Myopia is a process generally caused by excessive growth of the eye to the point where light rays are no longer focused on the retina, but instead are focused in front of the retina. In most myopes the eye grows normally in early childhood and then it expands to become myopic. It is difficult to explain exactly why this happens. When the eye expands it doesn’t necessarily grow in the sense, where more tissue is made, rather the amount of tissue in the eye stays the same – or even decreases – as the eye expands. Many layers in the eye appear to be stretched. Over the course of time these stressed tissues in the eye can decompensate. Many different unfavorable things can happen, and collectively these are often called “myopic degeneration”. Collectively these conditions are becoming very important causes of vision loss around the world. With development of modern society the proportion of people with myopia has greatly increased.
There are only a few risk factors commonly found for the development of myopia, but most center on spending more time indoors and close work when young. With the start of schooling for Eskimos the net refractive error went from being far-sighted to being near-sighted in one generation. Many countries in East Asia had agrarian economies and myopia was not common. With the economic development in these countries advancing the explosive growth in the proportion of eyes that are myopic is astounding. When the refractive error is greater than 6 diopters, the person is considered to have pathologic myopia.
In the United States the proportion of the population that is highly myopic is about 1 -2%. This proportion appears to be higher in large metropolitan areas. In Japan the proportion is 5 – 8%. In Taiwan nearly 40% of university students are highly myopic. Because of the various associated abnormalities, myopia is the second leading cause for vision loss in the world. Given the rapid increase in the proportion of people with myopia, it is likely to become the most important cause of vision loss in the world. The most important components of myopic degeneration are myopic macular schisis, myopic chorioretinal atrophy, and myopic choroidal neovascularization.
There are many other ocular conditions such as retinal detachment or glaucoma in which myopia is an important risk factor, however these conditions are not specifically related to myopia. All of these conditions, and more is covered in a new book, Pathologic Myopia by Drs. Richard F. Spaide, Kyoko Ohno-Matsui, and Lawrence Yannuzzi.
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