PURPOSE: To investigate the characteristics, mergers, and risk factors of different types of myopic maculopathy (MM) in a highly myopic population. DESIGN: Population-based, cross-sectional study. METHODS: A total of 1086 eyes (762 patients) were enrolled. Each participant underwent detailed ocular examinations. Combining the fundus photographs and optical coherence tomography images, types of MM were assessed as myopic atrophy maculopathy (MAM), myopic tractional maculopathy (MTM), or myopic neovascular maculopathy (MNM) according to the ATN classification system. Peripapillary atrophy (PPA) area, tilt ratio, and macular choroidal thickness (mChT) were measured individually.RESULTS: Eyes with larger PPA area were more likely to have MAM (odds ratio [OR], 1.220; P [ .037 per 1-mm 2 increase) and MNM (OR, 1.723; P < .001 per 1-mm 2 increase), and eyes with thicker mChT were less likely to have MAM (OR, 0.740; P < .001 per 10-mm increase) and MNM (OR, 0.784; P < .001 per 10-mm increase), whereas eyes with higher tilt ratio were less likely to have MTM (OR, 0.020; P < .001 per 1 increase). The severity of MTM and MNM was not precisely consistent with that of MAM.CONCLUSIONS: Different types of MM have different risk factors; larger PPA area and thinner mChT are risk factors for MAM and MNM, whereas lower tilt ratio is a risk factor for MTM. Our results indicate that the pathogenesis of MTM is different from that of MAM and MNM, and a tractional component should be considered as a possible component to the myopic macular classification. (Am J Ophthalmol 2019;208: 356-366. Ó

This study aimed to explore the morphological characteristics of Bruch's membrane opening distance (BMOD), border length (BL), border tissue angle (BTA), vertical tilt angle, and peripapillary atrophy (PPA), as well as their associations with choroidal thickness (ChT) in young healthy highly myopic eyes. METHODS. A total of 167 patients with high myopia and 172 individuals without high myopia were enrolled. All of the subjects were divided by axial length. The PPA area was measured on fundus photographs. BMOD, BL, BTA, vertical tilt angle, macular ChT (mChT), and peripapillary ChT (pChT) were measured on swept-source optical coherence tomography scans. RESULTS. The PPA area (P < 0.0001) and vertical tilt angle (P < 0.0001) were larger, BMOD (P < 0.0001) and BL (P < 0.0001) were longer, and BTA (P < 0.0001) was smaller in the high-myopia group compared with the group without high myopia. Every 1-μm increase in BMOD was associated with a 35.80-μm decrease in mChT; every 1°decrease in BTA was correlated with a 0.32-μm decrease in mChT and a 0.26-μm decrease in pChT; and no association was found between PPA area and ChT in the multivariate linear regression model. CONCLUSIONS. PPA area, BL, BMOD, and vertical tilt angle increased, but BTA decreased with axial elongation of the globe in young, healthy patients with myopia. Longer BMOD was positively correlated with lower mChT, and smaller BTA was positively correlated with lower mChT and pChT in this population.

Purpose To investigate the percentages and risk factors for visual impairment (VI) across age groups in a highly myopic cohort with a wide range of age (18–93 years). Methods A total of 2099 eyes (1220 participants) were enrolled. All participants underwent detailed ocular examinations. Myopic maculopathy (MM) was assessed as myopic atrophy maculopathy (MAM), myopic traction maculopathy (MTM) or myopic neovascular maculopathy (MNM) based on the ATN system. Results Most participants younger than 50 years had normal vision, while the cumulative risk of VI and blindness gradually increased after 50–59 years. The percentage of each type of MM increased nonlinearly with ageing (all p < 0.001), with an accelerated period of increase after 45 years for MAM, and after 50 years for MTM and MNM. Axial length (AL) ≥30 mm was the only associated factor for mild VI or worse in participants aged 18–39 years (p < 0.001). Older age, AL ≥30 mm and the presence of MAM were predictors for mild VI or worse in the group aged 40–49 years (all p < 0.05). In participants aged ≥50 years, older age, female sex, longer AL and increased severity of MM were risk factors for VI and blindness (all p < 0.05). Conclusion The percentages of MM and related VI increased nonlinearly with older age, with a turning point at 45 years for MAM, preceding that of MTM, MNM and VI by 5 years, warranting future longitudinal studies to confirm. Different age groups presented different risk factors for VI. Timely screening should be in place for middle‐aged high myopes.