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7/24/2019 ppt jurnal miopia
1/22
JOURNAL READING:JUVENILE MYOPIA PROGRESION, RISK
FACTORS, AND INTERVENTIONS
PEMBIMBING:
Dr. Wendy H Lewerissa, Sp.M
Oleh:
Dian aryanti
000!"00#$
7/24/2019 ppt jurnal miopia
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The development and progression of early onset myopia is actively
being investigated.
While myopia is often considered a benign condition it should be
considered a public health problem for its visual, quality of life, andeconomic consequences.
Uncorrected visual acuity should be screened for and treated in order
to improve academic performance, career opportunities and socio-
economic status.
Genetic and environmental factors contribute to the onset and
progression of myopia.
ABSTRAK
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Environmental factors include near wor, education levels, urban compared to rural
location, and time spent outdoors.
!n this "eld of study where there continues to be etiology controversies, there is
recent agreement that children who spend more time outdoors are less liely to
become myopic.
There have been rapid population changes in prevalence rates supporting anenvironmental in#uence.
!nterventions to prevent $uvenile myopia progression include pharmacologic agents,
glasses and contact lenses. %harmacological
&urther research will aim to assess both the role and interaction of environmental
in#uences and genetic factors.
%eyw&rds: My&pia, 'e(ra)ti*e err&r,E++etr&piati&n, 'e*iew
ABSTRAK
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The prevalence rate for myopia, an e'tremely common eye disorder
worldwide, rose over the past three decades in the United (tates from )*+ to
+ and has risen to /01/+ in some 2sian countries.
3igher myopia, over si' diopters, is also increasing and is associated with an
increased lifelong ris of rhegmatogenous retinal detachment, glaucoma, and
myopic degeneration.
Worldwide there are *4 million visually impaired persons due to uncorrected
refractive errors accounting for 1+ of all visually impaired persons.
Uncorrected visual acuity should be screened for and treated in order to
improve academic performance, career opportunities and socio-economic status. Understanding the ris factors and interventions for the most common form of
myopia, $uvenile myopia is the aim of this review.
Intr&d-)ti&n
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5ost studies classify over 6/+ of myopia as early onset also
called $uvenile or school myopia, occurring between 1 and
years of age with progression throughout the early teenage years.
There is agreement that both genetic and environmental factors
contribute to the onset and progression of myopia. 7ne variable predicting the future onset of myopia is a
cycloplegic auto refraction of /.* diopter or less of hyperopia
at a mean age of 8.6 years which has been shown to have a
sensitivity of 8+ and speci"city of 4+ in predicting futuremyopia.
(tarting with a year )/// report, many population studies
around the world are using a common protocol.
Juvenil My!i"
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The (ydney 5yopia (tudy uses a protocol common with
si' studies starting with the 9efractive Error (tudy in
:hildren ;9E(:< in )///.
The prevalence of myopia reported for 6 year oldchildren varies from /.6+ in 7man to )1+ in (ingapore.
The prevalence in 7man for 6 year old children was
/.6+, but the de"nition of myopia was more than ./
diopter when most studies use /.* diopter. The prevalence of myopia among pre-school children at
=ing 2bdula>i> 5edical :ity, 9iyadh, (audi 2rabia is
).*+.
Juvenil My!i"
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The visual system has an active process of emmetropi>ation
that involves defocus detection and a coordinated growth of
the refractive components toward emmetropia with active
structural changes.
!t is ama>ing how well emmetropi>ation wors andunderstanding what occurs when this process fails is the target
of the research.
!n the "rst three years of life the cornea and lens change to
counterbalance an appro'imately )/ diopter increase in a'iallength of the growing eye.
?etween ages 4 and 4 the lens and or cornea need to ad$ust
about 4 diopters to maintain emmetropia.
Juvenil My!i"
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2s the human eye grows the lens adds layers of tissue yet thins
by stretching in the equatorial plane so that it #attens, thins and
loses power to compensate for the increasing a'ial length and
maintains emmetropia.
When the lens fails to stretch and thin the eye becomes myopicand the eyeball shape becomes more prolate or less oblate.
When myopia develops the eye is longer than it is wider
;greater anteroposterior length than lateral transverse
dimensions
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This peripheral vision refraction is another hypothesis as a
potential impact or trigger on the active emmetropi>ation
process.
@ocal retinal regions can control local eye growth and myopia.
The peripheral refractive state of the eye can aAect eye
development especially the progression of myopia.
2n interesting study found + of young entering emmetropic
pilots with relative hyperopic defocus in their peripheral
refraction developed myopia during their training. 3yperopic eyes are usually myopic in the periphery adding to
the hypothesis that the periphery focus could be a trigger in eye
growth.
Juvenil My!i"
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3igh heritability in myopia suggests that there is a signi"cant genetic
component to e'plain the variance in the population.
2 high heritability inde' is found in twin studies varying from *+ to 1+.
2 recent large sample study of mono>ygotic and di>ygotic twins estimates a
heritability inde' of +.
7ther genetic evidence pointed to is the prevalence of myopia in children
increased with the number of myopic parents from .6, .1, to 4,6bpercent
for no, one or two myopic parents.
3owever, it is an interesting observation of low heritability values in parent-
oAspring correlations when there has been rapid environmental change
between generations. The Genes in 5yopia ;GE5< family study calculated the heritability inde'
between )+ and **+.
!n a non twin study heritable factors accounted for 8/+ of $uvenile myopia.
Gene#i$ %"$#&'
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5ultiple myopia genetic loci have been identi"ed establishing
myopia as a common comple' disorder.
2 recent review of data from the past decade in searching for
myopia genes points to a'ial length and refraction sharing
common genes and states that the ma$ority of myopia cases are
not liely caused by defects in structural proteins, but in defects
involving the control of structural proteins.
Thus we are still left with the impression that the in#uence of
environment e'erts a greater eAect than does the concerted
action of several genesBB.
Gene#i$ %"$#&'
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The increasing prevalence of myopia and high myopia which at times has
rapidly changed in Taiwan, (ingapore, 3ong =ong, (candinavia, and the
United (tates has been pointed out as liely being environmental.
!n can be diCcult to compare prevalence studies if the protocol forsampling, refraction and use of cycloplegia is not standardi>ed. (tarting
with a year )/// study there have been population studies in :hile,
:hina, Depal, Urban, !ndia, 9ural !ndia, (outh 2frica, and 2ustralia
using a common or comparable protocol.
ata on eye structure and changes over time in this study include using
:yclopentolate use with auto refraction, noncontact biometry including
optical coherence tomography.
Envi&n#(en# F"$#&'
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9ecently data have shown a protective eAect of the time spent
outdoors in 60 year old children.
This outdoor protective eAect was also reported in ) year old
(ydney children.;9ose et al., )//8bed environments, almost everyone could
become myopic.
Envi&n#(en# F"$#&'
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!nterventions to control $uvenile myopia progression have
included pharmaceutical agents, bifocal and %rogressive lens
glasses, and rigid gas permeable contact lenses.
!n a review of myopia trials to retard myopia progression in)//) it was felt there was insuCcient evidence to support any
interventions.
Iet, a two year controlled prospective study on myopic childrenaged 10 who were under corrected by appro'imately J/.*
diopter showed an enhanced rather than an inhibited myopia
development in a'ial length and thus more myopia.
In#e&ven#in'
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!n a randomi>ed mased ) year trial giving myopic children atropine in
one eye the treated eye progressed /.48 diopters and the untreated eye
progressed .)/ diopters.
This diAerence in myopia progression of /.1) was also accompanied
by a reduced a'ial elongation of /./ mm. Do serious adverse events related to atropine were reported.
This atropine study group also reports embaring on a new randomi>ed
clinical trial using three diAerent atropine concentrations with bilateral
treatment for more than two years with a post treatment monitoring to
evaluate long term comparative myopia control eAects of the treatment. There have been two studies using %iren>epine gel, in the United
(tates, and, in 2sia, showing a nearly */+ reduction in progression
when used twice a day.
In#e&ven#in'
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9igid contact lenses have been reported to slow myopia progression but had
not been studied in a controlled randomi>ed trial until )//4.
9igid gas permeable contact lenses were found to have only a mild
nonsigni"cant protective eAect.
2 more recent two year study of forty, 80 year old children given
corneal reshaping contact lenses during sleep reported slowed eye growth
compared to the matched soft contact wearing children.
3owever, recently in a two year study, three randomi>ed groups of children
wearing single vision glasses, bifocals, or bifocals with base in prism
progressed after two years .** , /.16 , and /./ , respectively.
In#e&ven#in'
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?aseline data for the (tudy of Theories about 5yopia %rogression
;(T25%< have recently been reported.
This )-year, double-mased, randomi>ed trial will loo at%rogressive addition lenses compared to single vision glasses and
myopia progression and also loo at peripheral refraction,
accommodative response and convergence, crystalline lens radii of
curvature, a'ial dimensions, intraocular pressure, corneal curvature
and thicness, as well as near wor and outdoor activityassessment.
The (T25% study will gather complete biometric data at 6
month intervals.
The (T25% baseline data found that indeed the myopic children
did have a peripheral hyperopic defocus similar to other reports
along the lateral meridian of the eye and a new "nding was a
myopic defocus along the vertical peripheral meridian of the eye.
;&ig.
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Cn$lu'in
Genetic studies are actively continuing, but to date have not yet identi"eda genetic pathway for familial ris of myopia.
The emmetropi>ation process continues to beinvestigated looing for ris
factors, such as peripheral vision defocus and accommodative lag,
contributing to $uvenile myopia progression.
%harmacologic treatments have reduced myopia progression but more
studies including longer follow up are needed.
9ecent epidemiological studies have identi"ed the time spent outdoors tobe protective of the development of myopia.
5uch progress has been made in the past decade both in epidemiological
studies as well as in clinical trials leading to new questions requiring
more research.
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TERIMAKASI)