What is pathological myopia? What are the complications? Is there any way to stop / slow it down?
I’ll briefly discuss the basics of pathological myopia in this article and if its possible to slow it down.
Information from following study [R]
What is pathological myopia?
Pathological myopia is classified as the only form of myopia that results in a decrease in BCVA. This is caused from the pathology associated with the eyeball becoming so elongated.
What classifies as pathological myopia?
This study classifies 4 levels of pathological myopia and their association with vision loss. Category 4 is typically always associated with vision loss.
Interesting to note that the hallmark “Staphyloma” appearance of the optic nerve is only class 2.
Complications
Some of the biggest concerns regarding pathological myopia is retina tears / holes, choroidal neovascular membranes, retinoschisis, and macular holes.
Treatment for choroidal neovascular membrane is still anti-VEGF injections to the elevated position of VEGF located in the vitreous.
Retinoschisis, and macular holes should be treated with pars plana vitrectomy / (there is some debate on if fovea sparing ILM peels should be performed to minimize the risk of post-operative macular holes aka – leave it up to the surgeon).
One recent study documented the resolution of a case of Myopic Macular Retinoschisis and Macular Hole With Topical Medical Therapy by using topical pred and bromfenac (R). Interesting to see where this goes in the future,
Until further research is produced, vitrectomies and anti-VEGF should be our golf standard when managing these complications.
Based on this definition can it be stopped?
Well, technically no…. In the presence of additional pathology that presents itself, such as the above issues, treatment can be taken. Anti-VEGF for CNVM, vitrectomies for macular holes or glaucoma treatment if needed. But preventative measures need to have taken place years ago.
Preventing the myopic progresser
This is were we get into the meat and potatoes of myopia management.
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