Update on the Pathology of Pathological Myopia
Pathological myopia is a leading cause of blindness across the world. Pathological myopia has been defined in several different ways, but usually combines a high refractive error with degenerative changes. High myopia is usually associated with enlargemen
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Update on the Pathology of Pathological Myopia Alia Rashid and Hans E. Grossniklaus
7.1
Introduction
Pathological myopia is the leading cause of blindness in many developed countries, especially in Asia and the Middle East [1–3]. Pathological myopia has been defined in several different ways, but usually combines a high refractive error with degenerative changes. Duke-Elder defined it as a myopia occurring with (predominantly posterior lobe) degenerative changes [4]. In Japan, where pathological myopia affects between 6 and 18 % of the myopic population, a high refractive error of >−8 diopters (D) is used as the diagnostic criteria for pathological myopia [5]. High myopia is usually associated with enlargement or elongation of the globe. The mechanical stretching forces associated with this enlargement can lead to several different types of fundus changes which can result in variable amount of visual deterioration. There have been a number of research studies that have documented the most common histopathological findings in myopic eyes. Most recently, a review of 308 eyes comprehensively delineated the histopathological findings in pathological myopia [6]. These include the tigroid fundus, lacquer cracks, geographic atrophy of RPE and choroid, posterior staphyloma, choroidal neovascularization also known as Fuchs spot, myopic configuration of the optic nerve head including peripapillary changes, macular holes and retinal holes or detachments, and vitreous, cobblestone, and lattice degeneration (see Table 7.1). Studies have shown that both genetic and environmental factors both cause and affect the development of pathological myopia [7–10]. Recent studies investigating the genomics of this condition have successfully identified novel loci which may be responsible for the development
A. Rashid, MBChB (*) • H.E. Grossniklaus, MD, MBA L.F Montogomery Laboratory, Department of Ophthalmology, Emory University School of Medicine, 1365 Clifton Road/ BT 428, Atlanta, GA 30322, USA e-mail: [email protected]; [email protected]
of this pathological process. With the under acknowledged but significant impact of pathological myopia in patients, the importance of genomic profiling and early recognition of pathological changes in the myopic eye can potentially aid earlier intervention or appropriate alternative therapies to improve the quality of life of these patients. In recent years, various interventional techniques have been tried to control progression myopia in children, including the use of antimuscarinic or cycloplegic drops, bifocal lenses, RGPCLs, and intraocular pressure-lowering drugs. According to a recent Cochrane review, the most promising results were shown in trials using antimuscarinic topical medication. Bifocal lenses and lenses to reshape the corneal surface were deemed to also be promising but in need of further elucidation with clinical trials [11]. Understanding the histopathology of pathological myopia is an important step in being able to focus the future development of appropriate interventions on
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