**5. Conclusions**

*Intraocular Lens*

**Figure 11.** *A braille display.*

translator software that converts a text from a language into a braille text. This text

or plastics). They instantly translate the text into braille that is appearing on the computer, and they change with the scrolling of the text on the PC screen. They are usually placed under the PC keyboard. Also portable note takers exit, making patients able to take notes via a keyboard in braille; the system is then able to recall and read them via voice activation. A braille writer is very similar to a standard typewriter, with the difference that its keyboard is made in braille. It instantly embosses letters on a thick paper. System based on optical character recognition (OCR) is made of a camera, which scans the text; this is then read by the system itself via a synthetized voice. Many OCR systems offer special features such as storage of the texts acquired, research of words, and chapters of the text. The advantage of these systems is that they are not dependent on a PC for working. Many OCR apps are now available, hence making this technology more widespread [45]. Audiobooks are another useful option in low-vision patients of pathologic myopia. Almost any of the best-known novels can be found in audiobook format, in which a voice reads the texts for the listeners. Many low-vision societies make audiobooks available and also apps for new devices such as that found in tablets.

Braille displays (**Figure 11**) are special displays made of special materials (metals

is then embossed into a thick paper with a braille printer [44].

*4.2.4 Household, personal, and other independent living products*

In this category, all the devices that improve patient's self-sufficiency, safety, and quality of life are included. As many of them exist, we will cite only the best known: vibrating-, braille and talking watches, talking blood pressure- and glucose meters, talking thermometers, weighted eating utensil fork, talking kitchen scale, cut-resistant gloves, talking microwave, labeling systems, object locators, etc.

As we already said, pathologic myopic patients are at risk to develop glaucoma and optic neuropathies. Patients can also develop ring-shaped scotomas even if the patient is not affected by glaucoma. However, when this pathology is present, one of the visual field alterations that a patient suffering from glaucoma can experience

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*4.2.5 Field enhancement*

High myopia, defined as refractive error of at least −6.00D and/or an axial length of 26.5 mm or more, can lead to many morphological changes in the eyeball that can cause development of complications. World is facing a rapid rise in high myopia and pathologic myopia incidence, and some areas of the globe show a more rapid increase in this trend than other ones, such as Asian regions. In such areas, the incidence rate can also reach 80–90% of children and young adults in school age. Major risk factors in myopia progression are intensive education and limited time outdoors. It is estimated that this percentage and the magnitude of myopic shift will rise in the future because of the rising educational pressure and needs especially in developing countries. The constant rising in the amount of time spent using high-tech devices worldwide such as tablets and smartphone and its use by children represents an adjunctive risk factor. These evidences produce a worrying outline for the future, because early onset of myopia in childhood is associated with high myopia in adult life. Prevention in such cases can count on interventions on school system, favoring open air activities if possible, and children's lifestyle modifications [48], spending more time outside and reducing the time spent with electronic devices. Recently, many clinical trials investigated the role of pharmacologic therapy with atropine 0.01% eye drops and orthokeratology [49] in slowing the progression of myopia in children and young individuals with good results.

Studies estimated that by 2050, half of the global population (5 billion people) would be myopic and 25% of those (1 billion) would be considered highly myopic (>−5D), making it a serious problem for healthcare systems and governments facing the rise in healthcare expenditure, because such patients have a greater need of care and assistive devices, low-vision interventions, and a greater impact of the disease on their work productivity, eventually quitting work and hence increasing the costs of this pathology. In our opinion, prevention of high myopia by reducing near work when possible and stimulating open-air activities for children is essential; we also think that atropine drops will be an useful tool for reducing the rising in incidence of myopia in children. For senior individuals affected by high myopia, a comprehensive ophthalmologic assessment with OCT exam, each 6–12 months, depending on the degree of myopia, is in our opinion crucial to be able to act promptly in case of onset of complications related to high myopia.

#### *Intraocular Lens*

As above mentioned, when complications due to high myopia occur, we talk about pathologic myopia. Many complications can develop, and their treatment can count mainly on surgery and anti-VEGF therapy. When treatment is not possible or after this in order to boost and maximize the visual recovery, ophthalmologist can recur to visual rehabilitation strategies. These can count into two main categories of tools: visual stimulation and visual aids. Acoustic biofeedback is one of the most effective techniques in order to stimulate visual system. First of all, it is mandatory to analyze the characteristics of the visual field defects that are affecting the patient. Two types of defects can occur in such patients: central scotomas (of various shape, size, and depth) and peripheral defects. The two can also occur simultaneously in various combinations. Then, in case of a central defect, after analyzing patient's retinal sensitivity and fixation stability with a microperimetry, if the patient has already developed a preferred retinal locus (PRL or pseudofovea) by itself, it is possible to stimulate this one if it is in a favorable position in order to boost fixation stability or to choose a new point to relocate the PRL in a position that the physician considers more favorable for the patient because of a better residual retinal sensitivity. A PRL is a point that the patient with a central scotoma uses to fixate object, as a "substitute" of the natural impaired fovea. This point is chosen considering patient's expectations, attitudes, activities and the residual sensitivity microperimetric map of the patient and the distance that the point candidate to be stimulated from the natural fovea. It means that for a better outcome it would be better to choose a point with the best residual retinal sensitivity not too far from the natural fovea if possible. Acoustic biofeedback is a technique that trains the patient relocating the PRL to a more useful position; when a point to become the new PRL is chosen by the examiner, during the acoustic biofeedback session, a beep is produced by the machine (microperimeter), and it becomes more continuous as the point to be stimulated gets closer to the center of the fixation target on the machine, hence training the patient to use the point set by the ophthalmologist. This one guides the patient during the whole session, giving him instructions where to move his gaze to match the trained PRL and the center of the fixation point of the machine. A typical acoustic biofeedback rehabilitation protocol is composed of 10 sessions of 10 min each, typically one session per week. However, it can be repeated if necessary. In case of a peripheral defect alone, acoustic biofeedback can be useful if an unstable fixation is present in order to stimulate the fixation point and make it more stable. Visual aid use can also benefit of a more stable fixation; they are available for distance and intermediate-near vision. For distance vision, the most popular devices are telescopes, Galilean, and Keplerian ones. They ideally "approach" far items to the observer by magnifying them. They can be monocular or binocular, clip-on, spectacle mounted, and handheld. For near vision, microscopic systems are available; they are high dioptric positive power lens that work by reducing focal length. There are many solutions that use this technology: handheld magnifiers, bar magnifiers, positive overcorrection of near prescription, visolettes, and prismatic hypercorrective are available in various spherical powers and so in various magnification power. Electronic aids for near vision are available, with portable and fixed CCTV being the mainstay of the category. Other solutions are also available such as braille systems (displays, printers, note takers), household, personal and other independent living products (for example, braille and talking watches, talking blood pressure and glucose meters, etc.), OCR systems, and audiobooks. Many recent apps for aided mobility, OCR, etc., have been placed on the market. In patients with peripheral visual field defects, field enhancement systems are very useful. Reversed telescopes and field expanding channel lens represent the mainstay of this category.

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**Author details**

provided the original work is properly cited.

*Pathologic Myopia: Complications and Visual Rehabilitation*

mology department in our hospital. You all are great!

Enzo Maria Vingolo, Giuseppe Napolitano, and Lorenzo Casillo declare that they

Authors would like to thank and dedicate this chapter to all the staffs of ophthal-

*DOI: http://dx.doi.org/10.5772/intechopen.85871*

**Notes/thanks/other declarations**

**Conflict of interest**

have no conflict of interest.

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

Enzo Maria Vingolo\*, Giuseppe Napolitano and Lorenzo Casillo Department of Medical-Surgical Sciences and Biotechnologies, U.O.C. Ophthalmology, Sapienza University of Rome, Terracina, Italy

\*Address all correspondence to: enzomaria.vingolo@uniroma1.it
