Correction (treatment) of myopia

In congenital myopia, early and correct correction is of particular importance as the main means of preventing and treating amblyopia. The earlier glasses are prescribed, the higher the corrected visual acuity and the lower the degree of amblyopia. Congenital myopia should be detected and corrected in the first year of a child's life. In young children with anisometropia up to 6.0 D, correction with glasses is preferable. Children easily tolerate a difference in the strength of lenses in paired eyes up to 5.0-6.0 D. Glasses are prescribed with a strength of 1.0-2.0 D less than the objective refractometry data under cycloplegia. Correction of astigmatism over 1.0 D is mandatory. It should be taken into account that with congenital myopia, refraction may weaken in the first years of life, so monitoring and appropriate correction changes are necessary.

In case of unilateral congenital myopia or anisometropia of more than 6.0 D, the method of choice is the use of contact lenses. If it is impossible to select them, it is necessary to prescribe glasses with the maximum difference in the power of corrective lenses (up to 6.0 D) for permanent wear and an additional second pair of glasses for training. In this case, the eye with higher myopia is fully corrected, and a non-dioptric glass and occluder are placed in front of the better eye.

These glasses are used from several hours a day to the whole day, depending on the condition of the better eye.

Surgical correction of congenital myopia cannot be considered a method of choice at present, since in order to achieve the main strategic goal - amblyopia prevention - it must also be performed at an early age, which is technically difficult and can pose a threat to the child's life. The only exception is very high (above 15.0 D) unilateral congenital myopia when contact correction is impossible. In this case, surgical intervention is possible - implantation of an intraocular lens.

Correction of acquired myopia is usually prescribed starting from 1.5-2.0 D, only in the distance. With myopia above 3.0 D, glasses are prescribed for constant wear. With weakened accommodation for reading, glasses are selected that are 1.0-1.5 D weaker (or bifocals).

Treatment and preventive measures for myopia 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;
• activation of the level of collagen biosynthesis in the sclera;
• prevention of complications;
• correction of trophic disorders;
• prevention and treatment of amblyopia (only in case of congenital myopia).

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

• accommodation training (with a moving object, with replaceable lenses), transscleral IR laser stimulation of the ciliary muscle using the MACDEL-09 device;
• magnetic therapy;
• magnetophoresis of nicergoline (sermion), pentoxifylline (trental), taurine (taufon);
• pneumatic massage;
• reflexology, myotherapy of the cervical-collar zone;
• laser speckle pattern observation;
• transconjunctival electrical stimulation using the ESOF-1 device.

In case of acquired myopia, electrical stimulation methods are used with caution due to possible accommodation spasm and acceleration of myopia progression.

For the treatment of amblyopia in congenital myopia, all types of pleoptics are used, especially laser pleoptics, amblyocor, video computer training, color pulse treatment, as well as transcutaneous electrical stimulation of the optic nerve.

In case of initial acquired myopia, it is advisable to use various exercises in the distance vision mode in order to relieve partial spasm and change the tone of accommodation: micro-fogging techniques, de-accommodation optical trainer, observation of laser speckle with the application of weak positive lenses.

In case of high myopia complicated by (dry) atrophic form of central chorioretinal dystrophy, the following are also indicated:

• 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 bath electrophoresis of angiotropic drugs, vitamins, biogenic stimulants (with caution - fibrinolytic enzymes in case of consequences of hemorrhages);
• hyperbaric oxygenation;
• ultrasound treatment and phonophoresis.

At the same time, all the listed methods are contraindicated in the hemorrhagic form of complicated myopia, "varnish cracks", retinal ruptures, vitreous detachment. 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 contraindications to pneumomassage.

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Drug treatment for myopia:

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

The most effective and pathogenetically justified method of slowing down the progression of myopia at present is sclero-strengthening treatment. 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, the degree and speed of myopia progression.

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

It is advisable to perform the so-called major scleroplasty, i.e. surgery using whole, non-crushed transplants, performed under general 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, obviously provided by the pronounced vascular and tissue reaction during biodestruction and replacement of the transplant on the operated eye, the progression of myopia in the fellow eye in the absolute majority of patients is suspended for 10-12 months, and sometimes longer. This allows for rational distribution of interventions on the fellow eyes and effectively slowing down or even stopping 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 in the case of congenital myopia, central chorioretinal dystrophy in the fundus.

Performing repeated scleral strengthening interventions, constant dynamic monitoring and, if indicated, preventive laser coagulation, including repeated, allows to reduce the rate of myopia progression, the frequency and severity of central and peripheral chorioretinal dystrophies and prevent the development of one of the most severe complications of myopia - retinal detachment - in the observed contingent of patients.

There are several possible ways to correct refractive errors:

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

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

• eye exercises - their effectiveness has not been proven;
• the use of cycloplegic drugs - the appropriateness of their use remains controversial;
• Bifocal glasses - published results of this treatment are contradictory;
• prismatic correction - there is no evidence of its effectiveness;
• orthokeratographic method of fitting rigid contact lenses that fit tightly to the cornea. Provides only a short-term effect; there is no data confirming the stability of the effect;
• sclero-strengthening injections, scleroplasty operations - the effectiveness of these procedures remains unproven.