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근시로 인한 안경 착용은 이제 너무 보편화 되었죠. 그리고 의학이 발달하면 할수록 질병의 수도 많아지고, 그에 따라 환자도 많아지고 전에는 없던 치료들도 많아집니다. 그래서 그런지 작은 증상에도 놀라서 오는 환자들도 많아지고 그에 따라 더 많은 질환들을 찾아내게 됩니다. 근시로 인한 다양한 합병증들도 발견하게 되었고, 특히 그 정도가 심한 경우 많은 합병증을 가져오게 됨을 알게되었죠.

요즘들어 부쩍 “내눈이 멀지 않을까요?” 하고 찾아오시는 분들이 많았습니다.
진료를 하다 보면 유행처럼 같은 진단명을 환자를 자주 보게되는 때가 있는데, 최근 고도근시 환자 분들이 많이 찾아오셔서 위의 질문을 많이 받았습니다. 얼마전 눈의 날 캠페인이 원인이었는지 모르겠지만 ^^

기억나시요? “근시도 병이다.”

기억을 되살려 보면 근시는

1. 단순 근시 : 정상 안구로써 다만 성장 과정에서 안구의 길이와 눈의 굴절력이 서로 일치하지 않는 상태
 2. 병적 근시 : 안구의 길이(축)가 비정상적으로 길어서 생기는 것으로써 성인이 되어서도 근시가 계속 진행
 3. 가성 근시 : 눈의 피로로 일시적으로 근시와 같은 상태가 되는 상태
 4. 합병 근시 : 노인성 백내장에 수반되어 근시가 유발되는 상태

이렇게 여러 종류가 있는데, 이 중 병적근시에 해당하시는 분들이 이런 걱정을 하시며
“내 눈이 멀지 않을까요?” 하는 의문을 가지시게 됩니다.

그럼 병적근시인 환자들이 실명에 이르는 확률은 얼마나 될까?

Br J Ophthalmol. 2006 년도 발표된 논문에 의하면 이렇습니다.

[#M_ more.. | less.. |

How does visual acuity change over time in adults with high myopia?

Scott Steidl
MD, Department of Ophthalmology, University of Maryland School of Medicine, 419 West Redwood Street, Suite 486 Baltimore, MD 21201-1734, USA; ssteidl@som.umaryland.edu

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High myopes can expect to retain good vision during the working years of life
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Keywords: myopia; myopic maculopathy; ageing; refractive status; axial length

In the article by Shih and associates in this issue of BJO (p 546), the authors report on a retrospective study of visual outcomes in patients with high myopia seen at the National Taiwan University Hospital over a 10 year period. Clinical concern about management and severity of myopia is increasing, especially in Asia. In the United States, approximately 25% of people aged 12–54 years have myopia. In this report, the authors remind us that myopia is the fifth most frequent cause of impaired vision and the seventh most frequent cause of legal blindness.1 The magnitude of the public health impact of myopia can be understood when considering that people with myopic retinopathy are legally blind for an average of 17 lifetime years, compared to 5 lifetime years of blindness caused by both diabetes and age related macular degeneration, and 10 lifetime years from blindness caused by glaucoma.2 As people in developed countries age, we will surely see increasing levels of myopic blindness. This problem is heightened by the fact that myopia appears to be increasing on a yearly basis.3,4 Underscoring these health concerns, the US Food and Drug Administration held an advisory committee meeting in 2003, which looked at the issues pertaining to chronic medical therapy for myopia. Before we can understand the potential impact of myopia on quality of life and develop appropriate preventative therapies, we need good information on its natural history and the impact of myopic vision loss in the adult population. This article by Shih and associates is an important report defining the changes in vision and maculopathy in an adult myopic population over a 10 year period.

Shih et al present a retrospective analysis of 552 myopic patients, aged 40 years or older with 6 dioptres or more of myopia. The worse eye of each patient was studied and records were reviewed for refraction, biometric axial length, best corrected Snellen visual acuity, and macular status. Of these 552 patients, 230 cases with myopic maculopathy were identified and graded on a maculopathy scale.5 This scale grades maculopathy using levels M0–M5 as follows: M0 is a normal appearing posterior pole; M1 shows tessellation and choroidal pallor; M2 includes level M1 findings with posterior ectasia; M3 includes choroidal pallor and tessellation, with lacquer cracks and posterior staphyloma; M4 indicates the presence of M3 findings with focal areas of deep choroidal atrophy; and M5 includes findings in group M4 along with choroidal neovascularisation.

Visual outcomes for older myopes with maculopathy tend to be poorer than for their younger counterparts over the same period of time

Young age was a protective factor relative to final vision outcome. They found that 60% of patients over 50 years of age progressed to worse than 20/200 vision in 10 years. In contrast, vision remained better than 20/40 in over 90% of patients who began the review period between 40 years and 49 years of age. Less severe maculopathy was also protective regarding final vision outcome. At each age group, a more severe level of maculopathy was predictive of a greater chance of more than two lines of vision loss. For example, of patients studied in the 50–59 year age group, 47%, 60%, and 67% showed two lines worsening over 10 years in the M3, M4, and M5 groups, respectively. In the over 70 years age group, a two line loss was seen in 60%, 78%, and 80% of patients for the M3, M4, and M5 groups, respectively.

All patients aged 40 years and older had some myopic findings, which were graded as M2 or greater. Age and initial level of maculopathy play a part in the development of the severe complications of myopia according to these findings. It would have been helpful to have more than three categories to analyse the visual acuity data. The three categories of better than 20/40, 20/40–20/200, and worse than 20/200 allowed for large changes within each group. A patient beginning and ending within the 20/40–20/200 category may have experienced a significant change of vision, say 20/40–20/100, which would not be reflected by the data. Also, the report does not discuss cataract development, and did not mention whether patients who had cataract extractions were kept in the study. As a result, the worsening of vision in the older age groups is difficult to interpret. Data in the study are from a single institution and patients are likely of predominantly Asian origin. Extrapolation of data to a broader population must be done carefully. We can infer from the study that high myopes can expect to retain good vision during the working years of life and that we can expect a trend of visual decline in later years, especially over 60 years of age.

The authors conclude that a significant difference between final visual acuity, age, refractive status, and axial length exists between groups with and without maculopathy. They state that visual outcomes for older myopes with maculopathy tend to be poorer than for their younger counterparts over the same period of time. These findings, along with those mentioned above, are important for the counselling of myopic patients. This research presented by Shih and associates will hopefully stimulate further investigation into mechanisms leading to the development of advanced myopic degeneration and foster therapies for intervention at an early stage in the course of disease that may decrease functional loss later in life.

_M#]
세줄 요약하면 이렇습니다.
1. 초진시 시력이 좋았던 고도근시들은 나중에도 시력이 좋았다.
2. 젊은 나이의 사람들이 나이든 사람들 보다 같은 기간 내에 시력저하의 정도가 작았다.
3. 최종의 시력, 나이, 근시가 심한정도, 안축장 은 황반변성 유무에 따라 유의한 차이가 있다.

의사로서 보면 이렇습니다. 같은 질환을 가지고 있다해도 그 정도에 따라 예후는 너무 (요즘 이효리가 구설수 에 오른 그 단어가 생각납니다만 ^^) 다르기 때문에 질환명 자체만을 가지고 너무 우울하게 생각할 필요는 없다!!! 라는 겁니다.

가끔 망막질환을 앓고 계신 분들이 이런 말씀도 하십니다.

“책을 너무 보는 것은 눈에 안 좋겠죠?”
“요즘 눈 떄문에 걱정이 너무 많아서 아예 눈을 감고 살아요”

그럼 제가 이렇게 말씀드립니다.

“그렇게 아무것도 안하실거면 도대체 무엇을 하실려고 그러세요?”
“하고 싶은 일은 다 하시고 사세요. 눈은 걱정 마시고요”
“생기지도 않은 일을 미리 걱정하실 필요은 없습니다.”

위의 논문의 아쉬움은 이런거죠.

This research presented by Shih and associates will hopefully stimulate further investigation into mechanisms leading to the development of advanced myopic degeneration and foster therapies for intervention at an early stage in the course of disease that may decrease functional loss later in life.

아직은 이러한 진행을 막는 연구가 더 필요하다는 것…
글쎄 의사가 질병을 모두 치료할 수는 없지만, 그래도 저 연구도 벌써 10년 이상 전 부터 시작된 것이고, 최근에는 급속한 시력저하를 막는 다른 치료들도 생기고 있고, 근시 자체의 진행을 막을 수는 없지만, 망막을 전공하고 계시는 훌륭하신 선생님들이 많이 계시니 어떻게 걱정만하시지 마시고, 활기차게 생활하시라는 의미에서 적어봅니다.

High myopes can expect to retain good vision during the working years of life
-고도 근시도 활발히 일할 나이에는 좋은 시력을 유지될 것을 기대할 수 있다. –

그래도 이런 문구가 있으니 힘이 좀 되실까요?