Senile myopization

Specialty: Ophthalmology.

• second sight syndrome
• senile myopic change
• crystalline index myopia

Why it occurs

• Progressive nuclear sclerosis or cataract (the increase in the molecular density of the nucleus of the lens artificially increases its refractive power or dioptric power, temporarily compensating for presbyopia and allowing the elderly to read without glasses up close)
• Decompensated diabetes mellitus with peaks of sustained hyperglycemia (the accumulation of sorbitol in the lens attracts water by osmosis, swelling it and increasing its refractive power towards myopia)
• Subclinical anterior subluxation of the lens (associated with capsular pseudoexfoliation syndrome or undiagnosed trauma)
• Chronic use of ophthalmic cholinergic miotic drugs (e.g., pilocarpine in chronic glaucoma)

Initial workup

Objective refraction through autorefractometry and subjective refraction through trial lenses; Slit lamp examination of the anterior pole to classify the degree of nuclear sclerosis of the lens using the LOCS III classification system; Urgent analytical determination of basal blood glucose, glycosylated hemoglobin (HbA1c) and basic metabolic profile; Ocular ecobiometry to rule out increased axial length of the globe.

Standard management

• There are no ophthalmic pharmacological treatments indicated to stop or reverse lens nuclear sclerosis; The definitive treatment of choice in case of cataract is surgical intervention — phacoemulsification with intraocular lens implantation
• Metformin (or insulin regimens adapted by endocrinology to restore systemic normoglycemia if the refractive change is secondary to diabetic lens edema, which will revert myopia to its baseline values in a few weeks).