MYOPIA

SEMINAR
Questions to be raised
 Shape of the lens?
 Refractive index of cornea and lens?
 What is accommodation?
 What is cylindrical lens?
 What is sturm’s conoid?
MYOPIA

 Myopia or short-sightedness is a type of

refractive error in which parallel rays of light
coming from infinity are focused in front of the
retina when accommodation is at rest
 Etiological classification
 Axial myopia results from increase in antero-posterior
length of the eyeball.
 Curvatural myopia occurs due to increased
curvature of the cornea, lens or both.
 Positional myopia is produced by anterior
placement of crystalline lens in the eye.
 Index myopia results from increase in the refractive index
of crystalline lens associated with nuclear sclerosis.
 Myopia due to excessive accommodation occurs in
patients with spasm of accommodation.
 Clinical varieties of myopia
 Congenital myopia
 Simple or developmental myopia

 Pathological or degenerative myopia

 Acquired myopia which may be:

(i) post-traumatic (ii) post-keratitic

(iii) drug-induced (iv) pseudomyopia (v) night
myopia (viii) consecutive myopia.
 Congenital myopia
 Present since birth,usually diagnosed by the age of 2-3
years.
 Usually the error is of about 8 to 10 which mostly remains
constant
 Child may develop convergent squint
in order to preferentially see clear at its far point
 May sometimes be associated with other congenital
anomalies such as cataract, microphthalmos, aniridia,
megalocornea, and congenital separation of retina.
 Simple myopia
 Simple or developmental myopia is the
commonest variety. It is considered as a
physiological error
 Not associated with any disease of the eye
 Sharpest rise occurs at school going
age i.e., between 8 year to 12 years so, it is also
called school myopia.
 Symptoms
 Poor vision for distance (short-sightedness)
 Asthenopic symptoms may occur in patients
with small degree of myopia.
 Half shutting of the eyes may be complained by
parents of the child. The child does so to
achieve the greater clarity of stenopaeic
vision(vision via slit like aperture)
 Signs
 Prominent eyeballs. The myopic eyes typically
are large and somewhat prominent.
 Anterior chamber is slightly deeper than normal.
 Pupils are somewhat large and a bit sluggishly
reacting.
 Fundus is normal; rarely temporal myopic
crescent may be seen.
 Magnitude of refractive errror. occur between 5
and 10 year of age, keeps on increasing till
about 18-20 years of age at a rate of about –0.5
± 0.30 every year.
 Pathological myopia
 Pathological/degenerative/progressive myopia,
 Rapidly progressive error which starts in
childhood at 5-10 years of age and results in
high myopia during early adult life.
 Usually associated with degenerative changes in
the eye.
 Etiology.
 Pathological
 Results from a rapid axial growth of the eyeball
which is outside the normal biological variations
of development
 Role of heredity.
progressive myopia is (i) familial; (ii) more
common in certain races like Chinese,
Japanese, Arabs and Jews,

 The sclera due to its distensibility follows

the retinal growth but the choroid undergoes
degeneration due to stretching, which in turn
causes degeneration of retina
 Role of general growth process,

Factors (such as nutritional deficiency,

debilitating diseases, endocrinal disturbances
and indifferent general health) which affect the
general growth process will also influence the
progress of myopia.
 Symptoms
 Defective vision. Considerable failure in visual
function as the error is usually high.
 Muscae volitantes i.e., floating black opacities in
front of the eyes.These occur due to
degenerated liquefied vitreous.
 Night blindness may be complained by very high
myopes having marked degenerative changes.
 Signs
 Prominent eye balls. The eyes are often
prominent, appearing elongated and even
simulating an exophthalmos, especially in
unilateral cases.
 Cornea is large.
 Anterior chamber is deep.
 Pupils are slightly large and react sluggishly to
light
 Fundus examination
 Optic disc appears large and pale and at its
temporal edge a characteristic myopic crescent
is present
 Sometimes peripapillary
crescent encircling the disc may be present,
 A super-traction crescent (where the retina is
pulled over the disc margin) may be present on
the nasal side.
 Degenerative changes in retina
and choroid

 White atrophic patches at the macula with a little

heaping up of pigment around them.
 Foster-Fuchs' spot :dark red circular patch due to
sub-retinal neovascularization and choroidal
haemorrhage may be present at the macula.
 Cystoid degeneration may be seen at the
periphery.
 In an advanced case there occurs
total retinal atrophy, particularly in the central area.
 Posterior staphyloma due to ectasia of sclera
at posterior pole may be apparent as an
excavation with the vessels bending backward
over its margins.
 Degenerative changes in vitreous include:
liquefaction, vitreous opacities, and posterior
vitreous detachment (PVD) appearing as
Weiss' reflex.
 a) Tessellated Fundus
 b) Focal CR atrophy
 c) Lacquer Cracks
 d) Sub-Retinal Hge
with CNV
 e) “coin” Hge
 Visual fields show contraction and in some
cases ring scotoma may be seen.
 ERG reveals subnormal electroretinogram
due to chorioretinal atrophy.
 Complications
 (i) Retinal detachment
(ii) Complicated cataract
(iii) Vitreous haemorrhage
(iv) Choroidal haemorrhage
(v) Strabismus
 Treatment of myopia
 Optical treatment of myopia constitutes
prescription of appropriate concave lenses, so
that clear image is formed on the retina

 The basic rule of correcting myopia :

Minimum acceptance providing maximum
vision should be prescribed.
In very high myopia undercorrection
is always better to avoid the problem of near
vision and that of minification of images.