The retinologists that I have quit for more serious reasons did not like the fact that I read so much. I have said this before. I have spent a lot of time learning about my eyes. So much more to learn. It is difficult, because I need to spend time on my work.
Your postings have made me aware how much I have to learn. I will get the book.
Thanks
I, too, seek additional information regarding posterior staphylomas. Are they easily discernable on clinical exam? Are they more definitely distinguished on an OCT? Is it readily diagnosable to the average retinal specialist?
No that is not the case. Dr Hagan will be the first to admit that some people can develop severe problems but that most do OK. I believe this to be generally the case too but Dr Hagan has much more experience with it than any of us so I'll let him comment. It is probably the case that some authors get to see much more severe cases as they are referred to them from all over so that can account for some differences in opinion. I think this is probably the case for Dr Curtin et al who had a myopia clinic back in the day. His opinion is far bleaker than anything I have ever read on this topic.
One of the problems that I have is that it is commonly stated that PM only affects the central part of your vision. This is 100% not true and can affect peripheral vision badly and profoundly.
PS, I'd be interested in hearing Dr. Hagan's (or any other doctor's) thoughts on all this.
Thanks for the information. Interesting that staphylomas appear to be so prevalent, yet many ophthalmologists (including Dr Hagan) seem to insist that their highly myopic patients do pretty well in the long term, with no serious vision loss. I wonder why the discrepancy. Seems that if you're highly myopic, you're very likely to have a staphyloma, and if you have a staphyloma, it's likely to progress until you're pretty much screwed/blind.
Basically, refractive error is not an indication of whether or not a person will develop pathological myopia. The length of the eye, or axial length, is far more important. The incidence of staphyloma ranges from around 15% to 90-100% in highly myopic eyes (>-8D) depending on which study you look at. With your level of myopia, about half of the eyes would be expected to have some degree of ectasia according to older research. It is not always easy to diagnose in early stages and it is my opinion that many docs do not even know what to look for. My doc says I do not have any, but I do not believe that for one second. They are usually present at birth but do tend to progress as you age. The level of this progression, or how deep the staphyloma becomes, essentially determines how badly affected the eye will become. Atrophy in and around the borders are what cause the problems. It is important to realise that staphyloma progression can occur in the ABSENCE of refractive changes. Therefore, just because your glasses prescription has not changed for a year or two does not mean you are out of the woods, although it probably does indicate that things wont be too bad! How and when you developed myopia can also be a clue to its future progression, but you sound OK to me. Note, however, that everything was fine for me up until I was 28 when it all started to go a bit wrong and I have an identical refractive error to you.
Don't worry but just be mindful of any changes.
Can you tell me more about posterior staphylomas? When do they usually develop? Do they always or usually develop in high myopes? I have high myopia, about -12D each eye, but my eyeMD and optometrists all say the eyes look 100% healthy. Is this something to be concerned about in the future? Thanks.
Very nice post and I am in complete agreement with you. Basically all you are left with is hope and that is about it. You just hope it doesnt get as bad for you as it might for others. But even then, what about those who do suffer disability. I have found people on line who are teenagers and who will never be able to drive because of this condition. What is going on here? It's a terrible shame but there are some positives for me. Because I know of my condition very early, I can plan for the future, just in case. I am about to take up a good disability insurance for example and that puts my mind at ease that at least I wont be reliant on the state if the worst should happen. What is annoying for me though is the lack of basic scientific information regarding progression and prognosis. I am a researcher too (post-doc) and it is very frustrating to see this.
Also, I have noticed that the studies that are out there are EXTREMELY poorly designed. There is basically one study on chorioretinal degeneration progression in myopia and it is woefully inadequate yet is cited by every single other paper out there. I dug it out at our library here and it is a joke. In any other biomedical research field, the paper would not get past peer review, no question, yet it is the go-to paper for discussions on the topic. Low number of subjects is the norm for these type of studies and they are massively over-analysed in their interpretation. Essentiallty the further you dig into this subject, the more desperate you realise the situation is.
I noted in your previous post that you made some decisions regarding implants. The outcome sounds unfortunate for you. Anything which raises IOP in myopia is potentially disastrous and can expand existing staphyloma leading to a increase in atrophy. I will not let anyone touch my eyes unless it is to treat the underlying condition. I would rather wear big fat glasses that risk the serious complications. I hope your case turns out ok though.
You finally "see the light." I have been stating this same sentiment for a very long time. As an avid researcher in both the medical and behavioral sciences, I know very well how research on particular disease processes is ignored while other disease processes are granted more than just due. Part of this has to do with advocacy, part has to do with professional interest, and part has to do with money (ophthalmologists who choose refractive surgeons make good money and have "happy" patients). The ophthalmologists here in the U.S. have ignored and basically "written off" pathological myopia - both in terms of its etiology and treatment (other than CNV). We have no advocacy and next to zero professional interest. It's sad to me that ophthalmologists in third world countries (e.g., China) are the medical professionals who show the greatest interest in this disease. I feel abandoned by my own country in this regard.
While many patients may just as well prefer "blissful ignorance" regarding their condition, I would have preferred that the ophthalmologists who had examined me all these years (I'm 38) been much more upfront concerning my condition and its threat to my vision. Knowing earlier would have enabled me to shape my professional and personal life differently. I would also been able to make better treatment decisions.
I can attest to the effects of peripapillary atrophy. I have significant distortion and have lost huge chunks of my peripheral vision in both eyes - so much for macular translocation implants.
Perhaps, Dukey, you will be one of the lucky ones - maybe your condition will stabilize and your vision loss will be minimal. If you do not have a posterior staphyloma, your prognosis - as you know - is better.
Finally, to end my soapbox, if pathological or high myopia runs in your family, make certain that your children spend plenty of time outdoors doing activities that emphasize distance vision (the vitamin D also can't hurt). Limit excessive near-vision activities. Regardless of the fact that a miniscule amount of controlled studies has said that these environmental factors do not play a role, there is an abundant amount of compelling evidence - allbeit more inferential - that they do indeed matter, at least when a person might be genetically predisposed.