin's have no effect on PVD, RD, retinal holes, lattice degeneration.

JCH III MD  Eye MD