Open Fundus Photograph Dataset with Pathologic Myopia Recognition and Anatomical Structure Annotation

Pathologic myopia (PM) is a common blinding retinal degeneration suffered by highly myopic population. Early screening of this condition can reduce the damage caused by the associated fundus lesions and therefore prevent vision loss. Automated diagnostic tools based on artificial intelligence methods can benefit this process by aiding clinicians to identify disease signs or to screen mass populations using color fundus photographs as inputs. This paper provides insights about PALM, our open fundus imaging dataset for pathological myopia recognition and anatomical structure annotation. Our databases comprises 1200 images with associated labels for the pathologic myopia category and manual annotations of the optic disc, the position of the fovea and delineations of lesions such as patchy retinal atrophy (including peripapillary atrophy) and retinal detachment. In addition, this paper elaborates on other details such as the labeling process used to construct the database, the quality and characteristics of the samples and provides other relevant usage notes.

A deep network using coarse clinical prior for myopic maculopathy grading

Pathological Myopia (PM) is a globally prevalent eye disease which is one of the main causes of blindness. In the long-term clinical observation, myopic maculopathy is a main criterion to diagnose PM severity. The grading of myopic maculopathy can provide a severity and progression prediction of PM to perform treatment and prevent myopia blindness in time. In this paper, we propose a feature fusion framework to utilize tessellated fundus and the brightest region in fundus images as prior knowledge. The proposed framework consists of prior knowledge extraction module and feature fusion module. Prior knowledge extraction module uses traditional image processing methods to extract the prior knowledge to indicate coarse lesion positions in fundus images. Furthermore, the prior, tessellated fundus and the brightest region in fundus images, are integrated into deep learning network as global and local constrains respectively by feature fusion module. In addition, rank loss is designed to increase the continuity of classification score. We collect a private color fundus dataset from Beijing TongRen Hospital containing 714 clinical images. The dataset contains all 5 grades of myopic maculopathy which are labeled by experienced ophthalmologists. Our framework achieves 0.8921 five-grade accuracy on our private dataset. Pathological Myopia (PALM) dataset is used for comparison with other related algorithms. Our framework is trained with 400 images and achieves an AUC of 0.9981 for two-class grading. The results show that our framework can achieve a good performance for myopic maculopathy grading.

Validation of Soft Labels in Developing Deep Learning Algorithms for Detecting Lesions of Myopic Maculopathy From Optical Coherence Tomographic Images

PURPOSE

It is common for physicians to be uncertain when examining some images. Models trained with human uncertainty could be a help for physicians in diagnosing pathologic myopia.

DESIGN

This is a hospital-based study that included 9176 images from 1327 patients that were collected between October 2015 and March 2019.

METHODS

All collected images were graded by 21 myopia specialists according to the presence of myopic neovascularization (MNV), myopic traction maculopathy (MTM), and dome-shaped macula (DSM). Hard labels were made by the rule of major wins, while soft labels were possibilities calculated by whole grading results from the different graders. The area under the curve (AUC) of the receiver operating characteristics curve, the area under precision-recall (AUPR) curve, F-score, and least square errors were used to evaluate the performance of the models.

RESULTS

The AUC values of models trained by soft labels in MNV, MTM, and DSM models were 0.985, 0.946, and 0.978; and the AUPR values were 0.908, 0.876, and 0.653 respectively. However, 0.56% of MNV "negative" cases were answered as "positive" with high certainty by the hard label model, whereas no case was graded with extreme errors by the soft label model. The same results were found for the MTM (0.95% vs none) and DSM (0.43% vs 0.09%) models.

CONCLUSIONS

The predicted possibilities from the models trained by soft labels were close to the results made by myopia specialists. These findings could inspire the novel use of deep learning models in the medical field.

Automatic detection of pathological myopia using machine learning

Pathological myopia is a severe case of myopia, i.e., nearsightedness. Pathological myopia is also known as degenerative myopia because it ultimately leads to blindness. In pathological myopia, certain myopia-specific pathologies occur at the eye's posterior i.e., Foster-Fuchs's spot, Cystoid degeneration, Liquefaction, Macular degeneration, Vitreous opacities, Weiss's reflex, Posterior staphyloma, etc. This research is aimed at developing a machine learning (ML) approach for the automatic detection of pathological myopia based on fundus images. A deep learning technique of convolutional neural network (CNN) is employed for this purpose. A CNN model is developed in Spyder. The fundus images are first preprocessed. The preprocessed images are then fed to the designed CNN model. The CNN model automatically extracts the features from the input images and classifies the images i.e., normal image or pathological myopia. The best performing CNN model achieved an AUC score of 0.9845. The best validation loss obtained is 0.1457. The results show that the model can be successfully employed to detect pathological myopia from the fundus images.

Association Between the Types of Posterior Staphyloma and Their Risk Factors in Pathological Myopia

Purpose

The purpose of this study was to investigate the relationship of posterior staphyloma (PS) types in pathological myopia (PM) with age, best-corrected visual acuity (BCVA), spherical equivalent (SE), axial length (AL), and myopic retinoschisis (MRS) using three-dimensional magnetic resonance imaging (3D-MRI) and optical coherence tomography (OCT).

Methods

This retrospective, cross-sectional study included 108 eyes of 59 patients with PM from the Henan Eye Institute, China. We classified the PS types based on current international classification criteria and analyzed the risk factors (age, AL, MRS, and BCVA).

Results

Most of the patients with bilateral PM had the same PS type (80.43%) in both eyes. Complex PS was more common in elderly patients than in younger patients (P < 0.05). Eyes with wide macular PS had a longer AL (P = 0.012) and worse BCVA (P = 0.049) than those with other PS types. MRS was always comorbid with PS (93.33%), and macular PS was the most common (82.14%).

Conclusions

Complex PS is associated with patient age. PS is related to MRS, and these changes observed by 3D-MRI and OCT affect the prognosis of visual acuity. The 3D-MRI scans shows changes in the eye shape and PS efficiently.

Translational Relevance

In patients with PM, 3D-MRI can guide the planning of posterior scleral reinforcement.

QUANTITATIVE TOPOGRAPHIC CURVATURE MAPS OF THE POSTERIOR EYE UTILIZING OPTICAL COHERENCE TOMOGRAPHY

PURPOSE

Deformations of the retina such as staphylomas in myopia or scleral flattening in high intracranial pressure can be challenging to quantify with en face imaging. We describe an optical coherence tomography-based method for the generation of quantitative posterior eye topography maps in normal and pathologic eyes.

METHODS

Using "whole eye" optical coherence tomography, we corrected for subjects' optical distortions to generate spatially accurate posterior eye optical coherence tomography volumes and created local curvature (KM, mm-1) topography maps for each consented subject. We imaged nine subjects, three normal, two with myopic degeneration, and four with papilledema including one that was imaged longitudinally.

RESULTS

Normal subjects mean temporal KM was 0.0923 mm-1, nasal KM was 0.0927 mm-1, and KM local variability was 0.0162 mm-1. In myopic degeneration, subjects KM local variability was higher at 0.0836 mm-1. In papilledema subjects nasal KM was flatter compared with temporal KM (0.0709 vs. 0.0885 mm-1). Mean intrasession KM repeatability for all subjects was 0.0036 mm-1.

CONCLUSION

We have developed an optical coherence tomography based method for quantitative posterior eye topography that offers the ability to analyze local curvature with micron scale resolution and offers the potential to help clinicians and researchers characterize subtle, local retinal deformations earlier in patients and follow their development over time.

Pathological myopia classification with simultaneous lesion segmentation using deep learning

BACKGROUND AND OBJECTIVES

Pathological myopia (PM) is the seventh leading cause of blindness, with a reported global prevalence up to 3%. Early and automated PM detection from fundus images could aid to prevent blindness in a world population that is characterized by a rising myopia prevalence. We aim to assess the use of convolutional neural networks (CNNs) for the detection of PM and semantic segmentation of myopia-induced lesions from fundus images on a recently introduced reference data set.

METHODS

This investigation reports on the results of CNNs developed for the recently introduced Pathological Myopia (PALM) dataset, which consists of 1200 images. Our CNN bundles lesion segmentation and PM classification, as the two tasks are heavily intertwined. Domain knowledge is also inserted through the introduction of a new Optic Nerve Head (ONH)-based prediction enhancement for the segmentation of atrophy and fovea localization. Finally, we are the first to approach fovea localization using segmentation instead of detection or regression models. Evaluation metrics include area under the receiver operating characteristic curve (AUC) for PM detection, Euclidean distance for fovea localization, and Dice and F1 metrics for the semantic segmentation tasks (optic disc, retinal atrophy and retinal detachment).

RESULTS

Models trained with 400 available training images achieved an AUC of 0.9867 for PM detection, and a Euclidean distance of 58.27 pixels on the fovea localization task, evaluated on a test set of 400 images. Dice and F1 metrics for semantic segmentation of lesions scored 0.9303 and 0.9869 on optic disc, 0.8001 and 0.9135 on retinal atrophy, and 0.8073 and 0.7059 on retinal detachment, respectively.

CONCLUSIONS

We report a successful approach for a simultaneous classification of pathological myopia and segmentation of associated lesions. Our work was acknowledged with an award in the context of the "Pathological Myopia detection from retinal images" challenge held during the IEEE International Symposium on Biomedical Imaging (April 2019). Considering that (pathological) myopia cases are often identified as false positives and negatives in glaucoma deep learning models, we envisage that the current work could aid in future research to discriminate between glaucomatous and highly-myopic eyes, complemented by the localization and segmentation of landmarks such as fovea, optic disc and atrophy.

Quantitative analysis with volume rendering of pathological myopic eyes by high-resolution three-dimensional magnetic resonance imaging

Discovering a relationship between axial length and vitreous volume would be helpful since the axial length is easier to measure than magnetic resonance imaging (MRI) parameters. This study aimed to analyze the topography of human eyes with pathological myopia through volume rendering images by high-resolution 3D-MRI and to establish a model to estimate the vitreous volume.This was a retrospective, non-randomized, controlled study of patients evaluated at Tongren Hospital from July 7, 2007 to December 12, 2018. The controls were emmetropic volunteers. All participants underwent ophthalmic examinations. Axial length was measured with an IOL Master. High-resolution 3D MRI and volume rendering was utilized for all the eyes. Logistic regression was used to establish a model to predict the vitreous volume.A total of 280 emmetropic eyes and 290 eyes with pathological myopia were included. Males represented 60.7% and 65.5% of the individuals. The mean axial lengths of those two groups were 23.1 ± 0.8 mm (95%CI: 22.7-23.4 mm) and 28.3 ± 2.2 mm (95%CI: 27.5-29.2 mm), respectively (P < .001). The regression model in the pathological myopic group for calculating the vitreous volume according to the axial length was: Vitreous volume = 546.27 × axial length - 6977.12. The regression model in the emmetropic group for calculating the vitreous volume according to the axial length was: Vitreous volume = 458.35 × axial length - 6331.14 (R = 0.360, P = .001).Elongation of the axial length is involved in eyeball enlargement in pathological myopic eyes. Measurement of the axial length could be recommended for the estimation of the vitreous volume during vitrectomy if vitreous cavity filling is needed.

Posterior staphylomas and scleral curvature in highly myopic children and adolescents investigated by ultra-widefield optical coherence tomography

Purpose

To determine the early signs of posterior staphylomas in highly myopic eyes of younger subjects by swept-source ultra-widefield optical coherence tomography (WF-OCT).

Methods

This was an observational case series study. Highly myopic subjects younger than 20 years old who were examined consecutively by prototype WF-OCT were studied. High myopia was defined according to the Ministry of Health and Welfare, Japan classification. A posterior displacement of the sclera and two OCT features indicating the staphyloma edges were used as markers of a staphyloma.

Results

Fifty-five eyes of 30 patients with the mean age of 12.3 years, and the mean axial length of 27.9 mm were studied. Seven of the 55 eyes (12.7%) had a posterior displacement of the sclera and were diagnosed as having a staphyloma. Among the two OCT features of the staphyloma edges, a gradual thinning of the choroid toward the staphyloma edge and gradual re-thickening of choroid from the staphyloma edge toward the posterior pole were found in these 7 eyes. However, the other feature of an inward protrusion of the sclera at the staphyloma edge, was obvious in only 2 eyes. The subfoveal choroid and choroid nasal to the optic disc were significantly thinner in eyes with a staphyloma than those without it.

Conclusions

The changes of the choroidal thickness toward the staphyloma edge with the posterior displacement of the sclera were considered an early sign which precedes an inward protrusion of sclera at the staphyloma edge.

Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN)

Myopia is a highly frequent ocular disorder worldwide and pathologic myopia is the 4th most common cause of irreversible blindness in developed countries. Pathologic myopia is especially common in East Asian countries. Ocular alterations associated with pathologic myopia, especially those involving the macular area-defined as myopic maculopathy-are the leading causes of vision loss in patients with pathologic myopia. High myopia is defined as the presence of a highly negative refractive error (>-6 to -8 diopters) in the context of eye elongation (26-26.5 mm). Although the terms high myopia and pathologic myopia are often used interchangeably, they do not refer to the same eye disease. The two key factors driving the development of pathologic myopia are: 1) elongation of the axial length and 2) posterior staphyloma. The presence of posterior staphyloma, which is the most common finding in patients with pathologic myopia, is the key differentiating factor between high and pathologic myopia. The occurrence of staphyloma will, in most cases, eventually lead to other conditions such as atrophic, traction, or neovascular maculopathy. Posterior staphyloma is for instance, responsible for the differences between a myopic macular hole (MH)-with and without retinal detachment-and idiopathic MH. Posterior staphyloma typically induces retinal layer splitting, leading to foveoschisis in myopic MH, an important differentiating factor between myopic and emmetropic MH. Myopic maculopathy is a highly complex disease and current classification systems do not fully account for the numerous changes that occur in the macula of these patients. Therefore, a more comprehensive classification system is needed, for several important reasons. First, to more precisely define the disease stage to improve follow-up by enabling clinicians to more accurately monitor changes over time, which is essential given the progressive nature of this condition. Second, unification of the currently-available classification systems would establish standardized classification criteria that could be used to compare the findings from international multicentric studies. Finally, a more comprehensive classification system could help to improve our understanding of the genetic origins of this disease, which is clearly relevant given the interchangeable-but erroneous-use of the terms high and pathologic myopia in genetic research.

Observational study of clinical characteristics of dome-shaped macula in Chinese Han with high myopia at Zhongshan Ophthalmic Centre

PURPOSE

To evaluate the prevalence of dome-shaped macula (DSM) in highly myopic eyes among Chinese Han and to detect the correlation with myopic maculopathy and macular complications.

METHODS

A total of 736 Chinese Han patients (1384 eyes) with high myopia (refractive error≤6.0 diopters or axial length ≥26.5 mm) are reviewed based on information entered into a high-myopia database at Zhongshan Ophthalmic Centre. Subfoveal choroidal thickness (SFCT) and parafoveal choroidal thickness (PFCT) are measured. The prevalence of DSM in patients with myopic maculopathy is categorised from C0 to C4. Clinical features, including macular complications, SFCT and PFCT, are compared between myopic eyes with and without DSM.

RESULTS

Among the 1384 eyes, 149 (10.77%) show DSM. In highly myopic eyes without macular complications, the best corrected visual acuity is significantly worse in patients with DSM (p=0.002), and the ratio between subfoveal and parafoveal choroidal thickness (S/PCT) is significantly elevated in patients with DSM (p=0.021). The proportion of foveal schisis (17.24% vs 62.86%) is much lower in eyes with DSM compared with those without DSM. However, the proportions of extrafoveal schisis (39.66% vs 5.37%), foveal serous retinal detachment (SRD) (5.17% vs 0) and epiretinal membrane (ERM) (24.14% vs 10.74%) are much higher in eyes with DSM. The proportion of DSM was lower in C0 and C1, but higher proportion of DSM was found in C3 and C4.

CONCLUSIONS

DSM is found in 10.77% of highly myopic eyes among Chinese Han. DSM might be a protective mechanism for foveal schisis and a risk factor for extrafoveal schisis, SRD and ERM.

Longitudinal Changes in Peripapillary Retinal Nerve Fiber Layer Thickness in High Myopia: A Prospective, Observational Study

PURPOSE

To determine longitudinal change of peripapillary retinal nerve fiber layer (pRNFL) thickness in patients with high myopia without ophthalmic disease.

DESIGN

Prospective observational study.

PARTICIPANTS

Participants were divided into 2 groups: a high myopia group (80 eyes) that included eyes with an axial length ≥26.0 mm and a control group (80 eyes) that included eyes with a spherical equivalent (SE) between +3.0 and -6.0 diopters (D). Both groups were further divided into age subgroups by decade: 20s, 30s, 40s, and 50s. Each subgroup included 20 eyes.

METHODS

After the initial visit, pRNFL thickness measurements were performed 2 times more with at least 1-year intervals between examinations using spectral-domain OCT. The mean pRNFL thickness was fitted with linear mixed models.

MAIN OUTCOME MEASURES

The pRNFL thickness and rate of pRNFL thickness reduction.

RESULTS

The mean patient age and thickness of the pRNFL at the first visit were 39.5±12.5 years and 90.16±9.06 μm, and 41.5±12.2 years and 96.80±9.50 μm in the high myopia and control groups, respectively. The high myopia group showed a significant reduction in mean pRNFL thickness between the first and second visits, and between the second and third visits (P < 0.001 and P = 0.002, respectively). For individuals aged 50 to 59 years, the reduction rate was -1.69 and -0.63 μm/year in the high myopia and control groups, respectively; the interaction between group and duration was significant (P = 0.014). The reduction rate in individuals aged 40 to 49 years was -1.70 and -0.48 μm/year in the 2 groups, respectively; the interaction was also significant (P = 0.031). Among those aged 30 to 39 years and 20 to 29 years, no such significant interactions were observed (-0.95 vs. -0.57 μm/year, P = 0.086 and -0.31 vs. -0.19 μm/year, P = 0.858, respectively).

CONCLUSIONS

Highly myopic eyes had a significantly greater decrease in pRNFL over 2 years than normal eyes. In addition, the reduction rate of pRNFL thickness was greater in older patients with high myopia, whereas similar values were shown in normal controls except individuals aged 20 to 29 years.

Comparison of the efficacy of intravitreal ranibizumab for choroidal neovascularization due to pathological myopia with and without a dome-shaped macula

Ranibizumab injection in the treatment of choroidal neovascularization (CNV) secondary to pathologic myopia (PM) with and without a dome-shaped macula (DSM).Prospective observational study.A total of 24 patients (24 eyes) with angiographic evidence of CNV secondary to PM were divided into 2 groups: eyes with a DSM and eyes without DSM. All patients received a baseline intravitreal ranibizumab injection. Additional injections were considered at each follow-up visit. Best-corrected visual acuity (BCVA) and optical coherence tomography were tested monthly through 12 months of follow-up. The mean changes in BCVA, central retinal thickness (CRT, including retinal and CNV thickness), and the number of injections were evaluated.There were no significant differences in visual outcomes between the groups over 12 months (P > .05). Patients with a DSM had a mean change in BCVA of +8.7 letters compared with +14.2 letters in patients without a DSM (P = .68). However, there were more patients without a DSM who gained at least 15 letters from baseline compared with patients with a DSM. By the end of the follow-up, there was no significant difference in the mean change in baseline CRT between patients with and without a DSM (-65.0 and -90.7, respectively, P = .42). The mean number of injections was 8.83 in the patients with DSM and 8.17 in the patients without a DSM (P > .05).For the pathological myopia patients who had CNV with a DSM, the DSM did not alter the effect of the ranibizumab treatment. There was no difference in the visual improvement, anatomic benefit and number of treatments between the 2 groups.

Axial length changes in highly myopic eyes and influence of myopic macular complications in Japanese adults

Purpose

To investigate changes of the axial length in normal eyes and highly myopic eyes and influence of myopic macular complications in Japanese adults.

Study design

Retrospective longitudinal case series.

Methods

The changes in the axial length of 316 eyes from 316 patients (mean age, 63.8 ± 9.0 years; range, 34–82; 240 females) examined using IOLMaster with a follow-up period of at least 1 year were studied. This study included 85 non-highly myopic eyes (|refractive error| ≤ 5 diopters; 63 females; non-highly myopic group), 165 highly myopic eyes (refractive error ≤ −6 diopters or axial length ≥ 26 mm; 124 females) without macular complications (no complications group), 32 eyes (25 females) with myopic traction maculopathy (MTM group), and 34 eyes (28 females) with myopic choroidal neovascularization (CNV group).

Results

All groups showed a significant increase in the axial length during the follow-up period (mean follow-up, 28.7 ± 16.8 months; range, 12–78) (P < 0.01). Changes in the axial length/year in the no complications group (0.041 ± 0.05 mm) were significantly greater than those in the non-highly myopic group (0.007 ± 0.02 mm) (P < 0.0001). Furthermore, changes in the CNV group (0.081 ± 0.04 mm) were significantly greater than those in the no complications (P < 0.0001) and MTM (0.040 ± 0.05 mm) (P = 0.0059) groups, whereas no significant difference was found between the changes in the MTM and no complications groups (P = 0.91). Multiple regression analyses indicated that CNV eyes (P < 0.0001) and female patients’ eyes (P = 0.04) showed greater changes in the axial length/year.

Conclusions

All groups showed an increase in the axial length, which was greater for highly myopic eyes. In particular, CNV eyes showed greater increases, indicating that larger changes in the axial length may require careful follow-up.

Vascular flow density in pathological myopia: an optical coherence tomography angiography study

OBJECTIVES

To investigate vascular flow density in pathological myopia with optical coherence tomography (OCT) angiography.

DESIGN

A prospective comparative study was conducted from December 2015 to March 2016.

SETTING

Participants were recruited in Beijing Tongren Hospital.

PARTICIPANTS

A total of 131 eyes were enrolled, which were divided into three groups: 45 eyes with emmetropia (EM; mean spherical equivalent (MSE) 0.50D to -0.50D), 41 eyes with high myopia (HM; MSE ≤-6.00D, without pathological changes), and 45 eyes with pathological myopia (PM; MSE ≤-6.00D and axial length (AL) ≥26.5 mm, and with pathological changes).

MAIN OUTCOME MEASURES

Macular, choriocapillaris and radial peripapillary capillary (RPC) flow densities were measured and compared between groups, and their relationships with AL and best corrected visual acuity (BCVA) were analysed.

RESULTS

Significant differences were found in macular, choriocapillaris and RPC flow densities among the three groups (p<0.05). Multiple comparisons revealed that, compared with the EM and HM groups, macular and RPC flow densities of the PM group were significantly decreased (p<0.05), but no significant difference in choriocapillaris flow density was found between the PM and HM groups (p=0.731). Compared with the EM group, retinal flow density in the macular and arcuate fibre region was not decreased in the HM group. In addition, there was a negative correlation between AL and superficial macular flow density (β=-0.542, p<0.001), deep macular flow density (β=-0.282, p=0.002) and RPC flow density (β=-0.522, p<0.001); and a positive correlation between BCVA and superficial macular flow density (β=0.194, p=0.021), deep macular flow density (β=0.373, p<0.001), and choriocapillaris flow density (β=0.291, p=0.001).

CONCLUSIONS

Macular and RPC flow densities decreased in pathological myopia compared with high myopia and emmetropia. No significant decrease of retinal flow density in the macular and arcuate fibre region was found in high myopic eyes compared with emmetropic eyes. Moreover, macular and RPC flow densities were negatively related to AL, and macular flow density was positively related to BCVA.

[Invagination of Retinal Vein into Conus Pit in a Case with Pathologic Myopia]

Background: Conus pits are reported to occur in eyes with pathologic myopia due to mechanical expansion of peripapillary region. We would like to report a case which had the peculiar pattern of a retinal vein at the site of conus pit. Case: A 61-year old woman with pathologic myopia who had been regularly followed in the High Myopia Clinic at Tokyo Medical and Dental University. The refractive error was -21.4 diopters (D) in the right eye and -22.8 D in the left. The axial length was 32.0 mm in the right eye and 31.7 mm in the left. The optic disc was vertically elongated and deformed. Conus pit was observed temporal to the optic disc in the left eye. The retinal vein was invaginated into the conus pit and lay in an abnormal position. OCT showed that the entire sclera was dehisced at the conus pit. Conclusion: The invagination of the retinal vein occured at the site of conus pits due to pathologic myopia.

[Current status on the pathogenesis of progressive myopia]

In the article shown is the modern diagnostic method of progressive myopia pathogenesis. Establishment of possible myopia progress using the ultrasonographic biometry while looking into and into and down contact equator at one and the same point. The research goal is to study the residual deformative changes developed as a result of sclera distraction during reading. We have researched 150 patients. The patients were split in three groups according to the age and myopia type: I group included patients of the age of 5-12 years; the II group had patients of the age of 13-19 years; III group - patients above the 19 years. The used age differentiation is based on the eye anatomic growth criteria. The research was held by the following scheme: all the researches patients underwent the preliminary anesthesia drops instillation; the ultrasonographic biometry catheter was put using one and the same equator point. In the first position they established the front and back axis size, in the second one - the eye size was established in the medial look regime; in the third position - the eye size was established in the reading regime. The data obtained are as follows: among the first group patients, aged from 5 to 12 years, in reading regime the eye size was increased in 93% cases; among the second group patients, aged from 13 to 19 years, in reading regime the eye size was increased in 90% cases; among the third group patients, aged above 19 years - 91% cases. The reason why the sclera capsule distraction during reading regime is that of the extraocular muscles and growth of the intraocular pressure influence the process. Because the sclera is fibrotic membrane, it is characterized with well-marked elasticity, stronger accommodation and the sigh load in the near distance causes sclera capsule distraction. After the contraction the residual deformation stays there. Accumulation of such residual deformations causes the sclera weakness and formation of myopia as a disease. According to the data obtained, it is necessary to work out the certain recommendations, from the sclera nutrition and other medical preparations standpoint. Improvement of the sclera nutrition will slacken the residual changes in sclera, and this will significantly decrease the myopic disease advancing.

Eye shape and peripheral visual field recording in high myopia at approximately 54 years of age, as based on ultrasonography and Goldmann kinetic perimetry

PURPOSE

This study describes the posterior pole contour and visual field (VF) findings in an unselected series of adults (aged approximately 54 years) with high myopia.

METHODS

In 1962, 39 14-year-old teenagers with myopia of >or=6 D, in one or both eyes, were identified in a 1948 Copenhagen birth cohort (n=9243). At a follow-up in 2002, 61 eyes (52 with high myopia and nine fellow eyes; n=31 subjects) were examined by ultrasound B-scan, to allow: (a) measurement of the axial vitreous length supplementary to the customary axial A-scan, and (b) assessment of the posterior pole contour of the eye. Further, the large-object (V, 4e) kinetic Goldmann perimetry isoptre was recorded to outline the ambulatory VF.

RESULTS

An irregular posterior pole contour was observed in 15 eyes, unilaterally in 11 eyes and bilaterally in four (two subjects). Nasal fundus ectasia was suggested in six and other deviations from the sphere in seven subjects. Kinetic Goldmann perimetry showed marginal restriction in 14 eyes (12 subjects). Larger defects were found in four eyes (three subjects); the corresponding axial lengths exceeded 32 mm in the two subjects with unilateral defects, and symmetrical inferior binasal defects, probably unrelated to the myopia, were found in the bilateral subject.

CONCLUSIONS

Unselected adult-age high myopia mainly presented with a regular eye shape that was close to spherical. An irregular shape suggesting posterior staphyloma was seen in 13 of the 32 subjects under study, mainly unilaterally. No subjects were restricted in everyday activities by VF defects. Marginal Goldmann perimetry restrictions were described in 12 and significant defects in three subjects. Generally, longer eyes more often tended to show irregular posterior eye contours and/or VF defects.

[Effect of pentoxifylline on Doppler blood flow parameters in the central retinal artery and the short posterior ciliary arteries in adolescents with progressive myopia]

PURPOSE

To evaluate the effect of pentoxifylline on blood flow in the central retinal artery and the short posterior ciliary arteries in patients with progressive myopia.

MATERIAL AND METHODS

48 eyes of 24 healthy patients aged between 12 and 18 years (mean 15.1 years) with myopia from -5.0 to -12.75 Dsph (mean -7.56 Dsph), were examined using color Doppler ultrasonography. The examination was performed before and after 10 days of intravenous administration of 200 mg of pentoxifylline. The peak-systolic, end-diastolic flow velocities, pulsatility, resistance and systolic/diastolic ratios were measured.

RESULTS

The use of pentoxifylline significantly increased PSV and EDV in the central retinal artery and in the short posterior ciliary arteries (p=0.0001) in patients with progressive myopia and in the same time decreased PI, RI and S/D (p=0.0001). There was no correlation between Doppler blood flow parameters and dioptres or axial length.

CONCLUSIONS

pentoxifylline increases retinal and choroidal blood flow in young patients with progressive myopia.