Anisomyopia and myelinated nerve fibers - a syndrome

Background The combination of anisomyopia and myelinated nerve fibres of th e higher myopic eye is often correlated with a deep and therapy-refractive amblyopia. As the cause for the entity anisomyopia/myelinated nerve fibres a disorder of development on the level of the lamina cribrosa during embryo genesis has been suggested in the literature. There are only very few repo rts on a successful therapy of the amblyopia that goes along with anisomyop ia/myelinated nerve fibres. Patients We report on six patients, aged 6 to 28 years, who presented with anisomyopia, myelinated nerve fibres and deep amblyopia in the higher myopi c eye. The four younger patients were enrolled into a therapeutic trial wit h contact lens correction and occlusion. Results The six patients presented with varying degrees of anisomyopia betw een -3.5 D and -18.5 D. In addition, in two patients we found a microstrabi sm and in three patients an exotropia. In spite of consistent occlusion and full optical correction in the four patients who underwent therapy visual acuity did not improve to more than 0.4 (1 x microstrabism, 2 x exotropia, 1 x no squint - best visual recovery in the patient with microstrabism). Conclusions The combination of unilateral high myopia and myelinated nerve fibres represents a special entity which usually is correlated with a deep amblyopia. The amblyopia is nearly refractive to therapy even under consequ ent therapy with contact lenses and prolonged occlusion. Nevertheless one s hould try to treat the amblyopia to achieve at least a small improvement. T he goal is to diagnose this constellation already in the first two years of life. As our cases show, occlusion therapy at this age can lead at least t o a limited improvement of visual acuity.