Associations of high myopia in childhood

Purpose High myopia in early childhood is a recognised association of ocula r and systemic disease. The aim of this study was to describe the types, pa ttern and frequency of these associations. Methods All children presenting to two ophthalmology units over 3 years who were found to have high myopia were recruited. High myopia was defined as one or both eyes demonstrating 6 dioptres spherical equivalent or more of m yopic refractive error on retinoscopy. We limited the age to less than 10 y ears old. A retrospective case review was undertaken of the 112 consecutive children who fulfilled the criteria above. The demographic data, source an d indication for referral were recorded along with the ocular and systemic findings and diagnosis. Results Only 9 (8%) of the children had 'simple high myopia' with no associ ated ocular or systemic associations. In 54% there was an underlying system ic association with or without further ocular problems (e.g. developmental delay, prematurity, Marfan, Stickler, Noonan, Down syndrome) and in the rem aining 38% there were further ocular problems associated with the high myop ia (e.g. lens subluxation, coloboma, retinal dystrophy, anisometropic ambly opia). A family history of high myopia did not preclude associated abnormal ity: in 4 cases the diagnosis of a systemic condition in the child led to t he identification of the disease in at least one myopic relative. Asian (p < 0.001) and male (p < 0.05) patients were overrepresented in the series. Conclusion High myopia is strongly associated with systemic and ocular prob lems; it may be the reason for the child's initial medical referral and an important clue to an underlying systemic or ocular condition. Referrals inf requently originated from community optometrists despite prior attendance. We suggest that all children under 10 years of age with high myopia are ref erred to a paediatric ophthalmology clinic for review and we propose a stru ctured clinical evaluation in the hospital eye clinic.