Correction (treatment) of myopia

With congenital myopia, early and correct correction is of particular importance as the main means of prevention and treatment of amblyopia. The earlier the glasses are assigned, the higher the corrected visual acuity and the less the degree of amblyopia. To detect and correct the congenital myopia is necessary in the first year of life of the child. In young children with anisometropia up to 6.0 D, correction with glasses is preferable. The difference in the strength of the glasses on the twin eyes to 5.0-6.0 diopters is easily tolerated by children. Assign glasses with a force of 1,0-2,0 D, less than the data of objective refractometry in conditions of cycloplegia. Compulsory correction of astigmatism more than 1.0 Dpt. It should be borne in mind that with congenital myopia, refraction in the first years of life may be weakened, so monitoring and appropriate correction of the correction are necessary.

With one-sided congenital myopia or anisometropia more than 6.0 D, the method of choice is the use of contact lenses. If it is impossible to select them, you should assign glasses with a maximum difference in the strength of the corrective glasses (up to 6.0 D) for a constant wearing and additionally a second pair of training glasses. In this case, the eye with a higher myopia is corrected completely, and a no-diopter glass and an occludor are placed in front of the best eye.

Use these glasses from a few hours a day to a whole day - depending on the state of the best eye.

Surgical correction of congenital myopia can not currently be considered a method of choice, since for the implementation of the main strategic goal - the prevention of amblyopia - it must be performed also at an early age, which is technically difficult and can pose a threat to the child's life. The only exception can be considered a very high (above 15.0 diopters) unilateral congenital myopia with the impossibility of conducting a contact correction. In this case, surgical intervention is possible - implantation of the intraocular lens.

Correction of the acquired nearsightedness is prescribed, as a rule, starting from 1.5-2.0 D, only in the distance. With myopia above 3.0, diopters are prescribed glasses for permanent wearing. With a weakened accommodation for reading, points are selected for 1.0-1.5 D, weaker (or bifocals).

Treatment and prophylactic measures for nearsightedness should be aimed at:

• normalization of accommodation;
• activation of hemodynamics and metabolic processes in the membranes of the eye:
• normalization of the balance of autonomic innervation;
• activating the level of collagen biosynthesis in the sclera;
• prevention of complications;
• correction of trophic disorders;
• prevention and treatment of amblyopia (only with congenital myopia).

With mild to moderate myopia, various non-surgical methods of treatment are widely used:

• accommodation training (with a moving object, with interchangeable lenses), transcleral infrared laser stimulation of the ciliary muscle on the MACDEL-09 apparatus;
• magnetotherapy;
• magnetograph of nicergoline (sermion), pentoxifylline (trental), taurine (taufon);
• pneumomassage;
• reflexotherapy, myo-therapy of the cervical-collar zone;
• Observation of the laser speckle structure;
• transconjunctival electrical stimulation on the device ESOF-1.

With the acquired myopia, electrostimulation methods are used with caution because of possible spasm of accommodation and acceleration of myopia progression.

For the treatment of amblyopia with congenital myopia, all kinds of pleoptics are used, especially laser pleiotics, amblycocor, videocomputer training, color pulse treatment, and percutaneous electrical stimulation of the optic nerve.

With the initial acquisition of myopia, it is advisable to use various exercises in the mode of long-range vision with the aim of removing a partial spasm and changing the tone of accommodation: the microclearing technique, the discomodation optical simulator, the observation of laser speckle with the addition of weak positive lenses.

With myopia of high degree, complicated (dry) atrophic form of central chorioretinal dystrophy, the following are also shown:

• direct transpupillary laser stimulation of the retina (LOT-01, LAST-1 and other low-energy lasers, as well as ruby, neodymium, argon lasers at subthreshold power);
• endonasal and panic electrophoresis of angiotropic drugs, vitamins, biogenic stimulants (with caution - fibrinolytic enzymes in the aftermath of hemorrhages);
• hyperbaric oxygenation;
• ultrasound treatment and phonophoresis.

At the same time, all listed methods are contraindicated in hemorrhagic form of complicated myopia, "lacquer cracks", rupture of the retina, detachment of the vitreous. In addition to the above, any forms of peripheral vitreochorioretinal dystrophies, as well as the length of the anteroposterior axis over 26.0 mm, even in the absence of changes in the fundus, are considered a contraindication to pneumomassage.

[1], [2], [3], [4], [5], [6], [7], [8]

Medication for myopia:

• the effect on the ciliary muscle with cholinolytics or short-acting sympathomimetics, sometimes in combination with digophton;
• stimulation of metabolic processes, normalization of cell membrane functions - taurine (taufon);
• angiotropic drugs;
• antioxidants;
• anthocyanins;
• activators of collagen synthesis - solcoseryl, chondroitin sulfate (khonsurid);
• microelements (especially C, Zn, Fe, involved in the synthesis of collagen and antioxidant protection);
• vitamins;
• peptide bioregulators (retinalamine, cortexin).

The most effective and pathogenetically justified way of inhibiting the progress of myopia at the present time is sclerotherapy. However, it should not be the first method, but rather a stage in the treatment complex. To determine the indications for the transition from functional treatment to minimally invasive interventions or scleroplasty, a table has been developed that takes into account the ratio of the patient's age, degree and rate of progression of myopia.

It should be noted that the progression of myopia in children becomes particularly rapid at the age of 10-13 years.

It is advisable to perform the so-called large scleroplasty, that is, surgery using whole, not crushed grafts, performed under anesthesia (at the age of 10-11 years on the first eye, after 1-1,5 years - on the second). Taking into account the well-known oculo-ocular effect, which is apparently provided by a pronounced vascular and tissue response during biodegradation and replacement of the graft on the operated eye, the progression of myopia in the pair eye in the absolute majority of patients is suspended for 10-12 months, and sometimes longer. This makes it possible to rationally distribute interventions on paired eyes and effectively inhibit or even stop the progression of myopia for 3 years (the most unfavorable years in the clinical course of myopia in children). It is at this age that the acceleration of myopia progression and the appearance of peripheral vitreochorioretinal dystrophies are noted, and with congenital myopia - and central chorioretinal dystrophy on the fundus.

Carrying out repeated sclera-strengthening interventions, constant dynamic observation and conducting according to the indications of preventive laser coagulation, including repeated, allows to reduce the rate of myopia progression, frequency and severity of central and peripheral chorioretinal dystrophies and prevent the development of one of the most serious complications of myopia - retinal detachment - in the observed contingent patients.

There are several possible ways to correct refraction disorders:

• glasses;
• contact lenses;
• refractive surgery (rarely seen in childhood).

To prevent the progression of myopia (myopia), there are various methods, including:

• gymnastics for the eyes - its effectiveness is not proven;
• the appointment of cycloplegic drugs - the appropriateness of their use remains controversial;
• bifocals - published results of this method of treatment are contradictory;
• prismatic correction - there are no evidence of the effectiveness of its use;
• Orthokeratographic method of selection of hard contact lenses, closely adjacent to the cornea. Provide only a short-term effect; data confirming the stability of the effect are absent;
• sclera-strengthening injections, scleroplasty operations - the effectiveness of these procedures remains unproven.