Surgical Interventions

There is currently no widely accepted surgical intervention for the progression of high myopia or to limit the complications associated with it and therefore its role in myopia progression is limited. Surgery for myopia in children is not routinely carried out as myopia progresses throughout childhood and into early adult life and it is important to have a stable prescription before surgical intervention.

However there has been some research looking at the value surgery may bring to control myopic progression by controlling axial elongation[1].  Most myopia is linked to axial length with associated thinning of the sclera and an increasing amount of biomechanical instability[2]. As the sclera thins so does the retina and choroid which gives rise to some of the risk factors discussed in the introductory pages of the Clinical Hub – Myopia Management section.

Surgical interventions are aimed towards stabilizing the sclera (and therefore reducing the comorbidities as above) and fall into three general categories:

  1. Scleral buckling surgeries such as posterior scleral reinforcement
  2. Injection based scleral treatments
  3. Scleral strengthening by collagen cross linking

Posterior scleral reinforcement is currently the only existing surgical intervention for high myopia and was first described in 1930. The surgery uses either donor sclera or non-biological materials to strengthen the scleral at the weaker posterior pole and prevent axial elongation. The research is limited and authors comment that it is “difficult to discuss efficacy and safety with confidence”.

There is at the present time (Feb 2021) a randomized clinical trial being undertaken with 120 patients in Beijing looking at the safety and efficacy of posterior scleral reinforcement on controlling myopia progression.[3] The researchers state: “This study will evaluate the efficacy and safety of posterior scleral reinforcement on controlling myopia progression, including change in refraction, axial elongation as well as sight-threatening complications, in adults with high myopia. Half the adults will receive posterior scleral reinforcement, while the other half will receive no surgical treatment”

The study was due to be completed by 31 December 2020 but no results are presently published.

It would fall beyond the scope of a dispensing optician to discuss surgical interventions in myopia management beyond commenting that they are not routine and that further research is being undertaken at the present time.

Discover more about myopia management

ABDO does not endorse nor recommend one approach to myopia management above another nor does it have any recommendations on appropriate products. The information on these pages is to facilitate practitioners’ ability to have an informed discussion with patients and their parents/carers, and signpost practitioners who do wish to research the subject in more depth.

References

[1] Christine F. Wildsoet, Audrey Chia, Pauline Cho, Jeremy A. Guggenheim, Jan Roelof Polling, Scott Read, Padmaja Sankaridurg, Seang-Mei Saw, Klaus Trier, Jeffrey J. Walline, Pei-Chang Wu, James S. Wolffsohn; IMI – Interventions for Controlling Myopia Onset and Progression Report. Invest. Ophthalmol. Vis. Sci. 2019;60(3):M106-M131. doi: https://doi.org/10.1167/iovs.18-25958

[2] https://www.myopiaprofile.com/posterior-scleral-reinforcement-as-a-means-of-myopia-control/ last accessed February 2021.

[3] https://clinicaltrials.gov/ct2/show/study/NCT03381079 last accessed February 2021.

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