|
 |
| ARTICLES |
|
| Year : 1983 | Volume
: 31
| Issue : 6 | Page : 741-743 |
|
Therapy of myopia
Madan Mohan
Chief Organiser & Prof of Opthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.MS., New Delhi & Adviser Ophthalmology, Government of India, Ministry of Health & Family Welfare, Nirman Bhavan, New Delhi, India
Correspondence Address:
Madan Mohan
Chief Organiser & Prof. of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi 110029
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 6676257 
How to cite this article:
Mohan M. Therapy of myopia. Indian J Ophthalmol 1983;31:741-3 |
The treatment of myopia can be considered basically under two heads:
1. Preventive
2. Curative
Although the exact pathogenesis of myopia is not well understood, various factors considered in this regard are:
1. Genetic factors.
2. Nutrition.
3. Febrile illnesses
4. Stress Physical & mental.
5. Early and excessive use of accommodation.
Curative treatment of myopia can be discussed under:
1. Optical
2. Medical
(i) Drugs
(ii) Physiological
3. Surgical
I shall be discussing some aspects of medical management of myopia. In the literature, various drugs have been used for the treatment of myopia but none is known to have given statistically positive results. The drugs tried are:
1. Cycloplegics.
2. Pilocarpine.
3. S/C Saline.
4. Dionine.
5. Mercury salt solution.
6. Heparin.
7. Carbogens.
8. Vitamin A,C,D,E.
9. Minerals.
I shall like to discuss the role of physiological aspects in the causation and management of myopia. Various factors like ocular muscular strains, excessive accommodation and improper posture during near work and rading, have been implicated in the causation and progression of myopia.
We undertook a study in rabbits to evaluate the role of the above factors in the pathogenesis of this conditions. Artificial myopia was produced in growing rabbits by raising the body temperature to 40°c for 30 minutes and repeatedly elevating the intra ocular pressure to 40° of mercury by applying section cup at the limbus. The animals in which experimental myopia was produced were divided into 5 groups as under:
Group I: Untreated control (three animals)
Group II: Treated control artificial myopia (A.M.) Five animals were subjected to the artificial myopia (A.M.) procedure as described above.
Group III: A.M. and Tenotomy (five animals) - Free tenotomy of all the rectus muscles was performed on both eyes immediately after the A.M. procedure.
Group IV A.M. and Resection (five animals). Resection 3-5 mm of all the four recti was carried out immediately after the A.M. procedure.
Group V Dependent posture and A.M. Five animals were placed with their heads in dependent position in a specially designed box, inclined at 6;° for 12 hrs. per day for 4 days and then subjected to the A.M. procedure.
The animals with any general or local pathology were excluded from study. The following parameters were used for the assessment of myopia.
1. Refraction under (Homatropine).
2. Keratometery.
3. Measurement of anetrior chamber depth.
4. Position of the lens.
Results
The average myopic changes reached a peak (-1.37 D) after 14 days and remained unaltered thereafter upto 30 weeks. These results are statistically significant (P /0.001) when compared with rabbits in the untreated control group (1).
In Group III in which a free tenotomy of all four recti was performed in order to achieve the maximum relaxation, the average myopic change in refraction (-0.63 D) developed slowly reached peak after 21 days and thereafter remained unaltered upto 6 months. These figures are significantly lower than those in GroupII (-0.63 S ± 0.07 S.E.M.) Vs. -1.37 D ± 0.05 (S. E. M.), P /0.001).
In Group IV in which resection of all four recti was carried out in order to increase their mechanical action on the glove, the average myopic change in refraction developed slowly and reached a peak (-1.90 D) after 12 days and remained unaltered thereafter upto 6 months.
Comparison of groups III and IV shows that resection of recti enhanced the production of artificial myopia while free tenotomy diminished it (-0.63 D ± 0.07) (S.E.M.) vs. - 1.90 D ± 0.08 (S. E. M.), P /0.001) and suggest that the tone of extra-ocular muscles may play a significant role in the genesis of artificial myopia.
The changes in refraction in Group V in which the effect of dependant posture has been studied, revealed that the myopic changes developed slowly to reach a peak of - 2.00 D and remained unaltered thereafter upto 6 months. A set of readings in this group taken after initial maintenance in the dependent posture but before the A.M. procedure showed no change in refraction. However, when the animals were subjected to rise of body temperature and increase in the intraocular pressure, significant degree of myopia was produced. The readings in Group V(-2.00 D ± 0.07) is significantly greater than -1.37 D ± 0.05 in Group II (P /0.001). It can be inferred from the above observation that dependent posture increased the production of experimental myopia.
Children with myopia of more than -1.0D and less than -3.0D with cyclinder not more 0.5D were selected for this study. Controlled group consisting of normal children chaving no refractive error.They were devided into three groups.
Group I Myopes using spectacles -40
Sub Group A. Put on treat- =20
ment
B. Not put on =20
treatment =20
Group 2 Mypes not using spectables -40
Sub Group A. Put on treat- =20
ment
B. Not put on =20
treatment =20
Group 3 Chiildren having no refrac- -40
tive error
Sub Group A. Put on treat- =20
ment
B. Not put on =20
treatment =20
The following daily schedule of medical treatment and exercises was prescribed to half the children in each group.
1. Early morning washing face and eyes.
2. Sun treatment in rising & setting sun for five minutes.
3. `Neck exercises for 5 minutes.
4. Eye exercise for 5 minutes (Pencil, short swing, long swing).
5. Palming for 5 minutes in between exercises and whenever eyes feel tired.
6. Diet (Protein 75 gm, Total 2000 calories).)
7. Proper posture & illumination 8. Honey eye drops 30%
9. Vitamins.
The children attended the hospital twice a week for doing the exercises under direct supervision. Various recommended drugs under Ayurveda and Bates system were included alongwith general physical and eye exercises. The purpose of the study was to see collectively if all these different measures contributre towards the prevention, arrest or reversal of myopia.
Without going into the details of the methodology adopted of each factor, the results at the end of 6 months follow up did not show any statistically significant difference in the refractive status in any of the children of the treated groupos. However, subjectively most of the children felt relieved of eye strain and other symptoms.
| Conclusions | |  |
Although the experimental evidence is in favour of the possible role of ocular muscle strain, excessive accommodation and dependent posture; avoidance of these factors and other exercises tried in the clinical study did not show any statistically significant results in a six months follow-up.
|
Search Pubmed for