Unequal Eye: A Case of Unilateral High Myopia and Anisometropia Amblyopia

e-CliniC 2025; Vol. 13, No. 1: 132-137 DOI: https://doi.org/10.35790/ecl.v13i1. 58459 URL Homepage: https://ejournal.unsrat.ac.id/index.php/eclinic Unequal Eye: A Case of Unilateral High Myopia and Anisometropia Amblyopia Anne S. M. Umboh,1 Alberta Y. M. Tansil2 1 Division of Pediatric Ophthalmology and Strabismus, Department of Ophthalmology, Faculty of Medicine, Universitas Sam Ratulangi, Manado, Indonesia 2 Department of Ophthalmology, Faculty of Medicine, Universitas Sam Ratulangi, Manado, Indonesia Email: Received: October 3, 2024; Accepted: February 27, 2025; Published online: March 6, 2025 Abstract: Myopia, or nearsightedness, is a common eye condition. Unilateral myopia, where only one eye is nearsighted, poses unique challenges. The causes are complex, involving both genetics and environment. Treatment options include glasses, contact lenses, and surgery. We reported a case of a 13-year-old girl with unilateral high myopia and anisometropic amblyopia in her right eye. Despite no family history of myopia, the patient developed severe myopia in her right eye at the age of 7. A comprehensive ocular assessment was conducted, along with auxiliary tests. The patient was diagnosed with unilateral high myopia and anisometropia amblyopia. Treatment included a combination of spectacle correction, soft contact lenses, atropine eye drops, and patching therapy. Unilateral high myopia requires a thorough evaluation. The difference in eye length between the two eyes contributed to the patient's nearsightedness. Treatment options include glasses, contact lenses, orthokeratology, and surgical procedures. The patient received a personalized treatment plan with regular follow-up to monitor progress and assess treatment efficacy. In conclusion, this case underscores the importance of early detection and aggressive management of high myopia in pediatric patients to prevent further visual deterioration and potential complications. Keywords: unilateral high myopia; amblyopia; anisometropia; management myopia 132 Umboh, Tansil: Unilateral high myopia and anisometropia amblyopia 133 INTRODUCTION Myopia is a common eye condition affecting 22.9% of the global population, with a projected increase by 2050. Asia-Pacific countries have the highest prevalence of myopia, followed by East Asia, Southeast Asia, and North America. High myopia, characterized by a spherical equivalent of more than -5.00 diopters, is a less common subtype with a global prevalence of approximately 2.7% and is expected to increase dramatically to reach 9.8% by 2050.1 Moreover, unilateral myopia is a refractive condition in which one eye shows significant myopia while the contralateral eye has a refraction closer to emmetropia.2 The causes of myopia are very complex, involving genetic and environmental factors. Although research has identified several risk factors, such as near visual activity and exposure to natural light, the exact mechanisms of myopia development are still not fully understood.3 Treatment for unilateral high myopia focuses on enhancing visual acuity and may include options like eyeglasses, contact lenses, occlusion therapy, or surgical interventions.4-7 The anisometropia that often accompanies this condition can make correction with glasses difficult, therefore, contact lenses or surgery may be a better option.8 CASE REPORT A 13-year-old girl complained of gradually losing vision in her right eye, which started when she was seven years old, to the ophthalmology clinic at Prof. R.D. Kandou General Hospital. She denied experiencing any related symptoms, including pain, redness, blurred vision, or wet eyes. The patient has a history of utilizing computers and reading books for extended periods. There was no family history of myopia, and never worn glasses or contact lenses. Her medical history, allergies, and medication use were unremarkable. The ophthalmological assessment revealed a significant reduction in the patient's right eye vision, down to 2/60. However, with the addition of a -15.00 C-0.75x51º lens, her vision improved to 4/60. Cycloplegic retinoscopy revealed a best-corrected visual acuity of 6/60 in the right eye with a -14.50 D correction. In contrast, her left eye vision was normal at 6/6. Both eyes had normal intraocular pressure: 11 mmHg right, 13 mmHg left. Examination of the anterior segment of both eyes was unremarkable. Additional assessments of the patient's eye alignment, employing the Hirschberg, coveruncover, and alternate cover techniques, did not identify misalignment. Visual field testing revealed no irregularities, and eye movements were unrestricted in all directions. Worth's Four Dot test indicated suppression of the right eye. Stereopsis testing using the TNO test did not detect depth perception, and Ishihara testing confirmed normal color vision. Examination of the right eye's posterior segment revealed signs consistent with peripapillary atrophy, tigroid fundus, an oval optic disc with well-defined borders, and vital color. The left eye appeared normal (Figure 1). Figure 1. Examination of the posterior segment revealed peripapillary atrophy (black arrow) and tigroid fundus (red arrow) Optical coherence tomography (OCT) of the right eye indicated an increased axial length, while the left eye exhibited unremarkable measurements (Figure 2). 134 e-CliniC, Volume 13, Nomor 1, 2025, hlm. 132-137 Figure 2. OCT of the right eye revealed elongation of the axial length Further measurements confirmed that the right eye was significantly longer than the left, measuring 28.96 mm and 23.16 mm, respectively (Figure 3). Figure 3. The biometric examination revealed that the axial length of the right eye was longer than that of the left eye B-scan ultrasonography (USG) further demonstrated an elongated shape of the right eyeball, while the left eye appeared normal (Figure 4). OD Figure 4. The B scan USG revealed an elongated shape of the right eye OS Umboh, Tansil: Unilateral high myopia and anisometropia amblyopia 135 The patient was diagnosed with high unilateral myopia and anisometropic amblyopia in the right eye, while the left eye is emmetropic. Management includes a combination of -4.50 diopter (D) glasses and -9.00 D soft contact lenses for the right eye and Plano lenses for the left eye. The patient uses atropine 0.01% eye drops in the right eye, one drop per day, and patches the left eye for two hours daily. The patient should limit screen time and avoid physically demanding activities. The patient has a follow-up appointment in four weeks. DISCUSSION Myopia, or nearsightedness, is the most prevalent refractive error affecting children and young adults. Due to a lack of awareness and associated stigma, it has become a significant concern.9 High myopia is a spherical equivalent of -6.00 diopters or more or an axial length exceeding 26.5 millimeters. The global prevalence of myopia varies widely. Studies indicate that Asian children aged 5 to 17 have the h (...truncated)