Causes of Myopic Shift (Acquired Myopia)

By Bradley Dempsey, Medical Student IV

The University of New Mexico School of Medicine
Acquired myopia is an increase in nearsihtedness! which in contrast to
physioloic (simple) myopia is induced "y patholoic processes# The increased myopia
may "e de novo or may manifest as chanes in pre$existin refractive errors! such as an
increased myopia or decreased hyperopia# Acquired myopia! li%e physioloic and
conenital forms of myopia! is caused "y an error in refraction in which parallel liht rays
focus in front of the retina& this results in "lurred distance vision and clear near vision#
'hysicians should have a hih index of suspicion for underlyin patholoy in patients
that present with a myopic shift# (eterminin the underlyin etioloy is essential as many
of the causes of acquired myopic are caused "y treata"le conditions#
)n order to evaluate myopic shift! it is useful to consider the anatomic structures
that determine the ocular refractive state* the optical power of the cornea! the optical
power of the lens! the anterior cham"er depth (which determines to the distance "etween
the cornea and lens)! and the axial lenth#
Differential Diagnosis
+# Corneal Power Increase,caused "y increased curvature of the cornea*
-eratoconus* usually manifests in late pu"erty! can cause a steepened
cornea# -eratometry! %eratoscopy! or corneal toporaphy will demonstrate
central thinnin of the cornea and irreular rins#
Steepened Cornea from contact lens wear (usually transient)
.dematous cornea
/# Lens Power Increase,chanes in the lens nucleus or shape chanes leadin to
increased curvature or increased refractive index*
Cataracts* an increased density of the lenticular nucleus can cause an
increased refractive power of the lens# 'atients may notice a newly acquired
a"ility to read up close without lasses! a phenomenon called 0second siht1#
Acute 2yperlycemia (serum lucose 3455 m6dl)* Non$%etotic hyperosmolar
syndrome! presents in dia"etics and is usually secondary to stressors such as
infection# Undianosed dia"etics may complain of transient chanes in
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distance vision! presuma"ly caused "y chanes in lens hydration related to
osmotic chanes associated with chanes in "lood lucose levels (myopic
increase in lens thic%ness and intraocular hypotension secondary to
hyperosmolarity)#
)n patients that present with fluctuatin distance vision! as% patients
a"out other sins and symptoms of dia"etes (polydipsia! polyuria! weiht
loss)# Consider chec%in "lood lucose levels and referrin the patient to a
primary care physician or endocrinoloist if appropriate#
8enticonus
9etinopathy of 'rematurity (9:')
;# Lens Repositioning,causin an increased effective lens power*
Ciliary muscle shift caused "y pre$eclampsia of prenancy or medications
(chlorthalidone! sulfonamides! tetracycline! car"onic anhydrase inhi"itors!
phenothia<ines)# )t is thouht that these medications induce edema of the
ciliary "ody! causin lens repositionin
Ciliary muscle spasm! inducin an increased lens curvature* may "e secondary
to proloned readin or other near tas%! leadin to excessive accommodation!
medications (miotics! alcohol! morphine! antihistamines)! inadequate
refraction technique! or functional#
8ens movement caused "y lens dislocation# The lens can "e dislocated as a
result of trauma! or secondarily from inherited diseases such as Marfan=s
syndrome and(autosomal recessive ectopia lentis et pupillae#
># Changes in !ial Length"nterior Cham#er Depth*
Conenital or developmental laucoma! posterior staphyloma! idiopathic
proressive myopia
Medications that can cause acute laucoma may lead to an increased ):'! and
thus an increased axial lenth
Scleral "uc%le surery for retinal detachment physically chanes the axial
lenth leadin to a myopic shift#
?# $ther%
non$physioloic! 0functional1
error in refractive measurement
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