February 2023 Virtual event Presentation

Exploring Posterior Segment Pathologies Related to Myopia

Exploring Posterior Segment Pathologies
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Jessica Haynes

By Dr. Jessica Haynes OD, FAAO, FORS, Dipl ABO, United States

About the presentation

Learn how myopia related signs and pathologies may change over a lifetime and hear how Jessica Haynes, consulting faculty at the Southern College of Optometry Advanced Care Ocular Disease Clinic and full-time associate optometrist at Charles Retina Institute, openly discusses how it is not always straightforward how to measure, diagnose, and treat these pathologies.

FAQ from the event

How often should a patient with myopic traction maculopathy be monitored?

It really depends on the severity of the situation and if there is any progression. Going back to the presentation, patient number 1 is such a common finding, and I suggest being monitored once per year as long as you are not concerned about anything else in the eye, or perhaps then every six months. Looking at patient number 2 and 3, you will probably want to watch them more closely, probably every three to four months while educating them about monocular vision monitoring in case something should happen in-between visits so they can come in sooner.

How often should you monitor a patient with lattice degeneration?

If you’re seeing the patient every year and perform a dilated exam you are probably operating within a standard of care; however, I do have some patients that I see every six months, and it really depends on the situation such as the status of the fellow eye, as we always have to be more careful with patients who are monocular. At the end of the day, I do rely a lot on the reporting of my patients, if they report flashes of light, newly onset floaters, shadows in their vision. It is also important to bear in mind that some patients and have problems and be entirely assymptomatic.

What is the referral timeline for a patient with choroidal neovascularization?

It is a more urgent referral timeline compared to someone with, for example, diabetic macular oedema. Someone with choroidal neovascularization probably need to be seen within a week.

Some patients may say "I cannot be dilated as I have to get back to work" and so on. How do you explain to a patient the importance of a dilated exam?

My strategy is to be upfront and sincere with the patient about the severity of the situation. Mentioning that “I am not putting these drops in your eyes to torture you, to charge you more money or to waste your time. I have seen far too many patients who have lost their vision due to complications such as retinal detachments and the reason that I want to dilate your eyes is to make sure you are not that patient.”

References

Hayashi K, Ohno-Matsui K, Shimada N, et al. Long-term pattern of progression of myopic maculopathy: A natural history study. Ophthalmology. 2010;117(8):1595-1611.e4.
https://pubmed.ncbi.nlm.nih.gov/20207005/

Curtin BJ. The posterior staphyloma of pathologic myopia. Trans Am Ophthalmol Soc. 1978;Vol. 75:67-86.
https://pubmed.ncbi.nlm.nih.gov/613534/

Tokoro T (1998) Atlas of posterior fundus changes in pathologic myopia. Springer, New York, USA, pp. 5-22.

https://link.springer.com/book/10.1007/978-4-431-67951-6

Fricke TR, Jong M, Naidoo KS, et al. Global prevalence of visual impairment associated with myopic macular degeneration and temporal trends from 2000 through 2050: Systematic review, meta-analysis and modelling. Br J Ophthalmol. 2018;102(7):855-862.
https://pubmed.ncbi.nlm.nih.gov/29699985/

Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci. 2019;96(6):463-465.
https://pubmed.ncbi.nlm.nih.gov/31116165/

Celorio JM, Pruett RC. Prevalence of lattice degeneration and its relation to axial length in severe myopia. Am J Ophthalmol. 1991;111(1):20-23.
https://pubmed.ncbi.nlm.nih.gov/1985485/

Yura T. The relationship between the types of axial elongation and the prevalence of lattice degeneration of the retina. Acta Ophthalmol Scand. 1998;76(1):90-95.
https://pubmed.ncbi.nlm.nih.gov/9541442/

Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern®. Ophthalmology. 2020 Jan;127(1):P146-P181.
https://www.aaojournal.org/article/S0161-6420(19)32094-9/pdf

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Mitigation
Measurement
Management

Prepared by the World Council of Optometry Myopia Management Resource Committee 2023.
The World Council of Optometry Myopia Management Standard of Care initiative is a collaborative partnership between World Council of Optometry and CooperVision.

Soft Dual Focus or Multifocal Contact Lenses

Spectacle Lenses for Myopia Control

Orthokeratology

Atropine

When to wear it

Children who are physically active
Ideal for very young wearers
Children disliking glasses and/or inclined to not wearing them full-time

Considerations

Shown to improve confidence and ability to participate in activities.

Typically more availability for astigmats.

No wearing time during waking hours.

Optical correction is still needed.

* Excluding children frequently engaged in water sports.