Multidisciplinary diagnostic approach and surgical ophthalmologic therapy for progressive high myopia

Myopia has become a leading cause of blindness and therefore a serious world health issue recently. This can be attributed to its extreme phenotypes on the „upper end of the scale”, namely high and pathologic myopia. Cases of high myopia with a rapid progression carry the risk of advancing into pathologic myopia, a condition that is associated with potentially blinding complications. Even with all the recent developments in many areas of ophthalmology have been encountered lately, progressive high myopia continues to remain an unjustly neglected field in many parts of the world. Because of their markedly different visual consequences, it is indispensable to distinguish between the two main classes of myopia. Common forms account for the vast majority of the cases. These are practically simple refractive errors that may be well corrected with the conventional visual aids like spectacles, contact lenses or refractive laser surgery. Early onset progressive high myopia (eoHM), in contrast, is not simply a refractive error that can be rescued with optical lenses or refractive surgery, but is potentially a vision threatening disease. The disparate genetic backgrounds also point to the basic differences between common versus early- onset high myopia (eoHM) forms. The manner of inheritance of the common forms is polygenic or multifactorial, i.e. both environmental factors and genetic predisposition are almost equally responsible for these cases. As opposed to this, early-onset high myopia is inherited in a Mendelian manner with one single causative, highly penetrant gene mutation, practically with minimal influence of environment or behaviour. The monogenic manner of inheritance further underlines the severity of this condition, and its specific mode of inheritance covers a wide range of forms including autosomal dominant, autosomal recessive or X-linked recessive. One of the most curious and exceptional modes of transmission is that seen for Myopia-26, displaying X-linked dominant, female-limited inheritance. Due to an explicit increase in the prevalence of such conditions lately, an urgent need for genuine, targeted treatment in the form of gene therapy is recognized. To devise such treatment options however, we need to thoroughly understand the exact molecular mechanisms of refractive errors and myopia development. Albeit nearly 270 genes associated with myopia have been identified so far, the underlying pathways through which these genes influence refractive error development remain obscure in most of the cases. To our current knowledge, eye growth, i.e. refractive development is guided locally within the eye, and the general pathomechanism of refractive error development is assumed to be based on a retina-to-sclera signalling cascade guided by light stimuli in the retina. Myopia genes may accordingly act at any point of this route; and dysfunction of either (disorder of retinal cell function, or signal processing as well as changes in the target tissue) may lead to the derailment of emmetropization, i.e. to refractive error development. The trait of myopia is quite complex, however, and the genes responsible for the myopic trait are accordingly also multiple. Therefore a genuine solution for treating myopia in its complexity is a challenge for the future. At present we only have the alternative of halting the progression of high myopia in order to prevent the development of vision threatening pathological complications. Four main classes of myopia control currently exist, i.e. pharmacological, optical, environmental/ behavioural, and surgical options. Since the underlying causes of myopia onset and progression are diverse; the treatment approaches should likewise be combined from the different groups to reach optimum results. Pathognomic feature of early-onset, progressive myopia is an uncontrolled, life-long elongation of the eyeball. Characteristically, the scleral tissue is biomechanically weakened in progressive high myopic eyes. As a result, the mechanical stretching and thinning of all three layers of the eye occurs along with gradual and excessive axial elongation; and this leads to the formation of vision-threatening degenerative lesions on the retina with age. Logically, the weakened scleral tissue needs to be the primary treatment target in such cases in order to retard excessive axial elongation, and to prevent the potentially blinding complications of pathological myopia. Posterior scleral reinforcement surgery was devised to this end almost a hundred years ago; and notwithstanding the novel alternative trials, this surgical procedure remains the only method of scleral reinforcement for now. In our clinical practice we encounter numerous cases of early-onset progressive high myopia (eoHM). Besides providing these children with adequate optical correction for their myopic refractive error; we perform posterior scleral reinforcement in order to prevent the development of irreversible visual l

A tanári alkalmassági vizsga intézményi gyakorlatai, (ön)reflexiók

Jelen írás négy felsőoktatási intézménytől – Szegedi Tudományegyetem Tanárképző Központ, Nyugat-magyarországi Egyetem Savaria Egyetemi Központ, Debreceni Egyetem Bölcsészettudományi Kar, Pázmány Péter Katolikus Egyetem Bölcsészettudományi Kar Vitéz János Tanárképző Központ – kapott, az osztatlan tanárképzésre jelentkezők pályaalkalmassági vizsgálatáról szóló önértékelés fontosabb sajátosságait, megállapításait és következtetéseit foglalja össze. Mivel az intézményi önértékelések szerkezete nem egységes, külön-külön alfejezetekben dolgozzuk fel az egyes felsőoktatási intézmények gyakorlatait. Ezt követően a tanári pályaalkalmassági vizsgával kapcsolatos releváns intézményi véleményeket, reakciókat, javaslatokat összegezzü

Echinococcus multilocularis: An emerging pathogen in Hungary and Central Eastern Europe?

Echinococcus multilocularis, the causative agent of human alveolar echinococcosis, is reported for the first time in Red Foxes (Vulpes vulpes) in Hungary. This parasite may be spreading eastward because the population of foxes has increased as a consequence of human interventions, and this spread may result in the emergence of alveolar echinococcosis in Central Eastern Europe

INTELLIGENT BUILDINGS, INTEGRATING DESIGN

According to the apt wording of a university lecture on the future of architecture [1]: `The growing focus on the issues of sustainable architecture may be evaluated as a paradigm change of building science, which reflects the changes in social priorities.´ The following article takes on to expound some important elements of this phenomenon, discussing: 1. the effects that form of energy, form of society and building activity impose on one another, 2. the change in the energy approach, 3. the definition of architecture-related intelligence, 4. the connection between ecology and high-tech, 5. the characteristics of integrating design and 6. the relationship between the building and its users