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Ophthalmology & Optometry/Some questions about high myopia

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QUESTION: Dear Dr Dovie,

Hello. I have a few questions about severe myopia, and I would be so grateful if you would be kind enough to help me.

1. My first question is about floaters in the eye. Once you have floaters, are they always there? In everything I have read, it talks about them as though they are constant, but I saw something yesterday that made it sound like they weren't. Are they constant, or do they come and go?

2. Is it possible for someone to be born with very severe myopia (a prescription of -16.00, for example), and then continue to have just about that same prescription throughout their life, or would their prescription be likely to get worse?

3. If it is possible for that severe degree of myopia to be present at birth, would you please tell me a little about how that would be diagnosed?

Thank you so much for your time. I'm so grateful for your help.

ANSWER: Maria,

1. Floaters are bits of debris (collagen fibers, old cells, etc) that are trapped in the vitreous body - the jelly-like substance that fills the inside of the eye.  The vitreous doesn't go anywhere - so anything that's trapped inside it will stay as well.  Think if it like a snow globe - those little bits are always there. Sometimes they may 'settle' out of the way, so you don't notice them as much, but they're always there.

2. The prescription of the eye is typically based on the size, or axial length.  i.e., how long (or short) is it from the front of the cornea, where light enters, to the back of the retina, where it is focused.  If a person is born highly myopic, that means they have a 'longer' eye than  the 'model' human eye, or one that would focus perfectly.  It is hard to predict how much the eye will change, but you would normally see some progression.

3.  We diagnose and measure infants with something called retinoscopy.  We would typically dilate the pupil to relax the muscles and eliminate any false readings, then essentially shine a light and measure the reflex of it.  http://en.wikipedia.org/wiki/Retinoscopy

Thanks for your questions!
Dr.D

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QUESTION: Dr Dovie, thank you so much for your help. You are extremely eloquent, descriptive and clear in your answers!

I'm sorry to bother you agian, but would you be kind enough to answer three more questions for me? I'm so grateful for your time and help.

My questions are:

1. I have read that being highly myopic greatly increases the risk of retinal detachment, and so a lot of care has to be taken to avoid trauma to the head. What I would like to know is, if you had a prescription of about -16.00, how careful would you have to be? Would it be best to avoid all sports?

2. If you had a prescription of about -16.00, how far could this be fixed by glasses or lenses? Could you have 20/20 vision with glasses on/lenses in, or would it never be quite that good?

3. If you had a prescription of about -16.00, what could you see without any glasses on or lenses in? Is it like being blind? Hypothetically, if I wanted to recreate the experience of being that myopic, would the closest thing be if I shut my eyes? Is it that level of blindness?
Or, is everything very, very blurred, but you can make out shapes, etc.?

You have helped me immensely. Thank you so, so much for your help.

Answer
Maria,

Thank you for your comments, here are some more answers!

1.  I have patients that have prescriptions that high, and while we are concerned over detachments, we don't limit them *too* much. I would avoid direct blow and shock trauma, so thinks like football, rugby, lacrosse, basketball, boxing, martial arts, etc would be out.  

2.  With an Rx that high, it may be difficult to get 20/20, but should be able to get 20/40 or better, which is enough to pass the driving test, etc.  Glasses will be necessary as part of life, spend more and get high index to thin the lenses.  When you can, get fit in contact lenses.

3.  Without correction would be very functionally blind.  Light/dark/colors and movement is about it.  If you got VERY close you may be able to make out shapes.

Good Luck!
Dr.D

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John M. Dovie, OD, FAAO

Expertise

As a residency-trained Fellow of the American Academy of Optometry I am able to answer most questions regarding eye and vision health. Anything is welcome, ranging from dry or allergy eyes, bifocal contact lenses, or thoughts on LASIK surgery. As I am not a surgeon, detail-oriented surgical-related questions may be better answered by an ophthalmologist.

Experience

Selected to participate in the PCO residency program in Philadelphia at The Eye Institute, where I worked OD and MD specialists gaining invaluable experience in various clinics including glaucoma, cornea and cataract, oculo-plastics, retinal disease, neuro-ophthalmic disease, primary care, emergency medicine, and special populations. Have practiced and trained in numerous settings including hospital, academic, retail and private practice. I earned my Fellowship in the American Academy of Optometry (FAAO). There are currently only about 3000 active fellows worldwide, and there are only about 70 Fellows in the state of Virginia. I currently own and operate my own optometric practice/clinic.

Organizations
American Academy of Optometry, American Optometric Association (Contact Lens/Cornea Section member since 2001), Southwest Virginia Optometric Association, Virginia Tech Alumni Association

Publications
Seminars/Presentations:
“Nyctalopia as the Presenting Sign of Vitamin A Deficiency: A Late Complication of Gastric Bypass Surgery.” Clinical Case Study Poster presented at The American Academy of Optometry Denver, Colorado, December 2006, co-authored with Bradley Lane, OD.
“The Importance of Considering Paranasal Sinus Mucocele as a Differential Diagnosis in Diplopia.” Clinical Case Study Poster presented at The American Academy of Optometry San Diego, California, December 2005, co-authored with Kelly Malloy, OD, FAAO and Cherie Farkash, OD.
“Acute Onset of Halos and Glare: Bilateral Keratitis—An Atypical Presentation of Amiodarone Keratopathy.” Clinical Case Study Poster presented at The American Academy of Optometry Tampa, Florida December 2004. Also Presented to New Jersey Academy of Optometry, Neptune, New Jersey March 2005.
“The Opportunity for an Optometrist to Save a Life.” Clinical Case Study and Grand Rounds Presentation presented at The Pennsylvania College of Optometry, Philadelphia, Pennsylvania, September 2004.
Publications:
“Corneal whorls cause wonder.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 10/15/2006.
“Acute onset of halos and glare: bilateral corneal epithelial edema with cystic eruptions--atypical presentation of amiodarone keratopathy.” Co-authored with Andrew Gurwood, OD, FAAO. Published February, 2006, Optometry.
“Pondering the posterior polka-dots.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 5/15/2005.
Professional Involvement:
“AION: Amiodarone-Induced or Anterior Ischemic Optic Neuropathy?” Participated as a peer-review referee for Expert Review of Ophthalmology (London, UK); refereed 10/2006.

Education/Credentials
Bachelor of Science, Cum Laude, Virginia Tech. Bachelor of Science, Pennsylvania College of Optometry. Doctorate (OD), Pennsylvania College of Optometry Residency, Pennsylvania College of Optometry Fellow of the American Academy of Optometry

Awards and Honors
Winner, First Place, "Best Beside Manner" by Our Health Magazine: 2012, 2013, 2014 Winner, First Place, "Best Eye Doctor" by The Roanoke Times: 2013, 2014 Recognized as a Fellow of the American Academy of Optometry, December, 2006 Recipient of the Onofrey G. Rybachok Memorial Scholarship, 2000-2001 Member: The Golden Key International Honor Society Member: The National Biological Honor Society Member: The National Honor Society Eagle Scout awarded 1994

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