ppt jurnal miopia

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    JOURNAL READING:JUVENILE MYOPIA PROGRESION, RISK

    FACTORS, AND INTERVENTIONS

    PEMBIMBING:

    Dr. Wendy H Lewerissa, Sp.M

    Oleh:

    Dian aryanti

    000!"00#$

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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)