The prevalence of myopia is increasing extensively worldwide. The number of people with myopia in 2020 is predicted to be 2.6 billion globally, which is expected to rise up to 4.9 billion by 2050, unless preventive actions and interventions are taken. The number of individuals with high myopia is also increasing substantially and pathological myopia is predicted to become the most common cause of irreversible vision impairment and blindness worldwide and also in Europe. These prevalence estimates indicate the importance of reducing the burden of myopia by means of myopia control interventions to prevent myopia onset and to slow down myopia progression. Due to the urgency of the situation, the European Society of Ophthalmology decided to publish this update of the current information and guidance on management of myopia. The pathogenesis and genetics of myopia are also summarized and epidemiology, risk factors, preventive and treatment options are discussed in details.
Women ophthalmologists are authoring publications in increasing numbers that match their prevalence in the academic and overall workforce. However, all editors are men. This discrepancy relates to the relatively younger generation of female ophthalmologists or selection bias, a subject that requires further investigation.
Background-Ocular alkali burns can be associated with a poor visual outcome. The release of collagenases and proteases after the injury leads to corneoscleral melting. The role of topical steroids in such patients is controversial as they have been postulated to exacerbate corneoscleral melting. Methods-30 patients were reviewed retrospectively after admission to King's College Hospital with alkali burns between 1990 and 1993. All patients were treated with an intense and prolonged regimen of topical steroids and topical and systemic vitamin C. Results-22 patients had mild injuries and eight had severe injuries as estimated by the Roper-Hall grading system. 23 patients were treated with topical steroids for > 10 days and 22 patients were treated with topical vitamin C for more than 10 days. One patient with a severe injury developed corneoscleral melting. Conclusion-Prolonged treatment with topical steroids when used in conjunction with topical vitamin C is not associated with corneoscleral melting. (Br J Ophthalmol 1997;81:732-734) Ocular alkali injuries remain a diYcult therapeutic challenge. After an ocular alkali burn there is a release of collagenases and proteases which can lead to corneal stromal thinning and perforation.
SUMMARYSickle trait is the commonest of the sickle haemoglo binopathies and affects approximately 9% of the Afro-Caribbean population of North America. ] Traditionally the condition was considered to be benign, important only for its genetic implications, 2 , 3 but some authors have challenged this viewpoint. Spontaneous vitreous haemorrhage, 3 , 4 proliferative retinopathr and other ocular lesions have been described, albeit in the presence of some precipitat ing factor.Factors known to enhance sickling of red blood cells, thereby increasing the risk of vascular throm bosis, include hypoxia, dehydration, acidosis, hyper viscosity and the percentage of abnormal haemoglobin.6 The combination of sickle trait and a significant degree of one or more of these factors may provoke sickle retinopathy. Three cases are reported to emphasise the importance of considering sickle trait as relevant to the management of eye disease in at-risk patients. presented to the eye casualty having been hit in the left eye by a paper pellet. On examination the vision was right 6/5 and left 6/18. On the left side a 5 mm hyphaema was present, the pupil was round and reactive and the intraocular pressure (lOP) was 18 mmHg. Dilated funduscopy was normal. The follow ing day the hyphaema had reduced in size but the lOP had risen to 38 mmHg, hence topical and oral ocular antihypertensive agents were introduced. Haemoglobin (Hb) electrophoresis revealed AS sickle trait with an HbS concentration of 38.3%. The next day the lOP had risen to 53 mmHg and oral glycerol was added to the regime. There was good response to this treatment, with the lOP returning to normal and gradual resolution of the hyphaema. Gonioscopy confirmed angle recession nasally.Six days after admission the patient was noted to have scattered preretinal and sub hyaloid haemor rhages in the temporal mid-periphery, but no retinal tears were identified. After 14 days the visual acuity was 6/6-3, the eye was quiet with no hyphaema and the rop was 13 mmHg. The haemorrhages in the mid-periphery remained and occluded vessels invol ving almost all of the peripheral retina were seen (Fig. 1). Six weeks after the incident the haemor rhages had resolved but there was no change in the appearance of the peripheral vasculature. A fluor escein angiogram (Fig. 2) showed extensive periph eral occlusion but no neovascularisation.The other fundus is normal and the lOP has remained at 12-15 mmHg on no treatment.
Case 2A 59-year-old Jamaican woman was referred from the diabetic clinic because of reduced visual acuity and the finding of background diabetic retinopathy. She had been an insulin-dependent diabetic for 30 years, hypertension had been diagnosed 4 years previously and this was well controlled on nifedipine and a diuretic. She did not smoke. Visual acuity was Eye (1995) 9,589-593
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