Myopia Progression: Factors Beyond Axial Length in Young Adults - Ophthalmology

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Myopia, or nearsightedness, is a common refractive error that affects many individuals, particularly in their teenage and young adult years. While axial length—the distance from the front to the back of the eye—is a significant factor in myopia progression, other components such as the cornea, lens, and vitreous body also play crucial roles. Your inquiry about the relationship between these structures and the progression of myopia, especially in the context of your son’s situation, is quite pertinent.

1. Understanding the Relationship Between Axial Length and Refractive Error: In your son’s case, the increase in myopia (150 degrees) is significantly greater than the increase in axial length (0.2 mm). This discrepancy suggests that other factors are contributing to the worsening of his myopia. The cornea and lens can influence the eye's overall refractive power. For instance, if the curvature of the cornea becomes steeper or if the lens becomes thicker, this can lead to an increase in myopia independent of changes in axial length.

2. Potential Abnormalities: There are several potential abnormalities that could explain the disproportionate increase in myopia relative to axial length. These include:
- Corneal Abnormalities: Conditions such as keratoconus, where the cornea becomes thin and cone-shaped, can lead to increased myopia.

- Lens Changes: Changes in the lens, such as an increase in thickness or changes in curvature, can also affect refractive power. Conditions like lenticonus or cataracts can lead to significant refractive changes.

- Vitreous Body Changes: The vitreous body, which fills the eye, can also undergo changes that might affect the eye's shape and refractive status, although this is less common.

3. Recommended Examinations: Given the concerns about potential abnormalities in the cornea, lens, or vitreous body, it would be prudent to conduct further examinations. While a slit lamp examination is a good start, additional tests may include:
- Corneal Topography: This test maps the curvature of the cornea and can help identify irregularities.

- Ultrasound Biometry: This can provide detailed information about the eye's internal structures, including the lens and vitreous body.

- Optical Coherence Tomography (OCT): This imaging test can provide cross-sectional images of the retina and other structures, helping to identify any abnormalities.

- Refraction Tests: Comprehensive refraction tests, including cycloplegic refraction, can help determine the true refractive error without the influence of accommodation.

In conclusion, while axial length is a critical factor in myopia progression, it is essential to consider the contributions of the cornea, lens, and vitreous body. The significant increase in your son’s myopia relative to his axial length suggests that further investigation into these structures is warranted. Consulting with an ophthalmologist who specializes in myopia management and ocular health will provide the best course of action for understanding and addressing your son’s myopia progression. Regular monitoring and appropriate interventions can help manage myopia effectively and preserve visual health.