Pathological myopia

I just returned from the Asia Pacific Academy of Ophthalmology Annual Meeting in Busan, Korea. I was invited to give several talks and co-chaired a session on “Pathological Myopia”. Patients with pathological myopia often get retinal problems like macular hole, retinal detachment and macular degeneration. The incidence of pathological myopia is increasing world wide due to the influence of our modern environment. Children who have parents who are myopic and do not do enough outdoor activities are at increased risk of becoming myopic.

Most of the retinal problems from myopia occur because the eyeball continues to grow longer as we get older. This results in our spectacle prescription becoming higher and higher. The retina becomes stretched on the inside and retinal holes can easily occur. This can result in retinal detachment which requires urgent surgery to save the eye sight. Myopic macula holes are also more common and vitrectomy surgery with peeling of the internal limiting membrane and gas tamponade is essential to close the hole and preserve vision.

One of the topics we discussed at the meeting was whether retinal specialists could predict which myopic patient are at greater risk of developing macular holes and needed early vitrectomy surgery. The use of the OCT machine to scan the layers of the retina is very important in the management of myopic patients. We can identify early splitting (schisis) of the different layers of the retina with the OCT. Patients with “outer lamellar schisis” and “foveal detachment” on OCT were found to develop macular holes much quicker. These patients require closer monitoring and probably early surgery would help prevent visual loss.

We also discussed the use of Anti-VEGF agents in the treatment of myopic macular degeneration (MMD). Patients with this condition do not appear to require as many injections as patients with AMD. Photodynamic therapy (PDT) is also less effective for MMD. There is a new clinical trial in Asia looking at the use of a new drug called VEGF Trap Eye (eyelea) for MMD and I am looking forward to the results of the trial.

Busan is the 2nd largest city in South Korea and the weather in April was lovely. The cherry blossoms were out in full bloom and I have the chance to take a walk in the local park to enjoy the weather and scenery of Busan. The food was also  very nice, in particular, the Korean BBQs. I also met up with many local and overseas colleagues at this meeting. I will update this blog with more insights that I gained from this useful meeting.