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 MODERN ASPECTS OF MIDAX USAGE 
NANA  GAPRINDASHVILI,
Ophthalmology MD
 
As everything new, overall computerization hasn’t only made life easy but also has posed a lot of problems for adults as well as for children too. In international medical literature we often encounter information about disorders caused by long time computer usage like: cervical radiculopathy, wrist and tarsal joint disorders, neural dysfunction but usually apart from other systems most damage is brought on vision system. Generally 70% of adult computer users and 25-30% of children have ophthalmologic problems (research done by Berckel’s Optometric school of university of California 2007). In the long list of vision problems, accommodation spasm, myopia and computer syndrome of the eye are leading.
 
Accommodation is property of eyes to see objects clearly at various distances. Its mechanism is in ciliary muscle’s contraction-relaxation ability by which the lense increase or decrease its convexity in accordance with the distance of the visible object. After long time working at distances (at the computer monitors, or while reading books) without breaks causes overstrain of accommodation and finally its spasm. For example if the visual acuity of a patient is normal in the morning after 6-8 hours of computer work myopia about -1 to -2 diopters can form. In addition to lowering short-sight patient also complains of difficulties in focusing at various distances, imaginary color changes of subjects, diplopia, increased photosensitivity, lowered eye-working abilities, headache, feeling of strain around brow areas, eye strain and fatigue (accommodation asthenopia).
 
Accommodation spasm can become the reason myopia. According to the latest data myopia has increased from 17% to 34% in children of 7-9 years since 1995. American association of optometry explains such worrisome dynamics by the following factors:
 
- Limiting knowledge about negative computer influence that causes that children spend most of their time with computers (at school, at home and with friends at leisure time) with little breaks, this becomes the reason of accommodation spasm and lately myopia.
- Children are very adaptable and accept vision problems as normal without complaining, so it is very important for parents to monitor visual acuity of their children after spending time with computers.
- Provided that mostly computer tables are suited for adults, it changes visual angle for children (that normally must be equal to 15O).This also negatively influence the eyes.
 
It’s important to mention that in addition to accommodation spasm: thin cornea, genetic predisposition to ciliary muscle weakness also contribute to myopia. But relieving accommodation spasm is easier than handling other problems. There are various exercises starting with changing focus from near to distant objects and finished by accommodation-training, physiotherapeutic methods (reflex-therapy) and so on. Most easily and effectively spasms can be relieved by using short-acting pharmaceutical agents. Drug of choice is MIDAX, which blocks M-cholinoceptors of iris spincter (pupils dilate for a short time) and of ciliary muscle causing accommodation paralysis.
 
Finally single instillation of MIDAX 0.5% solution is suitable for exploration of the vitreous body and fundus (after checking intraocular pressure and anterior chamber). Mydriasis form in 15-20 minutes and is maintained for 1-2 hours. During refractometry in patients younger 35 years, 1% solution is instilled for 2-3 times (according to spasmodic component) with 10 minute interval. With this regimen complete cycloplegia is achieved in 60-65% of cases. In other patients 1% sol. of MIDAX is prescribed once before bedtime 7-10 days prior to choosing eyeglasses. Otherwise hypercorrection will take place which will worsen spasm and visual acuity.
 
For treating accommodation spasm 0.5% sol. of MIDAX single instillation before bedtime for 2-3 weeks is prescribed. Positive effect is achieved in 68-73% of the cases, of course with correction of visual acuity if necessary.
 
We have also used MIDAX for treating computer eye syndrome in combination with artificial tears. Before treatment patients had the following complaints:
- Blurred vision
- Difficulty in focusing at various distances
- Rapid fatigue when working on short distances
- Eye sore and reddening
- Foreign body sensation in the eyes
- Painful eye movements
 
MIDAX in combination with artificial tears showed marked improvement in the first week after starting the treatment.
 
It is important to mention that besides high absorption of MIDAX its side effects like allergic conjunctivitis and dermatitis was noted only in 2-3% of cases. Such information makes it possible to use this medication in children aging 2-3 years for eye examination, because side effects are mainly expressed in this age group.
 
In accordance with information provided above, we can state:
 
1. 0.5% sol. of MIDAX is successfully used for evaluating lens and fundus via single instillation. Pupillary dilatation is high, action is short and opthalmotonic action is less than that for Atropine.
2. For diagnosing refractive errors and grades 1% sol. of MIDAX 2-3 times with 5min intervals is used. We receive full cycloplegia and after 2-3 hours patients can return to normal lifestyle.
3. For treating accommodation spasm and its complications, 0.5% sol. of MIDAX for 2-3 weeks or 1% sol. of MIDAX for one week, the result is fast and effective. Patients continue their usual way of life having no problems with focusing at near distances and with computer work.
Midax have few side effects compare Atropin, so its use should not be limited in pregnant women and children aging 3 years.
 
Reference:
 
1. American Optometric Association, Pediatric Eye and Vision Exam, "Frequently Asked Questions on Computer Vision Syndrome and Computer Glasses" by Larry K. Wan, O.D. 2007
2. Taiwan Department of Health and National Taiwan University, 2000; National Eye Center and National Eye Research Institute, 2000.
3. American Optometric Association, Pediatric Eye and Vision Exam, Optometric Clinical Practice Guidelines, 2007