Unmasking the Hidden Dangers: High Myopia and Its Retinal Risks Explained

For millions worldwide, nearsightedness or myopia is a common vision issue, easily corrected with glasses or contacts. However, for a significant subset, high myopia presents a far more serious concern, elevating the risk of potentially blinding retinal conditions. It's not just about blurry distant vision; it's about the very structure of the eye being compromised, making it a ticking time bomb for severe retinal problems.

Dr.

Aditya Kelkar, a renowned cataract and retina surgeon, sheds light on the critical distinction: "High myopia is generally defined as having a power of -6 diopters or more, or an axial length (length of the eyeball) of 26.5 mm or more." This elongation of the eyeball isn't merely an inconvenience; it stretches and thins the delicate layers of the retina, choroid, and sclera, making them significantly more vulnerable to tears, detachments, and degenerative changes.

Understanding these heightened risks is paramount for individuals with high myopia.

Let's delve into the specific retinal conditions that become a significant threat:

1. Lattice Degeneration: A Silent Precursor

Lattice degeneration involves areas of retinal thinning and atrophy, often appearing as crisscrossing white lines. These areas are weak spots, significantly increasing the risk of a retinal tear or detachment, even with minor trauma.

"Patients with high myopia are more prone to developing lattice degeneration, making regular monitoring crucial," Dr. Kelkar emphasizes.

2. Retinal Tears and Detachments: The Urgent Threat

When the thinned retina develops a tear, fluid from the vitreous gel can seep underneath, lifting the retina away from its underlying support layers.

This is a retinal detachment, a medical emergency that can lead to permanent vision loss if not treated promptly. The symptoms can be sudden and alarming: flashes of light, a shower of new floaters (dark spots or squiggly lines), or a dark curtain-like shadow creeping into the field of vision.

3.

Myopic Macular Degeneration (MMD) / Myopic Choroidal Neovascularisation (CNV): Central Vision Under Attack

The macula, responsible for sharp central vision, is particularly vulnerable in high myopia. Myopic macular degeneration encompasses a range of changes, from thinning and atrophy to the development of myopic choroidal neovascularisation (CNV).

CNV involves the growth of abnormal, fragile blood vessels under the macula, which can leak fluid or bleed, causing severe and rapid central vision loss, distortion, and blind spots. This condition often requires urgent intervention with anti-VEGF injections.

4. Glaucoma: A Secondary Concern

While primarily a retinal issue, high myopia can also predispose individuals to glaucoma, a condition where increased intraocular pressure damages the optic nerve.

Though not directly a retinal risk, it's a significant co-morbidity that high myopes should be aware of, further stressing the importance of comprehensive eye care.

Recognizing the Warning Signs: Don't Delay

Early detection is the cornerstone of preserving vision. Dr. Kelkar urges high myopes to be vigilant about symptoms.

"Flashes of light, a sudden increase in floaters, or any decrease in vision, especially if it's like a curtain coming down, should prompt an immediate visit to an ophthalmologist," he advises. For MMD, symptoms may include reduced central vision, distorted lines (metamorphopsia), or a central blind spot.

Diagnosis: Beyond a Basic Eye Exam

A comprehensive eye examination, including a dilated fundus examination, is essential.

Advanced imaging techniques like Optical Coherence Tomography (OCT) provide detailed cross-sectional views of the retina, detecting subtle changes. Fluorescein angiography might be used to identify and map abnormal blood vessels in cases of suspected CNV.

Treatment: Tailored Interventions

• Lattice Degeneration & Retinal Tears: Prophylactic laser photocoagulation can be used to seal off weak areas or tears, preventing progression to detachment.
• Retinal Detachment: This is a surgical emergency.

  Procedures like vitrectomy or scleral buckle aim to reattach the retina and preserve vision.

• Myopic Macular Degeneration (CNV): Intravitreal anti-VEGF injections are the primary treatment, effectively drying up leaky vessels and preserving central vision.

Empowering Eye Care: Proactive Tips for High Myopes

Living with high myopia requires a proactive approach to eye health.

Dr. Kelkar offers vital tips:

• Regular Dilated Eye Exams: "A yearly dilated eye exam is non-negotiable for high myopes, even if you feel no symptoms," he stresses. This allows for early detection and intervention.
• Be Symptom Aware: Know the warning signs and seek immediate medical attention if they appear.
• Avoid Strenuous Activities (with caution): While not all activities are off-limits, discuss with your ophthalmologist if contact sports or heavy lifting are advisable, especially if you have known retinal weaknesses.
• Screen Time Management: The 20-20-20 rule (every 20 minutes, look at something 20 feet away for 20 seconds) helps reduce eye strain.
• Healthy Lifestyle: A balanced diet rich in antioxidants, adequate hydration, and regular exercise contribute to overall eye health.
• UV Protection: Wear sunglasses that block 100% of UVA and UVB rays outdoors.
• Quit Smoking: Smoking is detrimental to overall health, including eye health, and can exacerbate retinal conditions.

High myopia may carry significant risks, but with informed awareness, regular monitoring, and timely intervention, individuals can significantly reduce their chances of severe vision loss.

Your vision is precious; prioritize its care.