Pathologic Myopia: Causes, Symptoms, and Treatment

Pathologic myopia, or degenerative or malignant Myopia, is a progressive form of nearsightedness that can lead to serious eye health complications. Unlike typical myopia, which stabilises in early adulthood, pathologic myopia worsens, often resulting in structural changes to the eye that increase the risk of conditions such as retinal detachment, myopic macular degeneration, and glaucoma. Understanding what pathologic myopia is, its symptoms, causes, and available treatments is essential for managing this condition effectively.

Pathological Myopia Meaning

Pathologic myopia is a severe and progressive form characterised by excessive eyeball elongation. This leads to extreme nearsightedness and increases the likelihood of retinal and macular damage. Unlike common myopia, which typically stabilises after adolescence, pathological myopia progresses throughout adulthood, often requiring specialised treatment to prevent vision loss.

The term “pathological myopia” refers to a chronic, degenerative form of myopia that results in irreversible changes in the eye structure. It differs from standard refractive myopia, as it involves thinning of the retina, stretching of the sclera, and potential development of myopic maculopathy. Due to these changes, individuals with this condition may experience a gradual decline in vision quality despite corrective lenses.

Pathological Myopia Causes

Several factors contribute to the development of pathological myopia. The most significant ones include:

• Genetic predisposition: A strong family history of high myopia increases the risk of developing pathologic myopia.
• Axial elongation: The excessive lengthening of the eyeball results in the distortion of the retina and choroid, leading to degenerative changes.
• Environmental influences: Prolonged near work, such as extensive screen use, reading, and lack of outdoor exposure, may accelerate myopia progression.
• Structural abnormalities: The sclera and retina undergo degenerative changes due to increased eye growth, making them more vulnerable to complications.

Pathologic Myopia Symptoms

Recognising the symptoms of pathological myopia early is crucial in preventing severe vision loss. Common symptoms include:

• Persistent blurred vision even with corrective lenses
• Frequent changes in prescription for glasses or contact lenses
• Floaters or flashes of light, indicating possible retinal detachment
• Distorted or wavy vision due to macular damage
• Difficulty seeing in low-light conditions
• Increased light sensitivity

Pathological Myopia Complications

Pathologic myopia significantly increases the risk of severe eye conditions, including:

Retinal detachment

The elongation of the eyeball leads to retinal thinning, making it more prone to detachment, which can cause sudden vision loss if not treated promptly.

Myopic maculopathy

Also known as myopic macular degeneration, this condition occurs due to progressive damage to the central retina, resulting in permanent central vision loss.

Choroidal Neovascularisation (CNV)

Abnormal blood vessels may grow beneath the retina, leading to leakage, scarring, and further vision deterioration.

Glaucoma

Individuals with pathologic myopia are at higher risk of developing open-angle glaucoma, a condition that damages the optic nerve and leads to gradual vision loss.

Diagnosis

Early diagnosis of pathological myopia is essential in preventing irreversible complications. Common diagnostic tests include:

• Visual acuity test: Determines the level of refractive error.
• Fundus examination: Evaluates the retina for degenerative changes.
• Optical coherence tomography (OCT): Produces detailed images of the retinal layers.
• Fundus fluorescein angiography (FFA): Identifies abnormal blood vessels and leakage.
• Axial length measurement: Assesses the extent of eyeball elongation.

Pathological Myopia Treatment

Although there is no cure for pathologic myopia, several treatment options help slow progression and manage complications.

Corrective lenses

• High-prescription glasses: Help improve vision clarity, but do not stop myopia progression.
• Speciality contact lenses: Ortho-K and rigid gas-permeable lenses may help reshape the cornea temporarily.
• Peripheral defocus offset lenses: Lenses like Stellest are designed to slow down myopia progression by redirecting peripheral light focus.

Pharmacological treatment

• Atropine eye drops: Shown to slow myopia progression in children by reducing eye elongation.
• Anti-VEGF injections: Used to manage complications such as choroidal neovascularisation.

Surgical interventions

• Vitrectomy: Performed for retinal complications like macular holes and haemorrhages.
• Scleral reinforcement surgery: Aims to prevent further elongation of the eyeball.

How to Prevent Myopia

While genetic factors cannot be controlled, certain lifestyle changes can help slow the progression of pathological myopia.

• Increase outdoor activities: Studies show that spending more time outdoors reduces the risk of myopia progression.
• Follow the 20-20-20 rule: Take a break every 20 minutes, and look at something 20 feet away for 20 seconds.
• Control screen time: Limit prolonged exposure to digital devices.
• Regular eye check-ups: Detects early signs of progression and allows for timely intervention.

While myopia is a common and manageable vision issue, pathologic myopia is a more severe, progressive condition that can lead to serious eye complications. Thus, it is important to understand the difference between the two and catch the symptoms as early as possible.

Now that you’re familiar with pathologic myopia, explore our guide on myopia– also known as nearsightedness- to better understand its causes, symptoms, and management options.

Regular check-ups and specialised care are key to preserving your long-term vision health. Pathologic myopia requires regular monitoring and specialised care to preserve long-term vision health.

Pathologic myopia can lead to serious complications if left untreated. Schedule an eye examination!

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