Refractive surgery and dry eye - An update.
Indian journal of ophthalmology
Dry eye disease is the most common complication and a frequent cause of patient dissatisfaction after corneal laser refractive surgery, which includes laser-assisted in situ keratomileusis (LASIK), small-incision lenticule extraction (SMILE), and photorefractive keratectomy (PRK). It has a complex, multifactorial etiology and is characterized by a highly variable clinical presentation. A detailed preoperative screening and optimization of the ocular surface prior to refractive surgery are the key to minimizing the incidence and severity of postoperative dry eye. Diagnosis of postrefractive surgery dry eye remains a challenge as no single symptom or clinical parameter is confirmative of the condition, and the symptoms and signs may not correlate well in many cases. A thorough understanding of the pathomechanism of the disease and its manifestations is essential to facilitate a treatment approach that is individualized for each patient. This article reviews various aspects of postrefractive surgery dry eye including its epidemiology, etiopathogenesis, risk factors, diagnosis, and management.
10.4103/IJO.IJO_3406_22
Glaucoma and Myopia: Diagnostic Challenges.
Biomolecules
The rising global prevalence of myopia is a growing concern for clinicians, as it predisposes patients to severe ocular pathologies including glaucoma. High myopia can be associated with clinical features that resemble glaucomatous damage, which make an accurate glaucoma diagnosis challenging, particularly among patients with normal intraocular pressures. These patients may also present with established visual field defects which can mimic glaucoma, and standard imaging technology is less useful in disease detection and monitoring due to the lack of normative data for these anatomically unique eyes. Progression over time remains the most critical factor in facilitating the detection of early glaucomatous changes, and thus careful longitudinal follow-up of high-risk myopic patients is the most important aspect of management. Here, we review our current understanding of the complex relationship between myopia and glaucoma, and the diagnostic challenges and limitations of current testing protocols including visual field, intraocular pressure, and imaging. Furthermore, we discuss the clinical findings of two highly myopic patients with suspected glaucoma.
10.3390/biom13030562
Recent Epidemiology Study Data of Myopia.
Xiang Zhao-Yu,Zou Hai-Dong
Journal of ophthalmology
Myopia, a pandemic refractive error, is affecting more and more people. The progression of myopia could cause numerously serious complications, even leading to blindness. This review summarizes the epidemiological studies on myopia after 2018 and analyzes the risk factors associated with myopia. The prevalence of myopia varies in different regions, age, and observation time. East Asia has been gripped by an unprecedented rise in myopia, and other parts of the world have also seen an increase. The prevalence of myopia in children continues to rise and aggravates with age. The prevalence of high myopia has also increased along with myopia. Racial dependence and family aggregation can be seen frequently in myopia patients. Increased outdoor activities are proven to be protective factors for myopia, as near-distance work and higher education levels affect in the opposite. The impact of gender or urbanization on myopia is controversial. The relationship between nutrition, digital screens, Kawasaki disease, pregnant women smoking during pregnancy, and myopia is still not clear for lack of sufficient evidence. Understanding the various factors that affect myopia helps to clarify the mechanism of myopia formation and also to formulate reasonable prevention and control measures of myopia to protect people's health, especially for adolescents.
10.1155/2020/4395278
Pathogenesis and Prevention of Worsening Axial Elongation in Pathological Myopia.
Clinical ophthalmology (Auckland, N.Z.)
PURPOSE:This review discusses the etiology and pathogenesis of myopia, prevention of disease progression and worsening axial elongation, and emerging myopia treatment modalities. INTRODUCTION:Pediatric myopia is a public health concern that impacts young children worldwide and is associated with numerous future ocular diseases such as cataract, glaucoma, retinal detachment and other chorioretinal abnormalities. While the exact mechanism of myopia of the human eye remains obscure, several studies have reported on the role of environmental and genetic factors in the disease development. METHODS:A review of literature was conducted. PubMed and Medline were searched for combinations and derivatives of the keywords including, but not limited to, "pediatric myopia", "axial elongation", "scleral remodeling" or "atropine." The PubMed and Medline database search were performed for randomized control trials, systematic reviews and meta-analyses using the same keyword combinations. RESULTS:Studies have reported that detection of genetic correlations and modification of environmental influences may have a significant impact in myopia progression, axial elongation and future myopic ocular complications. The conventional pharmacotherapy of pediatric myopia addresses the improvement in visual acuity and prevention of amblyopia but does not affect axial elongation or myopia progression. Several studies have published varying treatments, including optical, pharmacological and surgical management, which show great promise for a more precise control of myopia and preservation of ocular health. DISCUSSION:Understanding the role of factors influencing the onset and progression of pediatric myopia will facilitate the development of successful treatments, reduction of disease burden, arrest of progression and improvement in future of the management of myopia.
10.2147/OPTH.S241435
Pathologic myopia: advances in imaging and the potential role of artificial intelligence.
The British journal of ophthalmology
Pathologic myopia is a severe form of myopia that can lead to permanent visual impairment. The recent global increase in the prevalence of myopia has been projected to lead to a higher incidence of pathologic myopia in the future. Thus, imaging myopic eyes to detect early pathological changes, or predict myopia progression to allow for early intervention, has become a key priority. Recent advances in optical coherence tomography (OCT) have contributed to the new grading system for myopic maculopathy and myopic traction maculopathy, which may improve phenotyping and thus, clinical management. Widefield fundus and OCT imaging has improved the detection of posterior staphyloma. Non-invasive OCT angiography has enabled depth-resolved imaging for myopic choroidal neovascularisation. Artificial intelligence (AI) has shown great performance in detecting pathologic myopia and the identification of myopia-associated complications. These advances in imaging with adjunctive AI analysis may lead to improvements in monitoring disease progression or guiding treatments. In this review, we provide an update on the classification of pathologic myopia, how imaging has improved clinical evaluation and management of myopia-associated complications, and the recent development of AI algorithms to aid the detection and classification of pathologic myopia.
10.1136/bjophthalmol-2021-320926
Late in-the-bag intraocular lens dislocation.
Journal of cataract and refractive surgery
This review aimed to evaluate the cumulative incidence, patient characteristics, predisposing conditions, and treatment outcomes for late in-the-bag intraocular lens (IOL) dislocation. Literature searches in PubMed (MEDLINE), Embase, and Cochrane Library Central database identified 1 randomized clinical trial, 1 prospective case series, 2 prospective cohort studies, and 36 retrospective studies of this condition, which showed that the cumulative incidence was 0.5% to 3%, it occurred on average 6 to 12 years after cataract surgery, and mean patient age was 65 to 85 years. Pseudoexfoliation syndrome, myopia, and previous vitreoretinal surgery were the most common predisposing conditions. Studies indicated that IOL repositioning and IOL exchange provided similar visual outcomes and were equally safe. The long-term visual outcome seemed satisfactory. However, the quality of evidence regarding treatment was in general quite low. More studies of late in-the-bag IOL dislocation are needed, and in particular, different surgical techniques should be included in high-quality clinical trials.
10.1097/j.jcrs.0000000000000605
An evidence-based review of the epidemiology of myopic traction maculopathy.
Survey of ophthalmology
Myopic traction maculopathy (MTM), one of the complications of pathologic myopia, is a spectrum of pathological conditions that are attributed to tractional changes in the eye characterized by retinoschisis, lamellar or full thickness macular hole, and foveal retinal detachment. Considering the global public health burden of MTM and pathologic myopia, it is important to understand these sight-threatening complications and their associations. We conducted an evidence-based review of the prevalence and natural history of MTM and associated risk factors. The prevalence of MTM in the general population is low, but is increased among high myopes. MTM is associated with preretinal tractional structures, myopic refractive error and axial elongation, posterior staphyloma, dome-shaped macula, chorioretinal atrophy, and myopic macular degeneration. The clinical course of MTM tends to be stable; however, MTM may progress, resulting in visual acuity deterioration, although spontaneous improvement also occurs. The associations of MTM progression include vitreous traction, location, and extent of MTM, and lamellar macular hole-specific factors. More high-quality population-based studies that assess MTM prevalence and natural history are needed.
10.1016/j.survophthal.2022.03.007
Management of Myopic Maculopathy: A Review.
Turkish journal of ophthalmology
Myopia, including pathologic myopia, has seen a significant increase in prevalence in recent years. It is a significant cause of irreversible vision loss worldwide and prediction models demonstrate the substantial future impact on the population. With increased awareness and research, it is possible to prevent blindness on a large scale in the younger, productive age group affected by myopic maculopathy (MM). The vision-threatening manifestations of pathologic myopia include myopic choroidal neovascularization, macular atrophy, maculoschisis, macular hole, and retinal detachment. Myopic traction maculopathy (MTM) is a progressive manifestation of pathologic myopia and its treatment includes pars plana vitrectomy, macular buckle, or a combination. In this article we aim to review the diagnosis, clinical characteristics, and treatment of MM with an emphasis on recent developments in the surgical management of MTM. We discuss commercially available macular buckles, along with potential advantages to the use of macular buckle in MM. We review the new MTM staging system and its role in determining surgical management of these complex cases.
10.4274/tjo.galenos.2023.59844
A Review of Pathologic Myopia.
Eye & contact lens
ABSTRACT:Pathologic myopia is a leading cause of vision loss worldwide and is most prevalent in developed nations in East and Southeast Asia. Although the pathophysiologic mechanisms behind pathologic myopia have yet to be elucidated, the process is thought to stem from excessive axial elongation of the globe and subsequent degeneration of vital structures within the posterior segment. The array of complications that arise from this condition can lead to significant visual impairment. The purpose of this article is to review the classification, pathophysiology, complications, and management of pathologic myopia.
10.1097/ICL.0000000000000917