Krótkowzroczność – podstawy epidemiologii i patogenezy, zasady postępowania i leczenia, pułapki codziennej praktyki
Myopia – Epidemiology and Pathogenesis, Management and Treatment – Pitfalls of the Everyday Practise
Anna M. Ambroziak, Alicja Krawczyk, Jerzy Szaflik
Katedra i Klinika Okulistyki II Wydziału Lekarskiego Warszawskiego Uniwersytetu Medycznego
Samodzielny Publiczny Kliniczny Szpital Okulistyczny w Warszawie
Kierownik: prof. dr hab. n. med. Jerzy Szaflik
Summary: Currently there are approximately 1.6 billions of people worldwide with myopia – until 2020 the number will increase up to 2.5 billions, only approximately 40% of myopic individuals have proper refractive error correction. Myopia prevalence increases with age. In America myopia freqeuncy in children between 5 and 7 years of age is estimated to be 3%, between 8 and 10 years of age – 8%, between 11 and 12 years of age – 14% and between 12 and 17 years of age – 25% (1.6% > -8.0), resepctively. Similar increase tendency with age was showed in individual ethnic groups, beside percentage differences in given age ranges. For example, children from the Chinese ethnic group have significantly higher range of myopia in every age. National study conducted in Taiwan showed that myopia frequency is 12% among 6 years old children and 84% in children at the age of 16–18. Similar results were obtained in Singapore and Japan (Europe – 27%).
Myopia development mechanism is placed within eye itself and according some researchers it is based on myofibroblasts modification in sclera.
In our study except epidemiology and pathogenesis basis of the refractive errors, current aspects of optic basis of the myopia progression, advantages of the soft contact lens wear and myopia control concept will be presented – very promissing project of lenses introduction, which could limit myopia progression. Based on studies, one can say that eyeball elongation is mainly result of blurred preipheral image, and not of macular one. New concept predicts lenticular lens construction, which in the central part would have power required for refractive error correction and its‘ peripheral part would have plus addition. Thanks to that, image in the peripheral retina would become distinct (focused on the retina), and due to that myopia development could be stopped. First studies results are very promising – lens based on „double focus” construction; different zones on the lens: therapeutic zone and correction zone, causes myopia reduction of 37% and 49% of the axial lenght reduction after 10 months (N=40).
Myopia = refractive error + axial lenght increase + peripheral hyperopia associated with proteoglycans synthesis increase (2 years before myopia onset, children have hyperopia on the periphery of the retina). Lenses based on dual focus technology (dual focus) lead to myopia reduction in 50% of patients (atropine – 100%, 2% pirenzepine – 43% myopia reduction Orto K – 45–52%).
Słowa kluczowe: krótkowzroczność, wada wzroku, podwójne ognisko, siatkówka obwodowa.
Keywords: myopia, refractive error, dual focus, peripheral retina