[Anisomyopia and myelinated nerve fibers--a syndrome]

The combination of anisomyopia and myelinated nerve fibres of the 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 reports on a successful therapy of the amblyopia that goes along with anisomyopia/myelinated nerve fibres.

We report on six patients, aged 6 to 28 years, who presented with anisomyopia, myelinated nerve fibres and deep amblyopia in the higher myopic eye. The four younger patients were enrolled into a therapeutic trial with contact lens correction and occlusion.

The six patients presented with varying degrees of anisomyopia between -3.5 D and -18.5 D. In addition, in two patients we found a microstrabism 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 (1x microstrabism, 2x exotropia, 1x no squint--best visual recovery in the patient with microstrabism).

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 consequent therapy with contact lenses and prolonged occlusion. Nevertheless one should try to treat the amblyopia to achieve at least a small improvement. The 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 to a limited improvement of visual acuity.