Discover Degenerative Myopia: Strategies for a Clearer Future
Myopia, which people often call near-sightedness, is a vision issue where distant objects appear blurry. It’s like having a pair of glasses that make everything up close crystal clear, but things far away become hazy. Myopia usually shows up during childhood and sticks around as you grow into your teenage and young adult years. While myopia begins as simple “school myopia,” over time the elongation of the eye can lead to degenerative changes, known as degenerative or pathological myopia. This severe form of myopia increases the risk of permanent vision impairment.
Degenerative myopia occurs when excessive eye growth causes mechanical abnormalities. As the eye elongates, the retina stretches and begins to thin, particularly in the posterior pole region. This is called posterior staphyloma. Thin areas have increased susceptibility to tears, holes, and detachment. At the same time, the vitreous humor liquefies and collapses. The vitreous is the gel-like substance filling the eye – as it detaches from the retina, it can also cause retinal tears. Tears may lead to detachment where the retina separates from the back of the eye.
Other degenerative changes include choroidal neovascularization, where new blood vessels develop under the retina and macula. This can cause hemorrhage and fluid leakage. There may also be areas of chorioretinal atrophy, where the choroid layer of blood vessels serving the retina becomes thinner and less vascularized. All of these degenerative changes significantly raise the risk of severe vision loss.
Degenerative myopia usually progresses faster in childhood, slowing by adulthood. However, high myopes, with prescriptions above -6 diopters, remain at greater risk of degeneration throughout life. By age 75, 35% of people with high myopia experience vision-threatening complications. Severe cases may result in blindness.
Risk Factors for Degenerative Myopia
Several risk factors make progression to pathological myopia more likely:
- High-degree myopia — eyes longer than 26 mm are at increased risk. Each additional mm raises the chances of degeneration.
- Early onset myopia — developing before age 7-8. The earlier severe myopia starts, the more likely it is to advance.
- Genetic predisposition — variations in genes affect tissue structure. Autosomal dominant inheritance observed.
- Excessive near work — sustained close reading work may promote axial elongation. However, data are equivocal.
- Urbanization — is associated with less time outdoors, earlier education, and near work demands. Myopia is more common in urban areas.
- Diet — some research links vitamin D and nutrient deficiencies to myopia progression but more study is needed.
Research is still elucidating exactly why and how myopia turns into degenerative myopia. There are likely complex interactions between genetic susceptibilities and environmental triggers. While not all progression can be prevented, regular eye exams help detect changes for early management.
Managing and Preventing Degenerative Myopia
There is no cure for degenerative myopia. However, steps can be taken to maximize vision and eye health:
- Comprehensive eye exams every 1-2 years to monitor for retinal changes. High myopes may need annual exams.
- Spectacle correction to maximize visual clarity. Contact lenses do not slow progression. Under-correction can worsen elongation.
- Consider specialty contacts or surgical correction (ICL, LASIK) to stabilize vision. These do not slow degeneration.
- Control risk factors. Increase outdoor time, avoid glare, and optimize diet and lighting for close work.
- Caution with activities causing ocular trauma, like sports and vigorous eye rubbing.
- Stop smoking. Tobacco is associated with a greater risk of maculopathy.
- Monitor for metamorphopsia, micropsia, and blurry vision as early signs of change.
- Photocoagulation or cryopexy laser procedures may be used to repair some retinal lesions.
- Anti-VEGF injections can treat choroidal neovascularization to limit damage.
In summary, degenerative myopia involves progressive retinal thinning and other abnormalities leading to impaired vision. Regular eye health monitoring, risk reduction behaviors, and prompt treatment help preserve sight in those affected. Research to better understand and manage degenerative myopia continues to advance.
Q1: What is the main cause of degenerative myopia?
Answer: The main causes are a combination of genetic factors leading to excessive axial elongation of the eye and mechanical stretching of ocular tissues. This results in retinal abnormalities and degenerative changes over time.
Q2: Does degenerative myopia get worse over time?
Answer: Yes, the hallmark of degenerative myopia is that it is progressive, causing worsening vision and increasing the risk of impairment as complications accumulate in the retina and other eye structures. However, progression slows by adulthood and can be managed.
Q3: Can degenerative myopia be cured or reversed?
Answer: There is no cure for the underlying elongation and degenerative changes. However, treatments aimed at repairing retinal damage and optimizing correction of refractive errors can help slow further progression and vision loss. The goal is to stabilize rather than reverse degeneration.
Degenerative myopia is a leading cause of incurable vision impairment worldwide. As myopia prevalence increases, more individuals are at risk of developing associated retinal abnormalities and damage over time. Understanding risk factors, pursuing regular eye health monitoring, and promptly treating complications offer the best chance of preserving vision and quality of life for those afflicted. With a multipronged approach, people can successfully manage degenerative myopia.