myopia

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Classification according to ICD-10
H44.2 Degenerative myopia / malignant myopia
H52.1 Myopia
H52.5 Accommodation spasm
ICD-10 online (WHO version 2019)
Normal vision
Impression of the same scenery in myopia (simulated by blurring in the far range)
Beam path in the nearsighted eye (when looking into the distance; the incoming rays are - contrary to the representation in the drawing - almost parallel to each other). In the uncorrected myopic eye (above), the image position in front of the retina and the visual impression are blurred. The image position can be shifted backwards and down to the retinal level using a diverging lens in order to achieve a sharp visual impression (below).

With nearsightedness or myopia ( ancient Greek μυωπία muôpia ) refers to a particular form of optical ametropia ( refractive error ) of the eye . The eye focuses the light in front of instead of on the retina . This is mostly the result of either an eyeball that is too long or a refractive power of the optically active components that is too strong for its length . The result is an aberration that makes distant objects appear more blurred than nearby ones - the person affected sees better in the vicinity (hence the term “short-sighted” ) than in the distance. The extent of nearsightedness is determined by means of a refraction and is given in diopters . According to the cause and time of their occurrence, various forms can be distinguished, for which in most cases there is no causal treatment option. However , the refractive error can be corrected by wearing aids such as glasses or contact lenses . A surgical correction , which nowadays usually by means of a laser is carried out, is also possible in many cases.

description

In myopia, there is a disproportion between the overall length of the eye and the refractive power of the lens (axial ametropia). This results in an image position in front of the retina for a distant object, even with complete relaxation of the ciliary muscle and thus minimal curvature and refractive power of the eye lens . This results in a blurred visual impression. If the object is brought closer to the eye, the image position shifts backwards. If the distance to the eye is reduced so far that the object image is on the retinal plane, a sharp visual impression is created for the nearsighted person without the need for an optical correction.

Myopia is the geometrical-optical opposite of farsightedness (clarity, hyperopia). Both refractive errors are also referred to as axial image position errors and represent a low order aberration (defocus) .

In most cases, myopia is not actually a disease. According to today's view, it is generally related to a genetic disposition and is reinforced by external influences. The notion that a lot of reading, schoolwork, smartphone use and other close work would encourage the development of myopia in childhood has been called into question in recent years. In addition to genetic disposition, little daylight is currently a risk factor. Malignant myopia and some forms of refractive myopia (see below) can be regarded as pathological.

Measurement and investigation

The measurement of myopia and the determination of the optical correction (refraction determination) are carried out using objective (e.g. autorefractometer or skiascopy ) and subjective methods (using trial glasses or on the phoropter ).

During the examination, involuntary contractions of the ciliary muscle ( accommodation ) can increase the refractive power of the lens and thus lead to unintended myopization. In such cases, too high myopia is determined. This can be prevented by performing the refraction measurement in cycloplegia . The administration of so-called "cycloplegic" eye drops temporarily paralyzes the ciliary muscle and eliminates this source of error for the duration of the measurement.

To prepare for refractive surgical interventions on the cornea, wavefront aberrometers (also called wavefront analysis devices ) are used to precisely measure the optical conditions of the eyes (aberrations ), which also measure myopia, among other things.

distribution

Nearly 25% of the world population is affected by myopia. In Germany , around 25% of the population is affected, and the trend is rising. In Europe, the proportion of young people nearsighted is now almost 50%. Myopia is ubiquitous, especially in Asia; around 95% of 20-year-olds in the South Korean capital Seoul are affected by myopia.

Treatment and correction

Myopia is often corrected with glasses.

There is currently no causal therapy for the most common form of myopia, axial myopia.

Conventional solutions

A corresponding refractive error is corrected by wearing aids such as glasses or contact lenses with concave (actually: convex-concave) curvature (i.e. negative diopters ).

Orthokeratology

Special, dimensionally stable contact lenses deform the cornea during sleep, so that the refractive error is compensated for on the following day without further aids. The process of orthokeratological lenses has only been possible for a few years due to technical advances. The applicability is limited to spherical correction values ​​up to −6.00 D and an astigmatism up to −1.75 D.

Operations

Surgical corrections are also possible with different procedures , which nowadays are mostly carried out with the help of a laser . The Commission for Refractive Surgery (KRC) recommends a correction with the excimer laser of −10 D as the maximum limit. Greater myopia achieve a better overall optical result through lens implantation. However, these operations do not correct the eyeball that has grown too long, but only reduce the refractive power of the cornea by flattening the curvature of the front surface.

Other procedures

Myopia can also get better visual acuity by narrowing their eyes to a small slit. This mechanism is based on the principle of the “ Stenopean gap ”: The pinching leads to a reduction in the aperture , which in turn leads to an increase in the depth of field and a reduction in disturbing marginal rays (spherical aberration) . Myopia got its name from this widespread attempt to compensate: Myops also means "blinking face".

The thesis that traditional Chinese medicine methods , such as acupuncture , could slow the progression of myopia in children and adolescents could not be supported in a current systematic review by the Cochrane Collaboration .

Special forms of myopia can be treated causally, for example cataract- induced myopia through a cataract operation or glucose-induced myopia through precise adjustment of the blood sugar level . For pseudomyopia, treatments with low-dose cycloplegics, drugs that calm the ciliary muscle or temporarily paralyze it at high doses, have been suggested.

Secondary prevention: Atropine is believed to be able to slow the progression of myopia in children.

Risks and Effects

Unlike in the past, myopia is now considered a long-term risk to eyesight. The biologist Ulrich Bahnsen writes: "Especially dreaded consequence of suffering in the short-sighted are green and cataracts , the degeneration or retinal detachment and edema , so water retention in the macula , the point of sharpest vision."

Due to the limited maximum object distance that can be imaged sharply on the retina in myopic people, it is often not possible to see objects that are very distant. Because of this, with increasing myopia, the depth of field is also increasingly reduced and is increasingly limited to the close range in front of the eye. Since the risk of accidents is increased in traffic, appropriate eye tests are mandatory and regular repetition is recommended.

An increase in axial myopia leads to a stretching of the wall structures, especially of the choroid and retina with secondary atrophy of the retinal pigment epithelium and perfusion disorders of the choroid. The changes in stretch affect the peripheral ( equatorial ) retina and the posterior pole with the macular area and the region around the optic nerve head .

Surgical correction of ametropia (e.g. laser surgery ) reduces the refractive power of the cornea and thereby the axial refractive error, but not the problems of the eyeball that has grown too long. The risks of myopia caused by elongation of the eyeball persist even after the operation.

Changes in the peripheral retina

Retinal degeneration may occur in the equatorial area (e.g. grid lines , cobblestones , atrophic round or horseshoe foramina ), which can lead to retinal detachment . Even with nearsightedness of −1.00 to −3.00 D, the risk of retinal holes (foramina) and retinal detachment is increased by more than four times due to the deformed eyeball, and by more than −3.00 D by ten times.

Changes in the macular area

The stretching can lead to a thinning of the choroid (areolar chorioretinal atrophy), usually involving the papilla, as well as cracks in the Bruch's membrane (so-called lacquer cracks ). A complication can be the formation of new vessels in the choroid (choroidal neovascularization (CNV)), which can lead to bleeding or disciform scarring ( Fuchs spot ).

Others

The risk of primary open-angle glaucoma also increases sharply with increasing myopia. With higher myopia, vitreous opacities ( floaters ) often occur , which can disturb those affected.

Classification

In the ICD-10 classification, degenerative or malignant myopia is coded with H44.2, simple myopia with H52.1 and pseudomyopia caused by ciliary muscle spasms with H52.5 ( accommodation spasm ).

In everyday medical practice and research, the forms of myopia are classified according to various criteria, depending on the specific requirements.

Physico-optical criteria

Ivan Borish and Stewart Duke-Elder classified the forms of myopia according to physical-optical criteria:

  • Axial myopia : Myopia due to an increased axial length of the eye compared to the norm. As a rule of thumb, every millimeter of deviation of the axial length from the ideal length leads to an increase in myopia by three diopters.
  • Brechungsmyopie or Refraktionsmyopie : myopia by increased compared to standard refractive power of the refractive components of the eye, d. H. the cornea and / or the lens , but also aqueous humor and vitreous humor . Borish further subdivided refractive myopia into:
    • The Krümmungsmyopie is a plurality of refractive surfaces of the eye, particularly the cornea caused by the increased curvature of one or. A keratoconus can cause this form of myopia, as can a lenticonus . In patients with Cohen syndrome , myopia appears to occur as a result of increased curvature of the cornea and lens.
    • The Linsenmyopie caused by the change in the refractive index of one or more of the materials of the eye (usually the lens).

Degree and extent

The degree of nearsightedness is measured using the refractive power in dioptres (dpt) that a lens must have in order to correct the ametropia in such a way that images of distant objects are accurately reproduced on the retina. Therefore, myopia can be classified as follows according to its extent:

  • Mild myopia usually describes myopia of −3.00 dpt or less.
  • The moderate myopia is usually diopters myopia from -3.00 to -6.00.
  • Severe nearsightedness (also: myopia magna ) usually describes an ametropia of −6.00 dpt or more. About 4.5% of nearsighted people develop severe myopia.

Time of origin

Another possibility is to classify myopia according to the age of the person affected when the disease develops:

  • The congenital (congenital or infantile) myopia is present from birth and persists throughout childhood.
  • The resulting in childhood and adolescence myopia develops at the age up to 20 years.
  • The resulting early adulthood myopia occurs between the ages of 20 and 40 years.
  • The nearsightedness that develops in late adulthood appears for the first time after the age of 40.

Disease value

  • Simple myopia, myopia simplex, school myopia : An eye with myopia simplex is an otherwise normal eye that is too long for the refractive power given by its cornea and lens or (less often) has too high a refractive power in relation to its axial length. Myopia simplex is the most common type of nearsightedness. It is believed that genetic as well as various environmental factors, especially extensive work in the vicinity of the eye, contribute to the development of myopia simplex. Myopia simplex can be considered a physiological (non-pathological) form of myopia because the only deviation of the eye from normal structure and function is the need to use minus lenses to see clearly in the distance. The statutory health insurances in Germany argue similarly when they refuse to cover the cost of visual aids for patients with myopia simplex from the age of 18. The degree is easy to moderate, it usually arises in childhood and adolescence.
  • The degenerative myopia or Malignant myopia is by significant changes in the fundus of the eye characterized, for example, a Staphyloma (a bulge at the posterior pole of the eyeball), and coupled with high refractive deviation from the normal values and subnormal vision after correction. With this form of myopia, the refraction values ​​often increase throughout life. Degenerative myopia has been cited as a major cause of visual impairment . The degree is usually strong, it is often innate (congenital) or has existed since early childhood (infantile).

Other clinical forms

Other forms of myopia can be differentiated according to their clinical appearance: some of these forms can also be assigned to the aforementioned classifications.

  • The accommodation spasm is a spasm of the ciliary muscle that causes what is known as pseudomyopia , in which the ciliary body cannot relax enough to see distant objects clearly. These neuromuscular problems are perceived by the patient as nearsightedness, which is why the effect is called pseudomyopia or functional myopia , especially in the English-language literature . Young patients and people whose eyes are strained by excessive accommodation , for example when reading, studying or working on computers, are particularly affected . This functional myopia, caused by accommodation spasms, should not be confused with physiological myopia, as it requires a fundamentally different treatment and should never be corrected with lenses with negative diopters. The differential diagnostic clarification is carried out by means of an examination in cycloplegia .
  • The Nachtkurzsichtigkeit (also: Dämmerungsmyopie ) is occurring in visibility with low contrast myopia (at dusk, at night, but even in fog). If the image projected onto the retina is not rich enough in contrast to be able to provide enough information for focusing, then the neural accommodation control adjusts itself to a resting point called dark focus about 0.5 to 2 m in front of the eye. Some authors also suspected increased optical aberrations at the edge of the lens with a wide open pupil as the cause of the phenomenon, however artificially dilated pupils in studies did not lead to increased night myopia.
  • The Indexmyopie or Linsenmyopie caused by changes in the refractive index in one or more of eyes materials. A cataract (cataract) may cause Linsenmyopie.
  • The Induced or acquired myopia is caused by the ingestion of some drugs , excessive glucose -mirror (see also diabetes mellitus ), cataracts or other abnormal conditions. The constricting ligaments (cerclage) used in the surgical treatment of retinal detachment can induce myopia by increasing the axial length of the eye. Myopia can result from surgery on the cornea or lens. The degree of this myopia is mild to moderate.
  • The Induced Formdeprivationsmyopie or lens-induced myopia is a form of myopia, which occurs when the eye, the normal view is rendered impossible by an unnatural environment with limited visibility or poor lighting, artificial lenses or semi-transparent covers. This results in an artificially elongated eyeball. In lower vertebrates , this myopia seems to be reversible within a short time due to lifelong growth. With such methods, myopia was and is induced in various animal species in experiments in order to study the development of the disease ( pathogenesis ) and the mechanisms of myopia. Similar situations can arise in humans due to (treated or untreated) congenital cataracts.
  • The Transient myopia referred effects that lead to myopic to a temporary shift. In the ICD-9-CM classification used in the USA, such effects could be classified as transient refractive change (ICD-9-CM 367.81).
  • The Raummyopie occurs at a maximum Akkommodationsruhelage and irritant empty visual field at high altitudes, such as pilots. Any active innervation of the ciliary muscle is stopped. Only the remaining resting tone and the mechanical influences of the zonular fibers are still effective.

Statistical normal distribution and deviations

In the normal population too, the parameters relevant for myopia are subject to a certain spread, which can also vary significantly depending on age, living conditions and even time of day. Knowledge of these variations is important for both the patient and the doctor in order to be able to differentiate between normal temporary symptoms and ametropia. The variations of the individual parameters can accumulate to significant measurement inaccuracies, which under certain circumstances are significantly higher than the measurement errors of the optometric diagnostic methods .

Age dependency

Results of two studies on the development of the normal distribution of refraction values ​​in children aged 3–15 years from the United Kingdom (1961) and in children aged 6–14 years from the USA (2003). The dark area contains 68.27% of all measuring points (one standard deviation ), up to the edge of the medium dark area 95.45% of all persons are included, the outer border of the light area encloses 99% of all test persons.

Numerous studies on the occurrence of nearsightedness in the population ( prevalence ) have been published. However, due to non-standardized measurement methods, these are hardly comparable, and the selection of the population groups examined can have a strong influence on the result. The prevalence is generally higher among college students than patterned soldiers, and higher among school children than preschoolers. There is no consensus on the definition of the threshold value for differentiating between myopia and normal vision when determining the prevalence; depending on the study, this is sometimes set at −0.25, −0.50, −0.75 or −1.00 dpt.

The data from a large number of studies without the administration of cycloplegica were also collected to determine the ametropia. However, more recent studies have shown that determining the ametropia without administration of Cycloplegica leads to considerable measurement inaccuracies, which leads to a significant overestimation of myopia in some studies, since the administration of Cycloplegica was often not considered practical in serial examinations for reasons of time.

Only a few studies give the statistical distribution of the determined optical values ​​of the examined subjects in their publication.

The WHO-funded Refractive Error Study in Children (RESC) attempted for the first time to use a standardized procedure to determine the distribution of ametropia in children in the age groups in which myopia simplex usually sets in (ages 5–15 years) and thus enable an interethnic comparison. The results are published in a number of publications, but so far only data in developing and emerging countries have been recorded. The distribution of refractive values ​​of children in underdeveloped countries like Nepal seems to be quite stable in the youth, while in the neighboring emerging countries India and China there is a real "myopia" in the age groups from 6 to 15 years: the statistical mean the ametropia moves in the direction of myopia, at the same time the standard deviation increases extremely quickly within a few age groups.

Although the statistical distribution often with a slight curvature (kurtosis) and skewness (skewness) deviates in the direction of myopia from the ideal Gaussian distribution, it is usually having a symmetrical Gaussian distribution modeled.

Amplification of myopia through feedback

As the child grows, the eyes adjust due to homeostasis . Your growth will u. a. influenced by the optic nerves and the nerves of the ciliary muscle . The length of the eyeballs adapts so that the image on the retina is sharp for the most frequently used viewing distance when the eye lens and the ciliary muscle are at rest (first level of feedback ). When a child reads a lot or looks a lot at the screen of a PC or smartphone, the ciliary muscle is often tense so that the image on the retina is sharp. As a result, the eyeballs can grow longer over time and myopia develops if the child has a disposition for it. There is a detailed and interesting video by Prof. Manfred Spitzer about the development of myopia

The second level of feedback comes into play when the child or adolescent also prefers to use their eyes at close range while wearing glasses. Then the process described above continues and after a while more corrective glasses will be necessary. The second stage can be prevented if the child, as soon as they have glasses, consistently does not use them for close range, because then no further elongation of the eyeball is provoked (see above).

The intensification of myopia can also be stopped in adolescents if the "new" glasses are only used for distance vision and the "old" glasses are used for close range. (With "children's reading glasses" of approx. 2 dioptres one could possibly even preventively prevent nearsightedness in children at risk.)

Time of day fluctuations

Like all other organs, the eye is not absolutely rigid and has fixed properties. Rather, it is subject to the processes of homeostasis with which the body regulates its growth and functions itself and adapts to the environmental conditions. A German study reported in 1988 that in a sufficiently large group of test persons, the degree of myopia differed significantly between measurements in the morning and in the evening by 0.25 D, but at that time the authors could not make any statements about the causes of these fluctuations do. A few years later it was observed that the growth of the eyes of chicks examined in animal experiments was subject to a pronounced day and night rhythm: while strong growth spurts are recorded during the day , shrinkage occurs at night, i.e. H. to reduce the axial length of the corns examined. Similar cycles were then demonstrated in experiments with rabbits and monkeys.

In human children and adults too, the size, and thus the axial length of the eye, varies depending on the time of day. The highest myopic shift occurs around noon in most subjects. Studies found between 0.015 and 0.04 mm and 0.020-0.092 mm variations in the length of the eyeball over the course of the day. This corresponds to a change in the refractive index of 0.05 to 0.32 dpt. and is consistent with the older data of the above-mentioned German study from 1988, which could only roughly map the effect with only two measurements per day.

However, the optical properties of the cornea and lens seem to be comparatively constant.

pregnancy and breast feeding period

During pregnancy, a temporary myopic shift of up to about −1 D can occur in women. This goes away on its own no later than a few weeks after the end of pregnancy and breastfeeding.

Temporary appearance due to visual stress

As early as 1914, Lancaster and Williams observed that immediately after working in the vicinity of the eyes in the subjects examined (children and adults up to 60 years of age) there was a temporary myopic shift of the far point of up to −1.3 D, lasting up to 15 minutes lasted. More recent studies since the 1980s determined mean shifts between −0.12 and −0.93 dpt, depending on the experimental setup. This temporary nearsightedness subsides more slowly in subjects with developed myopia than in those with normal vision.

The effect has been described in various ways in the literature, such as “accommodative lag” , “accommodative hysteresis of refractive errors” , “visual fatigue” , “transient myopia” and “nearwork-induced transient myopia” (NITM). It lasts longer on average in myopic people than in others. Some authors suggested a possible link between NITM and the development of permanent myopia.

In the years from 1995 to 2003, the CLEERE long- term study was the first to determine not only the ametropia but also the associated effects of the accommodative lag in a large group of children between the ages of 6 and 15 . From these data it emerged that the accommodative was not yet present, but can only be proven with the onset of myopia. It must therefore be assumed that it is not the cause, but a consequence of myopia. In the test subjects who corrected their nearsightedness with glasses or contact lenses, the delay in subsidence increased annually, and the degree of myopia itself increased somewhat more than in the children who did without a visual aid despite their ametropia. On the basis of this data, however, it has not yet been possible to say whether the more pronounced myopia among the test subjects wearing glasses was the cause or consequence of using the visual aid.

Development of myopia (animal experiment)

Empirical experiments to research myopia are mostly carried out on animals, since the deliberate and controlled induction of myopia in humans is not ethically justifiable. Some typical animal species in which researchers have induced myopia for experimental purposes are fish, chickens, mice, guinea pigs and monkeys. These species differ greatly in their physiology , but many similarities could be recognized. In such cases, it is hoped that the results will be of a general nature if the eyes of all the species examined show certain common characteristics in their development or differences can be understood and plausibly explained. However, this does not turn out to be correct in every case.

Daylight exposure is very important for the development or deterioration of myopia . This lowers the risk of myopia and increases visual activity at short visual distances. The probability ratio for the occurrence of myopia is increased by a factor of 5 with low daylight exposure and increases by a factor of up to 16 due to an additional high degree of close-up work. A retinal neurotransmitter, dopamine, has an important regulatory function here; it and other factors influence the growth of the eye. The more dopamine the retina releases, the more light hits the eye.

Normal distribution and deviations

The normal distribution of ametropia in primates hardly differs in its statistical parameters from that of humans. The differences between different studies are usually greater than those between the species. While at birth there is an on average very strong farsightedness with a strong scatter, the refractive values ​​approach normal vision ( emmetropia ) in the first months of life and the scatter decreases. With age they fluctuate by 0 to +0.5 D with a standard deviation between ± 0.7 and ± 2 D. Females show a slightly higher ametropia than males; animals raised in the laboratory are almost 0.5 D more myopic than those raised in the wild, even in their youth, this difference increases somewhat with age. The standard deviation in laboratory animals is more than twice that of wild animals in all age groups and increases with age.

Emmetropization

The growth of the eye in childhood occurs in spurts synchronized with the rhythm of waking and sleeping: while the size of the eyeball increases during the day, the eye shrinks again at night. In youth, the eye grows faster during the day than it shrinks at night, so that the overall size is constantly increasing. The exact growth rates vary from individual to individual and between the left and right eye of the same organism, and they decrease rapidly as they reach adulthood.

If the normal vision of the eye is influenced by covers or lenses, a change in this behavior can be observed: the nocturnal decrease in the size of the eyeball decreases, does not occur, or can even turn into growth. If this condition persists over a longer period of time, the result is a permanently elongated eyeball, as the growth is no longer compensated for by a corresponding shrinkage. This continues until an equilibrium is reached: the eye adapts to its surroundings so that the length of the eyeball again better matches the refractive power of the optical lens system. This process, known as emmetropization, comes to rest as soon as the ametropia has approached the refractive power of the additional lens: the eye “grows towards the focal point of the lens”. From now on, the normal daily fluctuations around the new ametropia, the optical correction by a "visual aid" prevents re-emmetropization in the direction of normal vision.

Controlling growth

Severing the optic or ciliary nerve changes the course of myopic development, but cannot prevent it. It is therefore assumed that both the neuronal mechanisms via the optic nerve and ciliary nerve and local mechanisms in the eye control growth.

Early on it was observed that the dopamine balance of the retina is related to the growth of the eyeball, and that dopamine receptor-influencing drugs also modulate the development of form-deprivation myopia induced by covering the eyes. The intravitreal injection of 6-OHDA into the eyeball prevents the induction of form deprivation myopia in young chicks despite covering the eyes. (6-OHDA or 6-hydroxydopamine is a neurotoxin that neurons with dopaminergic and noradrenergic receptors destroyed). Lens-induced myopia cannot be influenced in this way, so the experimenters suspected that these two forms of induced myopia are controlled by two different mechanisms.

Nerve toxins such as nicotine and neurotransmitters such as GABA also influence the growth processes of the components of the eye involved in the development of myopia.

With some muscarinic acetylcholine receptor blockers such as atropine and pirenzepine , the development of myopia can be reliably prevented with the correct dosage. The exact mechanisms of the action of these substances are so far poorly understood. The results of the present studies indicate that they probably do not prevent myopia by their paralyzing effect on the ciliary muscle, but by inhibiting glycosaminoglycan synthesis in the extracellular matrix of the sclera and thus modulating its viscoelasticity . Similar biochemical processes are also observed in the sclera in the recovery phase after an experimentally induced form deprivation myopia.

The administration of the adenosine receptor blocker 7-methylxanthine (7-mx) was also able to reduce myopic development in animal experiments. The mechanism seems to be based on a selective strengthening of the connective tissue fibers of the sclera. In a three-year, randomized and placebo-controlled pilot study with 107 test persons aged between 8 and 13 years, doses between 40–706 (∅444) mg / day administered in the form of 400 mg tablets stabilized myopia in 59% of the test persons with a medium rate of progression before starting therapy. No side effects occurred in any of the test subjects. After the end of the therapy, the progression rates increased again, the authors therefore assume that such a therapy would have to be continued until the end of the adolescent growth phase at the age of 18–20 years.

Recovery from induced myopia

If the covers or lenses are removed from the eyes while they are still in the growth phase, the emmetropization steers back towards normal vision. Chicks, guinea pigs, shrews and primates recover even from drastic ametropia in their youth. The eyeball is not simply deformed, but the cell structure of the sclera is downright rebuilt.

It remains to be seen to what extent findings from animal experiments can be generalized and transferred to humans.

Genetic Mechanisms

Despite extensive studies on the genetic mechanisms of ametropia, little concrete information is known about the interactions between genetic mechanisms and the development of ametropia. The existing studies are often contradictory and often only examined individual families or small isolated ethnic groups. Follow-up studies in other ethnic groups were only able to verify results for the rare cases of very extreme myopia.

In a study on more than 4000 adult twins in 2010 it was shown that myopic patients have increased expression of the RASGRF1 gene (locus 15q25). RASGRF1 encodes a protein in neurons and receptors of the retina, which can be detected in high concentrations, especially in the developmental phases. RASGRF1 expression is stimulated by stimulating muscarinic receptors. This result is consistent with previous studies, in which the administration of low-dose muscarinic acetylcholine receptor blockers such as atropine and pirenzepine prevented or at least reduced the development and progression of myopia in growing mammals as well as in human children and adolescents.

The following genes have been or are suspected of directly or indirectly influencing the development of myopia:

gene Gene locus Age at the outbreak Responsible for OMIM reference
MYOPIA1; MYP1 Xq28 1.5-5 years −6.76 ... −11.25 dpt 310460
MYOPIA2; MYP2 18p 7 years (∅) −6 ... −21 dpt 160700
MYOPIA3; MYP3 12q 6 years (∅) −6 ... −15 dpt 603221
MYOPIA4; MYP4 7q −13 dpt (∅) 608367
MYOPIA5; MYP5 17q 9 years (∅) −5 ... −50 dpt 608474
MYOPIA6; MYP6 22q12 −1 D or less 608908
MYOPIA7; MYP7 11p13 −12 ... +7 dpt 609256
MYOPIA8; MYP8 3q26 −12 ... +7 dpt 609257
MYOPIA9; MYP9 4q12 −12 ... +7 dpt 609258
MYOPIA10; MYP10 8p23 −12 ... +7 dpt 609259
MYOPIA11; MYP11 4q22-q27 younger than 7 years −5 ... −20 dpt 609994
MYOPIA12; MYP12 2q37.1 younger than 12 years −7 ... −27 dpt 609995
MYOPIA13; MYP13 Xq23-q25 before school age −6 ... −20 dpt 300613
MYOPIA14; MYP14 1p36 −3.46 D (∅) 610320
TGIF-β 19q13.1 Growth factor 602630
PAX6 11p13 Development of the eye 607108
RASGRF1 15q25 Growth factor 606600

Myopia and presbyopia

A resulting presbyopia does not compensate for the nearsightedness developed in youth, but complements it. The elongated eyeball is not shortened again, only the lens material hardens exponentially with increasing age. As a result, the ciliary muscle can no longer deform the lens sufficiently to also focus on close objects: the range of accommodation decreases. For the patient, this means that additional reading glasses are required in addition to the visual aid for distance vision, or alternatively bifocal glasses or varifocals .

Myopia changes the range of accommodation insofar as the near and far points are closer to the eye. Myopia can sometimes mean that nearby presbyopes can see properly, or at least better, simply by removing their distance correction. In the optimal case, this situation is given when the purely numerical extent of myopia, irrespective of the mathematical sign, corresponds approximately to the value of an objectively required close-up correction. The coincidence of such optical conditions is purely coincidental and in no way means that there would be any mutual change or active influence with regard to myopia on the one hand and presbyopia on the other. However, it is not uncommon if, for example, a person with a myopia of −1.50 to −2.50 D and fully developed presbyopia does not need any reading glasses to read at a distance of 20 to 45 centimeters.

Special form monovision

In refractive surgery using laser eyes or the implantation of artificial lenses, what is known as “ monovision ” allows people to be relatively free from glasses or contact lenses in the distance and near, even beyond the age of 45. A surgically induced difference in refractive power of up to 1.5 D is usually well tolerated by the brain if the distant-dominant eye sees absolutely sharply in the distance and the near-dominant eye in the vicinity. A detailed orthoptic examination may have to test this fusion ability before an operation by wearing trial contact lenses. After a certain period of getting used to (adaptation), the brain suppresses (suppression) the more blurred visual impression when the brain is offered two differently sharp images through the binocular (two-eyed) visual act. With a mean visual range of 1-3 m, depending on the pupil size ( stenopean effect), both eyes see almost equally well, especially in good light, which is why the transition from far to near and vice versa is barely perceived. However, if the pupils are wide, for example driving a car at night, the diopter jump of the monovision is most clearly perceived, which is why an optical correction may be necessary here. An estimated 5–8% of the population naturally have this type of optical variation in the human eye, which is why they can manage without optical near correction but also without refractive eye surgery until advanced presbyopic age.

etymology

The medical term myopia is derived from the ancient Greek word μύωψ mýōps "short-sighted", which is composed of the components μυεῖν myein "close" and ὤψ ōps "eye". Even in antiquity - when there was no way to correct ametropia - it was known that people suffering from myopia tend to "blink" to form a kind of pinhole and thus increase the depth of field according to the principle of the " Stenopean gap " and at least partially compensate for their visual defects.

See also

literature

  • Franz Grehn: Ophthalmology . 30th edition. Springer, Berlin 2008, ISBN 978-3-540-75264-6 .
  • Jack J. Kanski: Clinical Ophthalmology: Textbook and Atlas . 6th edition. Urban & Fischer, Munich 2008, ISBN 978-3-437-23472-9 .
  • Gerhard K. Lang: Ophthalmology: Understanding - Learning - Applying . 4th edition. Thieme, Stuttgart 2008, ISBN 978-3-13-102834-1 .
  • Matthias Sachsenweger: Ophthalmology . 2nd Edition. Thieme, Stuttgart 2003, ISBN 3-13-128312-2 .
  • Theodor Axenfeld, Hans Pau: Textbook and Atlas of Ophthalmology . Gustav Fischer Verlag, Stuttgart 1980, ISBN 3-437-00255-4 , p. 32 (With the collaboration of R. Sachsenweger et al.).

Web links

Commons : Myopia  - Collection of images, videos, and audio files
Wiktionary: Myopia  - explanations of meanings, origins of words, synonyms, translations
Wiktionary: Myopia  - explanations of meanings, word origins, synonyms, translations

Individual evidence

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  2. ↑ LA Jones, LT Sinnott, DO Mutti, GL Mitchell, ML Moeschberger, K. Zadnik: Parental history of myopia, sports and outdoor activities, and future myopia . In: Investigative Ophthalmology and Visual Science . tape 48 , no. 8 , 2007, p. 3524-3532 , PMID 17652719 (English).
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  10. ^ Theodor Axenfeld, Hans Pau: Textbook and Atlas of Ophthalmology . Gustav Fischer Verlag, Stuttgart 1980, ISBN 3-437-00255-4 , p. 32 .
  11. ↑ Zhong Kai: Acupuncture Treatment for Juvenile Myopia. In: Chin Med. 1992; 3, pp. 72-78.
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  18. ↑ ICD-10 online
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  39. ↑ a b c W. Shen, M. Vijayan, JG Sivak: Inducing form-deprivation myopia in fish . In: Investigative Ophthalmology and Visual Science . tape 46 , no. 5 , 2005, p. 1797-1803 , doi : 10.1167 / iovs.04-1318 , PMID 15851585 (English).
  40. ↑ C. Meyer, MF Mueller, GI Duncker, HJ Meyer: Experimental animal myopia models are applicable to human juvenile-onset myopia . In: Survey of Ophthalmology . tape 44 , Suppl 1, October 1999, pp. 93-102 , PMID 10548121 (English).
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  42. ↑ a b K. Zadnik, RE Manny, JA Yu, GL Mitchell, SA Cotter, JC Quiralte, M. Shipp, NE Friedman, RN Kleinstein, TW Walker, LA Jones, ML Moeschberger, DO Mutti: Ocular component data in schoolchildren as a function of age and gender . In: Optometry and Vision Science . tape 80 , no. 3 , March 2003, p. 226-236 , PMID 12637834 (English).
  43. ^ YF Choong, AH Chen, PP Goh: A comparison of autorefraction and subjective refraction with and without cycloplegia in primary school children . In: American Journal of Ophthalmology . tape 142 , no. 1 , July 2006, p. 68-74 , PMID 16815252 (English).
  44. ^ A. Cervino, SL Hosking, GK Rai, SA Naroo, B. Gilmartin: Wavefront analyzers induce instrument myopia . In: Journal of Refractive Surgery . tape 22 , no. 8 , October 2006, p. 795-803 , PMID 17061717 (English).
  45. ↑ R. Fotedar, E. Rochtchina, I. Morgan, JJ Wang, P. Mitchell, KA Rose: Necessity of cycloplegia for assesing refractive error in 12-year-old children: a population-based study . In: American Journal of Ophthalmology . tape 144 , no. 2 , August 2007, p. 307-309 , PMID 17659966 (English).
  46. ^ T. Toh, LS Kearns, LW Scotter, DA Mackey: Post-cycloplegia myopic shift in an older population . In: Ophthalmic Epidemiology . tape 12 , no. 3 , June 2005, p. 215-219 , PMID 16036481 (English).
  47. ↑ GA Kempf, SD Collins, BL Jarman: Refractive errors in the eyes of children as determined by retinoscopic examination with a cycloplegic. Results of eye examinations of 1860 white school children in Washington DC . Ed .: United States Public Health Service. United States Government Printing Office , Washington, DC 1928, p. 1-56 .
  48. ^ FA Young, RJ Beattie, FJ Newby, MT Swindal: The Pullman study: a visual survey of Pullman school children I. In: American Journal of Optometry & Archives of American Academy of Optometry . tape 31 , no. 3 , March 1954, p. 111-121 , PMID 13138702 (English).
  49. ^ FA Young, RJ Beattie, FJ Newby, MT Swindal: The Pullman study: a visual survey of Pullman school children II . In: American Journal of Optometry & Archives of American Academy of Optometry . tape 31 , no. 4 , April 1954, p. 192-203 , PMID 13148296 (English).
  50. ↑ AD Negrel, E. Maul, GP Pokharel, J. Zhao, LB Ellwein: Refractive Error Study in Children: sampling and measurement methods for a multi-country survey . In: American Journal of Ophthalmology . tape 129 , no. 4 , April 2000, pp. 421-426 , PMID 10764848 (English).
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  53. ↑ GP Pokharel, AD Negrel, SR Muñoz, LB Ellwein: Refractive Error Study in Children: results from Mechi Zone, Nepal . In: American Journal of Ophthalmology . tape 129 , no. 4 , April 2000, pp. 436-444 , PMID 10764850 (English).
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  56. ^ GV Murthy, SK Gupta, LB Ellwein, SR Muñoz, GP Pokharel, L. Sanga, D. Bachani: Refractive error in children in an urban population in New Delhi . In: Investigative Ophthalmology and Visual Science . tape 43 , no. 3 , March 2002, p. 623-631 , PMID 11867576 (English).
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  59. ↑ PP Goh, Y. Abqariyah, GP Pokharel, LB Ellwein: Refractive error and visual impairment in school-age children in Gombak District, Malaysia . In: Ophthalmology . tape 112 , no. 4 , April 2005, p. 678-685 , PMID 15808262 (English).
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    D = 1 / f_orig - 1 / f
    1 / 0.017 - 1 / (0.017 + 0.000015) = 0.05 or
    1 / 0.017 - 1 / (0.017 + 0.000092) = 0.32.
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This version was added to the list of articles worth reading on May 18, 2009 .