Myopia Advise needed

[vnthomas]

Hello,

Our son has Myopia and his left eye has a power of 10 and right has a power of 8. We are more worried on the increasing power.

Where can we get the best treatment? We do consult our eye doctor (Ophthalmology) and doctor says, he is fine as his nerve is in good shape.

However, we would like to consult a doctor who specialist in Myopia so that any treatment we can have, we would like to get it for him.

Any help on this would be highly appreciated.

[John C Hagan III, MD, FACS, FAAO]

Hell vnthomas   You know there is really nothing you can do about stopping high myopia from progressing. It's like having a child that is growing taller than you would like them to be. No way to stop a kid that is destined to be 6 foot 6inches tall from stopping at 6 foot tall.

In the past bifocal glasses, and rigid contact lens have been tried but not helpful.

In very young children some pediatric ophtalmologists use bifocals combined with atropine drops. In an older child say 6 or more this is not going to be helpful.

Anyone that nearsighted will see better with contacts than glasses because of the larger image size with contacts. Gas permeable contacts may "mask" increases of contacts.

The retina needs to be checked carefully to be sure there are no weak spots, thin areas, retinal tears or detachments or myopic macular degeneration. At some time it would be worthwhile to have a retina specialist do a detailed dilated retinal exam.

You can find pediatric ophthalmologists and retina surgeons in your area at www.aao.org and use the Find An Eye MD feature.

JCH III MD

[John C Hagan III, MD, FACS, FAAO]

Cheers

JCH III MD

[myopic74]

Dear Doctor/Indi 1664,

Sincerely appreciate and thank you for all your advises and kind offer to help.

I am still fine for now, just that very confused and a feeling of uncertainty over the future.

Guess have to accept the reality and learn to relax and not get overly worried and take things as it comes.

And to all of us who are suffering from incurable retina diseases right now, hopefully our eyes would be able to hold as long as it's possible and wait for the day where new technology and medical treatments will come along to cure us of the conditions  :(

Cheers!

[John C Hagan III, MD, FACS, FAAO]

You are at high risk of developing problems. I can not give you an exact figure of your chances of NV developing. I suggest you ask your Retina doctor or do a literature search yourself.

I do not believe that there are studies to give you the reassurance you want about what will happen in the future. Total blindness in both eyes from your problem is extremely, extremely unlikely.

Only regular eye exams by a ophthalmologist preferably a retina specialist can tell if things are stable. you should have these done at least every 6-12 months the rest of your life.

I would re-read the passage. My understanding is that you can have lacquer cracks without CNV.

If you had CNV you would be treated with one of the new VEGF inhibitors that are almost miraculous in the help they let us now give CNV that we formerally were unable to help.

JCH III MD

[myopic74]

Dear Doctor,

My RS said I have some lacquer cracks in both eyes, mild posterior staphyloma and slight lattice degenerations.  

My question is: with all these classical signs of pathological myopia, especially lacquer cracks, is my future prognosis for vision going to be very poor?

You mentioned 'Most cases of the latter stabalize and do not develop wet myopic macularMacular degeneration degeneration Macular degeneration', are you referring to high myopia or pathological myopia that will stabilise?

Does pathological myopia generally progresses during young adulthood ie; in the 20s?

How do we know whether it has stabilised? Is the amount of increase in refractive error a good indication?

I have read that lacquer crack is a result rather than cause of CNV, or growth of abnormal blood vessels, how true do you think of the statement?

Thank you for your kind advises, doctor!

[John C Hagan III, MD, FACS, FAAO]

High myopia is greater than 6 diopters of minus lens to correct follow this link

http://www.retinaconsultations.com/texts/highmyopia.html

Pathologic myopia is when the back of the eye starts to show anatomical damage: staphylomas or weak outpocketings, splits in the layers of the eye, thinning or holes in the retina, anatomical damage to the macula.

It is not absolutely or proportionally related to the degree of myopia. By that I mean that a -6.00 myope may have a great deal of pathologic myopia while a -8.00 may have a normal appearing retina.

JCH IIII MD

[kg17]

What is the difference between high myopia and pathologic progressive myopia?  Are there definitive tests?

Thank you kindly, doctor

[John C Hagan]

1. Simple myopia is very common, high myopia is not uncommon, pathologic progressive myopia is relatively unusual. Most cases of the latter stabalize and do not develop wet myopic macular degeneration.

2. The exact cause of CNV in pathologic myopia is not know for sure but probably relates to breaks or defects in Bruch's membrane rather than thinning of the retina.

3. See #1  most patients with progressive high myopia do not develop CNV.

JCH III MD

[myopic74]

Dear Doctor,

Based on your clinical experiences and knowledge, will thinning of the retina (or dry myopic degeneration) stabilise around certain age, or it is usually progressive over time?

Does the occurrence of CNV in those with myopic degeneration a direct function of the extent of the thinning of the retina?

In your estimate, how long on the average does it usually take for patients with dry myopic degeneration to turn wet?

Appreciate if you could share with us some thoughts. Thank you so much!  

[John C Hagan III, MD, FACS, FAAO]

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[John C Hagan III, MD, FACS, FAAO]

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[indi1664]

Hi myopic74
                      Real sry to hear abt yr vision..but there is hope..I am 43 yrs old I have been wearing soft contacts for some 25yrs and glasses as well.At the start of contact lenses for abt 8-10yrs i wore hem for upto 12 -14 hrs ..NOT A GOOD IDEA...i developed blood vessel growth than i went back to 8 hrs a day and the vessel growth dissapeared...the other problem i have faced is the availabilty of good toric contact lenses....yes yr RS is corect high myopics tend to have thinner retinas...but if your health is good ..ie no blood presure ,diabetes ...than i would not worry abt this to much.I have regular chek ups and my prescription is quite stable and varies .5 -1 diopter..not drastic for us....I have not had any other problems as such ..slight Vitreous gel degenerationan..but tht is expected in high myopics..i am also cosidering CLEAR lens surgery in next few weeks see my other posts...I am waiting for surgeons report will update you if there anything else i find out.
Pls dont hesitate to contact me for anything...and if ever you need than we can talk on the phone in future.take care

indi 1664

[myopic74]

Hi indi 1664,

I am very surprised that you've a prescritpion of -20D each eye. I also have similar prescription (-20D,-18D).

I am 33 years old and was diagnosed with lacquer cracks and myopic degeneration, due to severe thinning and stretching of the retina (I think so). I also had a small bleeding from lacquer crack in one of my eye six months' back. The bleeding has since resolved on it's own without any medication nor leave behind any scarring. Now I am worried about the future.

May I know how old are you? Do you go for eye checkups and do you have any problems with your eyes so far? My RS said some people who has very high myopia will have very thin retina whereas others may not.

Dear doctor, my RS also said myopic degeneration will probabaly stabilise at this age and may not progress further, any thoughts on this? She also said age is probably not a very strong determinant factor for choroidal neovascularisation (CNV), any thoughts?

She said she had seen some old folks who are very severely myopic and the retina is so thin until it almost disaapears and you can see the sclera and yet they don't have CNV. I was thinking if the retina becomes so thin until it almost disappears, how can they still see? Do you think such cases are possible?

Thank you for your kind inputs!

[John C Hagan III, MD, FACS, FAAO]

I neglected to mention that retinopathy of prematuring associated with low birth weight and prematuring are often quite myopic and that needs to be excluded also along with weakness of the back of the eye (staphylomas).

JCH III MD

[indi1664]

Hello,
            I am real sorry yr son has such high myopia....I myself have -20 in each eye ..and for many years i have got by with contact lenses and glasses .In your sons case due to lower prescripion you can get extremely good corrective Contact lenses much better than i have been able to....thereby avoiding any surgery.Alhough as i write this I am considering lens implants in next few weeks.

there are wonderful surgeons on this site who can better advise on other procedures.
I wish your family all the best.