True myopia refers to myopia that still exists after examination with ciliary muscle paralyzing agents, and is fundamentally different from pseudomyopia.
I. What is true myopia?
Myopia is a state in which the eyes can see clearly near but not far, i.e., they can only see near but not far. Children and adolescents are studying at school, reading, writing and other near work for a long time, looking at near objects, the eyes have to use the adjustment function, that is, the ciliary muscle in the eye to contract, long time near work or improper overuse of the eyes, such as reading novels, playing video games, watching TV, etc. can make the ciliary muscle contract continuously, in a spasm state, when looking at the distance should be relaxed, at this time also can not relax, has been If there is no pathological change in the fundus, it is called pseudomyopia, also called regulatory myopia; if there is pathological change in the fundus, it is called true myopia. True myopia can be divided into: regulatory true myopia, axial true myopia, refractive index true myopia, curvature true myopia, etc.
Clinical characteristics of true myopia
1. The main clinical features of true myopia are.
(1) The degree of myopia is mostly medium and high myopia, which occurs and develops over a long period of time, and the patient has different degrees of ectropia in eye appearance.
(2) True myopia is difficult to self-adjust and recover.
Causes of true myopia
Myopia is a kind of refractive error. Myopia is a type of refractive error in which distant objects do not converge on the retina and form a focal point in front of the retina, resulting in visual distortion and blurring of distant objects.
The cause of true myopia is still not clear, but the accepted view is that myopia is caused by a variety of factors. The specific causes can be divided into two types: internal and external.
Exogenous causes are mainly environmental factors: this is mostly seen in people who work in writing or other close work, and myopia is also more prevalent among teenage students, and its prevalence increases significantly from the fifth and sixth grades of elementary school, a phenomenon that indicates that the occurrence and development of myopia is very closely related to close work.
The internal causes of myopia include genetic factors and developmental factors. Genetic quality means that myopia has a certain genetic tendency, and this is especially true for high myopia, where patients with genetic myopia have the disease at an early age, mostly above 6.00D. High myopia is autosomal recessive, and general myopia is a multi-factor genetic disease, so genetics is a factor that triggers myopia.
Developmental factors can also lead to myopia, because infants have small eyes, so they are farsighted, but as they grow older, the eye axis also gradually lengthens, until adolescence when the development is normal, such as excessive development, then myopia is triggered.
Ophthalmologists remind: because of the complications of high myopia and the serious impact on visual function, it is recommended that patients with high myopia regularly go to a specialist hospital to have their fundus and intraocular pressure checked to facilitate early detection, diagnosis and treatment.
Identification of true myopia and pseudomyopia
Both true and pseudomyopia are characterized by decreased distance vision and good near vision. Pseudomyopia is functional and occurs mostly in adolescents, and vision can decline within a few weeks or 1 to 2 months, and can be restored to some extent after proper rest. True myopia is an organic change that cannot be recovered naturally. The differential diagnosis methods are as follows.
V. Ciliary muscle paralysis method
In the ciliary muscle paralysis drug to relax the regulation, so that the ciliary muscle relaxation, so that the eye in a static refractive state, and then check the visual acuity and optometry to determine. Use 1% atropine drops, 1~2 times daily for 3~4 days; or 2% posterior tropine or 0.5% tropine amide every 5~15 minutes for a total of 6 times. The visual acuity of the naked eye under the small hole lens was checked before and after the drops, and if the visual acuity remained unchanged after pupil dilatation, it was true myopia, and if the visual acuity increased, it was pseudomyopia; the optometry with myopic refraction was true, and without myopic refraction was false. This is recognized as the most reliable method of differential diagnosis.
Sixth, the cloud method
Let the patient wear +3.0D spherical lens in both eyes at the same time, look at distant objects for 3 minutes, then remove the right lens, immediately check the bare eye visual acuity, visual acuity progress for false, not progress for true; then check the left eye by the same method. This method is not very accurate.
Seven, the dynamic examination method
1.No dilated pupil
1. First, check the distance and near naked eye visual acuity of both eyes. Poor distance vision, normal near vision and no other eye diseases affecting vision are the identification targets.
2.The doctor and patient sit facing each other in the dark room.
3.The patient wears a trial frame with +2.25D spherical lenses in front of the left and right eyes.
4.The patient gazes at the visual marker on the examination mirror with both eyes at the same time.
5.Make a 33cm distance isotropic dynamic examination.
Eight, the results are determined.
1.The patient’s eyes are true myopia if the radial direction is retrograde.
2.The radial direction is parallax or immobile, or one radial direction is parallax and the other radial direction is immobile for orthopia or hyperopia. Because of its performance vision for myopia, so for pseudomyopia.
3.A radial direction is retrograde, and another radial direction is prograde or immobile for mixed astigmatism.
Nine, a simple identification method
Identification of true and pseudomyopia, in addition to hospital optometry, a simple method can be hung at a distance of 5 meters an international standard vision table, first determine the vision, and then put on 300 degrees of presbyopic glasses, look into the distance, will slowly appear in front of the cloudy scene, half an hour after removing the glasses, and then check the vision, such as vision enhancement, can be considered pseudomyopia; such as vision remains or instead of declining, you can follow this method once a day. Repeat this method once a day for three consecutive days, and if your vision still does not improve, you can be sure that it is true myopia.
Pseudomyopia is generally due to prolonged close work, poor eye posture, reading on a table, lying in bed or in a volatile carriage; too strong and too weak light, etc. so that the eye ciliary muscle is often in a state of tension and fatigue, resulting in vision loss. If proper rest or atropine drops are used to relax the paralyzed and spastic ciliary muscle, vision can be restored. True myopia, vision below 0.8, myopia degree more than 100 degrees must wear glasses, otherwise myopia degree will become deeper and deeper.
Ten, true myopia prevention methods
1, text method head stiffness, or shoulder stiffness will make the blood circulation deteriorate, indirectly leading to the decline of eye function. Using the head and neck, which is a combination of head movement and point-of-view movement, can naturally restore the above-mentioned healthy functions.
Training essentials: In a light mood, spread your feet shoulder-width apart and let your shoulders relax; gaze into the distance and shake your head to write. You can describe any article you like; eyes to match the activities of the face, move the point of view, do 20 minutes; be sure to match the rhythmic activities, you can put some music, naturally can be carried out in a relaxed atmosphere.
2, long-distance running method to exercise foot strength can also strengthen the eyes. As the saying goes, fatigue starts from the feet and eyes, likewise, aging and fatigue both start from the feet and eyes. The symptoms of fatigue tend to appear in the eyes and feet these two parts. Whenever the feet feel tired, the eyes will be tired too. And vice versa. This interrelationship allows us to include the long-distance running method into the whole training system.
3, hot and cold method this is a method of alternating hot and cold towels on the eyes, for eliminating eye fatigue, promote blood circulation, stimulate the eye muscle and ease the stiffness of the external eye muscle has a very good help, can achieve the purpose of refreshing the eyes, revitalize the eye cells and enhance metabolic function.
4, paste over method: true myopia easy eye fatigue, relieve visual fatigue is also an important factor to prevent the deepening of true myopia. The eye patch can effectively promote eye blood circulation, eliminate eye fatigue, so that the eyes in a short period of time to get a better recovery. The unique pure Chinese medicine preparation can directly act on the nerve tissue in the eye 2mm, activating the nerve of the eye tissue, which has a better auxiliary treatment effect on myopia, farsightedness and amblyopia.
Modern ophthalmic medical research shows that: through the eye supplementation, improve eye microcirculation, improve eye immunity and antioxidant capacity, promote eye tissue metabolism, it can effectively eliminate the causes of a variety of eye diseases, so as to protect eye health to the maximum extent.
Eleven, training methods: prepare two towels: one towel soak hot water to make the towel hot, the other covered in an ice pack or first refrigerated (wet paper towels can also be); sitting, standing, lying posture is not limited, relaxed body and mind, eyes closed; first fold the hot towel into the appropriate size, covering the eyes for 3 to 5 minutes, and then replaced with a cold towel, about 2 to 3 minutes clock. Alternating 2 to 3 times, the temperature to the eyes can accept as appropriate. Do this 2 to 3 times a week. It should be noted that: eye inflammation, eyelid redness, keratitis, long needle eyes, pain or fever can not be hot compresses.
Twelve, true myopia wearing glasses precautions
Wearing myopia glasses is mainly to correct the vision and can clearly see the objects at a distance. In order to keep the ciliary muscle of the eye to maintain a certain adjustment ability, for patients with low myopia, it is better to take off the glasses, that is, wear glasses when looking at distant objects and not wear glasses when looking at near objects. However, if you wear more than 300 degrees of glasses, it is best to keep wearing glasses. Because in principle, only to maintain a clear vision, in order to avoid aggravating myopia.
1, correct wearing glasses degree will not wear deeper and deeper
The development of myopia is not directly related to the wearing of glasses. Myopic patients wear the right glasses, pay attention to eye hygiene, myopia will stabilize at a certain level. However, if you think that everything will be fine with glasses and you don’t pay attention to eye hygiene, you will continue to keep your eyes in a state of long-term fatigue, which will lead to vision loss and myopia deepening. In addition, wearing inappropriate glasses, such as: no optometry or optometry is not allowed, the degree with too large, will increase the burden on the eyes, so that vision loss, the degree of deepening.
2, after the glasses to wear long-term
The normal wearing glasses suffer from myopia at the same time has been diagnosed as true myopia, the degree in the 100 above, should wear suitable myopia glasses to correct. Once you have glasses, you should wear them except for washing your face and sleeping, because after wearing the right glasses, myopic patients are in the state of positive vision, and the adjustment and convergence functions are restored to their natural relationship. Wearing glasses is not only to improve vision, but also to read and work at an appropriate distance, so that there is a normal coordination between the regulation and convergence functions of the eyes and avoid eye fatigue.
XIII. Treatment of true myopia
True myopia, once formed, is irreversible and is an organic change in the eye. The anterior and posterior axes of the eye become longer and external objects are imaged in front of the retina through the refractive system of the eye, and there is no clear image on the retina. This organic change cannot shorten the eye and change the refractive power by any method other than surgery, which is why myopia is difficult to cure. Once true myopia is formed, the situation is the same whether it is high myopia or low myopia.
1, lens correction, before prescription lenses, first of all, through the examination of the shadow difficult light to find out the true degree of myopia. For adolescents with glasses optometry should be carried out under ciliary muscle paralysis to control the role of regulation and exclude pseudomyopia. The principle of prescription lenses should be the same as the lowest degree lenses that can correct myopia to the best visual acuity. Generally below 6.00d myopia, to fully correct and often wear; high myopia, both to fully correct to obtain better vision, but often can not tolerate, therefore, had to reduce the lens degree (generally between 1.00d ~ 3.00d), to be able to maintain comfortable and binocular visual function.
2, corneal contact lenses, wearing contact lenses can increase the field of vision, have a better cosmetic effect, but also can make the refractive difference between the two eyes significantly reduced, so that the maintenance of binocular vision function. Youth myopia, not only can contact lenses increase visual acuity, but also can compress the cornea to prevent myopia continue to develop. But must pay attention to cleanliness and hygiene, disinfection maintenance and frequent replacement as required.
3, telescopic glasses, very high myopia patients or macular lesions, borrow telescopic glasses, often able to read or do near work. The magnification of such glasses is 1.8 times, so it can enhance the distance vision by 2% to 3.5%, and look at near can be enhanced by up to 5 times. Because the field of view is too small, so it cannot be used when traveling.
4, radial keratotomy, this method was first tried by the Soviet scholar kranov (1970). China has now been reported in several places. Its method is in the central cornea 3 to 5 mm beyond and between the corneoscleral edge, make 8 to 16 radial incisions, incision depth of 0.36 to 0.50 mm. corneal surface incision, so that the corneal curvature flattened, and thus reduce its myopia. It is generally believed that 3.00d myopia can be corrected. Because the long-term results of this method are still difficult to be sure, and to be strictly selected to determine the indications and contraindications, and the possibility of surgical complications. Therefore, it is difficult to be universally implemented.
5, scleral shortening, this method is the most commonly used surgical treatment, from highly myopic eyes with reliable results, and has been commonly used.
6, keratomileusis, this method is to use specially designed instruments from the central cornea for lamellar resection, remove the corneal piece after cryogenic treatment, grinding in a very fine lathe to achieve the required refraction and then sewn back to the original, used to correct high myopia, but the surgery is extremely complex, and there are certain risks, so it is difficult to promote.
7, New Rare Tablet Therapy: Myopic patients are generally lacking in chromium and zinc, and myopic patients should eat more foods that contain more zinc. Foods such as soybeans, almonds, nori, kelp, mutton, yellow fish, milk powder, tea, meat, beef and liver contain more zinc and chromium and can be increased in moderation. It is best to take protein zinc, such as the new Rarely used tablets, for zinc supplementation.
8.Visual aids Any kind of device or equipment that can improve the mobility of patients with low vision. It has a certain improvement effect on the vision of low vision, which can keep the ability of independent living.
Vision aids are divided into optical vision aids, non-optical vision aids, non-visual aids or devices and high-tech vision aids, and there are many kinds. Such as head-mounted telescopes, contrast-enhancing color filters, closed-circuit television aids, etc.
XIV. Dietary therapy for true myopia
True myopia patients should eat less high-sugar food, too much sugar, will make the blood to produce a certain amount of acid, acid and salts in the body, especially and calcium phase neutralization, reduction in the blood caused by a reduction in blood calcium, will affect the toughness of the eye wall, so that the eye axis elongation, and promote the development of myopia and development. To prevent true myopia, it is important to use foods that replenish the nutrients necessary for the ciliary muscle and sclera in the eye to increase the muscle strength of the ciliary muscle and restore its inherent function, and to strengthen the toughness of the sclera to enhance its resistance to the outside world and prevent its continued expansion. The following nutrients can be supplemented.
1.Vitamins
Vitamins are necessary to maintain normal growth and development, and play an important role in regulating the physiological functions of the body. Patients with true myopia are treated with vitamins A, B1, B2, D, C and E. This is because these vitamins can improve the nutrition and metabolism of the retina, optic nerve and other tissues in the eye, and have a role in enhancing the toughness of the sclera and the muscle strength of the ciliary muscle. Vitamin D can promote the absorption of calcium and phosphorus and maintain the balance of calcium and phosphorus in the body, so children should be supplied with adequate amounts of calcium and vitamin D. Vitamins cannot be synthesized in the body and must rely on food supply, animal liver, dairy, eggs, cod liver oil and other vitamin content is high, fresh fruit contains a large amount of vitamin C, beans, peanuts, etc. also have a certain content.
2.Protein
Protein is the basic substance of human life activities, consisting of more than 20 kinds of amino acids. In terms of scleral tissue, it can become the eye against tough shell, although the sclera has a certain degree of toughness, such as poor resistance and then by the impact of external forces. It will be forced to stretch, so that the eye gradually become longer, partial food, picky food is not good for the health, more detrimental to true myopia. Such as fish, meat, milk, eggs have rich protein.
3, food to benefit the liver and kidneys
Chinese medicine believes that the cause of myopia, mainly due to liver and kidney deficiency, qi and blood loss, so the treatment can be used with liver and kidney food and drugs. Food such as meat, eggs, liver, kidney, carp, yellow fish, cuttlefish, light vegetables, sea cucumber, shrimp, turtle and cinnamon, lychee, grapes, walnut meat, mulberry, jujube, etc. have the effect of nourishing the liver and brightening the eyes.
4, calcium and phosphorus
Calcium and phosphorus are the main components of the sclera, and their content is high, which plays a major role in enhancing the toughness of the sclera. At the same time to fully supply vitamin D to promote the absorption and utilization of calcium. This has a role in enhancing development and preventing myopia. Foods such as beef bones, pork bones and other animal bones are rich in calcium and are most absorbed and utilized by the body. Other foods such as dairy, bean products, clams, crabs, shrimp, eggs, capers, rape, peanut rice, dates and other calcium content is also high; and milk, eggs, fish, meat, vegetables, coarse grains and purple cabbage, beans, walnut meat, pumpkin seeds and other food phosphorus content is relatively high.
5, zinc and chromium
Zinc and chromium are also essential trace elements, especially zinc to the eye tissue has more role, myopic patients generally lack of zinc chromium, so they have to supplement the food containing zinc and chromium, it is necessary. Such as soy, oat flour, almonds, nori, kelp, lamb, steak, yellow fish, sea slug, oyster, milk powder, cocoa powder, tea, etc. contain more zinc; yeast, beef, cereals, meat, liver and cheese, etc. contain more chromium. You can choose to take it.
XV. Other treatment methods
1. Gaze from afar
Find a place 10 meters away from the grass or green trees: green because of the shorter wavelength, imaging in front of the retina, prompting eye regulation relaxation, eye ciliary muscle relaxation, reduce eye fatigue. Do not squint and do not blink, but concentrate and gaze for 25 seconds to identify the outline of grass or leaves. Next, place your left palm slightly above the eye at 30 cm, and look at the palm lines one by one from head to tail for about 5 seconds. Repeat 20 times for 10 minutes, three times a day, and increase the number of training sessions if your eyesight is declining.
2.Crystal exercise
Turn your eyes: Hold your cheeks with both hands and let your eyes turn in the order of up, down, left and right 10 times, then turn counterclockwise and clockwise 10 times each.
Find a scene 3 meters away (e.g., wall paintings, etc.), while holding up one’s left hand slightly higher from the eyes and straightening it (about 30 cm), look at the palm of the hand and then look at the distant object, and try to move the gaze between the two as quickly as possible, 20 times round trip.
3.Push-up exercise
Sitting or supine, close both eyes naturally, then massage the acupuncture points around the eyes in turn. Require accurate acupuncture points, gentle techniques, to the degree of local soreness and swelling.
4, acupressure therapy
Also known as eye exercises, it is based on the causes of myopia, integrated Chinese acupuncture medicine, meridians, acupressure and other methods designed. The main purpose is to massage acupuncture points such as Qingming, Zanzhu, Sun, Fengchi, and Sibai, etc. By massaging the acupuncture points, the meridians are unblocked and the qi and blood are harmonized, so that the eye adjustment spasm and collection tension can be relieved and the effect of myopia can be treated and prevented.
5.Acupuncture therapy
Acupuncture is performed at the Sun, Zanzhu, Chengwu and other acupuncture points, together with Fengchi and Cataract. 1-2 main acupuncture points and their supporting acupuncture points are used each time, once a day, for 20-30 days.
6.Electrical stimulation therapy
Select the above acupuncture points, connect to the electrical stimulation device, and perform intermittent or continuous electrical stimulation once a day for 10-15 minutes each time. 12 times is a course of treatment.
7.Pupil dilation drug therapy
The method is to use 1% atropine or 2% postmastropine ophthalmic solution to dab the eyes once a day for three days. These drugs can paralyze the ciliary muscle and thus have a significant therapeutic effect on pseudomyopia.
8, antispasmodic drug treatment
At present, some people advocate the use of 0.25% Shuangxingming eye solution, eye drops once a day, these drugs mainly relax the ciliary muscle spasm, so as to achieve the purpose of treatment of myopia, but the efficacy is slow.
The use of myopia treatment device in the image distance of the near and far change, exercise the function of the ciliary muscle to enhance the regulation function of the eye, such as vision optimizer.
Other physical therapy, such as magnetic beads of ear pressure, ear acupuncture, qigong therapy, etc., these methods are mainly due to improve the excitability of the visual center and optic nerve cells, the near future can have the effect of improving visual acuity.
Sixteen, myopia should not be divided into true and false
In our long-term clinical work, we often encounter parents worriedly leading their children to the clinic with a strong request to identify whether it is pseudomyopia.
It is true that it is right to attach importance to all aspects of a child’s growth, but the excessive fear of myopia is unnecessary. This is also related to the pseudomyopia doctrine that is still in vogue.
The main content of the pseudomyopia theory is that among the youngsters with reduced vision, the main one is pseudomyopia, which is the early stage of true myopia, and the vision of pseudomyopia “falls fast and recovers fast”, and the changes are reversible, preventable and treatable. The theoretical basis of the pseudomyopia theory is that the long-term close eye use of adolescents makes the regulation tense or spastic, and over time, the eye axis lengthens and becomes true myopia.
Modern research shows that regulation is an important factor in the development of simple myopia, but not the only factor. Experimental myopia studies with form deprivation or lens defocusing show that regulation does not play a dominant role, and that regulation-paralyzing drugs such as atropine prevent the development of myopia through non-regulatory mechanisms. In addition, the regulation of myopia is not as excessive or spastic as previously thought, but relatively low and sluggish.
The term “pseudomyopia” has been prevalent in China for a period of time and is still very familiar and used by the public and some medical professionals. It is undeniable that this doctrine has played a useful role in promoting academic research on myopia and the public’s attention to the prevention and treatment of myopia. With the deepening of myopia research and prolonged clinical observation, experts are increasingly considering whether it is necessary to distinguish between true and false myopia.
In the mid-1990s, Professor Wang Fangrun, a leading myopia scholar in China, suggested that it was no longer appropriate to distinguish between true and false myopia. Here are a few facts: Europe and the United States do not emphasize the distinction between true and false myopia and limit it to academic discussions at most; Japan and the former Soviet Union, where the doctrine of pseudomyopia once existed, no longer mention it; even in Taiwan, where myopia is highly prevalent, the Department of Health has made it clear that the distinction between true and false myopia is unnecessary.