Managing Complex Vision Issues: Myopia, Hyperopia, and Astigmatism in Teens

Q: Managing Complex Vision Issues: Myopia, Hyperopia, and Astigmatism in Teens

Hello： 1. <br>The purpose of mydriatic agents is to paralyze the ciliary muscle, temporarily impairing the eye's ability to adjust focus. <br>This helps relax the eye muscles for fitting glasses or examining the fundus, and can effectively suppress the progression of myopia, but

One eye has myopia with astigmatism, while the other eye has hyperopia with astigmatism, resulting in a significant disparity in vision?

The patient is 14 years old, with hyperopia of +3.25 diopters and astigmatism of +0.75 diopters in the left eye, and myopia of -0.75 diopters and astigmatism of +1.50 diopters in the right eye (using 0.05% atropine for nighttime dilation, which affected daytime activities; after one week, switched to 0.01% atropine for nighttime dilation for about two weeks).
The left eye is blurry, and there are occasional occurrences of esotropia.
The right eye also has blurred vision throughout the day due to dilation.

1.
Does the dilation treatment for the right eye only stabilize myopia without improving it? Will this require continuous use like a long-term prescription? It is very challenging during daytime classes...
2.
Does the astigmatism in the right eye seem unrelated to the dilation treatment?
3.
Can the hospital's orthokeratology lenses be used for both eyes of the patient? Can orthokeratology lenses also address astigmatism?
4.
Are there contact lenses available for both hyperopia and myopia?
5.
Is the patient's condition suitable for laser treatment?
6.
If left untreated, is there a possibility that the condition could worsen?

Dongt, 10~19 year old female. Ask Date: 2024/04/16

Dr. Gao Pilin reply Ophthalmology

Hello: 1.
The purpose of mydriatic agents is to paralyze the ciliary muscle, temporarily impairing the eye's ability to adjust focus.
This helps relax the eye muscles for fitting glasses or examining the fundus, and can effectively suppress the progression of myopia, but it does not reduce existing refractive errors.
If a patient feels strain during daytime classes, the use of orthokeratology lenses may be considered.
2.
Astigmatism is a type of refractive error caused by uneven curvature of the cornea or lens, preventing light from focusing properly on the retina and resulting in a clear image.
Mydriatic agents do not correct astigmatism, so the astigmatism in the right eye is unrelated to mydriatic treatment.
3.
Orthokeratology lenses are high-oxygen-permeable rigid contact lenses that can temporarily reshape the cornea while worn at night, correcting myopia and astigmatism.
4.
There are contact lenses available for both hyperopia and myopia.
5.
Laser refractive surgery is a procedure that uses laser light to reshape the cornea to correct refractive errors.
Candidates for laser refractive surgery must be at least 18 years old, have stable refractive errors for at least one year, and have no other eye diseases.
6.
If left untreated, a patient's myopia and astigmatism may continue to worsen.
Additionally, the patient may develop esotropia in the left eye.
Therefore, it is recommended that patients undergo regular ophthalmic examinations and follow the treatment advice of their ophthalmologist.

Reply Date: 2024/04/16

More Info

Managing complex vision issues in teenagers, particularly when dealing with myopia (nearsightedness), hyperopia (farsightedness), and astigmatism, requires a comprehensive understanding of the conditions and available treatment options. In your case, the patient is 14 years old and presents with a combination of refractive errors: left eye hyperopia of +3.25 diopters with astigmatism of +0.75 diopters, and right eye myopia of -0.75 diopters with astigmatism of +1.50 diopters. The patient has also been experiencing occasional esotropia (inward eye turn) in the left eye and has been undergoing treatment with nighttime atropine drops to manage myopia progression.

1. Atropine Treatment and Myopia Stabilization: The primary goal of using atropine drops, especially at lower concentrations like 0.01%, is to slow the progression of myopia rather than to improve visual acuity. While it may help stabilize the degree of myopia, it does not correct the existing refractive error. Therefore, the patient may still require corrective lenses for clear vision during the day, especially in a school setting. It is important to note that the use of atropine is generally a long-term strategy, and some patients may need to continue using it for several years to maintain its benefits. Regular follow-ups with an eye care professional are essential to monitor the effectiveness of the treatment and make necessary adjustments.

2. Astigmatism and Atropine Treatment: The astigmatism in the right eye is typically independent of the atropine treatment. Astigmatism is caused by an irregular curvature of the cornea or lens, leading to distorted or blurred vision. While atropine can help manage myopia, it does not directly address astigmatism. Corrective lenses, such as glasses or contact lenses specifically designed for astigmatism, are necessary to provide clear vision.

3. Orthokeratology (Ortho-K) for Astigmatism: Orthokeratology lenses, or corneal reshaping lenses, can be effective for managing myopia and, to some extent, astigmatism. These specially designed gas-permeable contact lenses are worn overnight to temporarily reshape the cornea, allowing for clearer vision during the day without the need for glasses or contact lenses. It is essential to consult with an eye care professional to determine if the patient is a suitable candidate for Ortho-K, especially considering the differing refractive errors in each eye.

4. Contact Lenses for Mixed Refractive Errors: There are specialized contact lenses available for individuals with mixed refractive errors, such as multifocal or toric lenses. These lenses can correct both hyperopia and myopia simultaneously, along with astigmatism. A thorough fitting by an eye care professional is necessary to ensure the best vision correction and comfort.

5. Laser Treatment Considerations: Laser vision correction procedures, such as LASIK or PRK, are generally not recommended for individuals under 18 years of age, as their eyes are still developing. Additionally, the presence of significant refractive errors, particularly in a teenager, may complicate candidacy for such procedures. It is crucial to have a detailed discussion with an ophthalmologist regarding the potential risks and benefits of laser treatment once the patient’s vision has stabilized.

6. Consequences of Not Addressing Vision Issues: If left untreated, the patient’s refractive errors could worsen over time, potentially leading to increased difficulty with daily activities, academic performance, and overall quality of life. Additionally, untreated strabismus (like esotropia) can lead to amblyopia (lazy eye) if one eye is consistently favored over the other. Therefore, it is vital to address these vision issues promptly to prevent further complications.

In conclusion, managing complex vision issues in a teenager requires a tailored approach that considers the individual’s specific refractive errors, lifestyle, and visual demands. Regular follow-ups with an eye care professional, appropriate use of corrective lenses, and potential treatments like atropine or orthokeratology can help maintain and improve the patient’s vision.

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