When life is a big blur, optometric diagnosis and management can come in very handy! This is a case of a young female with pathological myopia who was able to return to partial functional activities thanks to careful retinal evaluation and basic low vision management.
Quiz: What is the highest myopia ever recorded? Find out at the end of this case!
A 45 y/o female presented for medical follow with a history of high myopia, multiple surgeries including cataract extraction and YAG capsulotomy OU, retinal detachment surgery OS, Intravitreal Avastin injections, and overall poor vision. She stated that her vision was stable but not very functional, preventing her from reading or watching TV. She was only using +3.00 OTC readers.
Distance VAsc
OD: 20/800 Ecc viewing @ 12 O’clock
OS: 20/200 Ecc viewing @ 12 O’clock
EOM
Pupils were equal and reactive
Confrontation VF:
Subjective Refraction
OD: -1.00 VA 20/350 Ecc viewing @ 12 O’clock
OS: -1.00 VA 20/150 Ecc viewing @ 12 O’clock
Anterior segment evaluation was unremarkable except for YAG capsulotomy OU
Fundus evaluation showed classic pathological myopia with patches of atrophy involving the macula and peripapillary staphyloma OU. The OCT showed an overall thin and atrophic retina with a very thin underlying choroid (see color-coded arrows).
Pathological Myopia represents 2% of the US population and is most common in young adult women.
Peripheral signs include lattice, snail-track, and Pavingstone degeneration, retinal breaks and detachments.
Signs in the posterior segment include staphylomas (hallmark), Fuch’s spot (subfoveal pigmentation secondary to scarring or CNVM), Lacquer’s cracks (breaks in Bruch’s, 5% of high myopes), and macular holes.
Non-retinal signs include NS and especially PSC cataract, extensive vitreous syneresis, and early PVD.
A careful dilated exam is important in these patients due to the higher risk of retinal breaks/detachments whereas OCT of the macula should be performed to rule out macular holes and CNVM.
This patient stated having trouble reading and watching TV. On exam she was able to read 20/100 OD and 20/60 OS with a +6.00 ADD and some base in prisms for convergence comfort. We also recommended she purchase the “MaxTV” glasses for distance magnification as well as to get a larger TV!
These patients can get some functional vision back so make sure to send them to low vision services as well!
Coming back to our Quiz, the highest myopia ever recorded is -108.00D! 🤯
The world record was recorded in 2016 by 59 y/o Slovak Jan Miskovic. This patient has both high myopia and keratoconus and is still progressing at a rate of 4-5 D/ year
His Rx was recorded to be:
OD: -106.00 + 6.00 x180
OS: -108.00 + 6.00 x 025
