Tessellated fundus appearance and its association with myopic refractive error

Abstract

The appearance of tessellated fundus in an eye may act as a marker in identifying visual performance, degree of myopia or risk of progression of myopia in a given eye. A systematic literature search using key words was performed using PubMed, Web of Science and Google Scholar and of the 832 studies identified, 10 full-length articles, which met the inclusion criteria, were considered for review. The primary outcome measures were association of tessellated fundus with: (i) visual acuity, (ii) refractive error, (iii) axial length, (iv) choroidal thickness and (v) future progression of myopia when compared to either no myopic maculopathy, or more severe myopic maculopathy. There was no significant difference in the visual acuity noted between eyes with normal fundus and tessellated fundus appearance. Compared to eyes with tessellated fundus, eyes with more severe myopic maculopathy had a four-line decrease in best-corrected visual acuity, more myopia (mean difference 2.75 D, range 0.28-5.78 D) and a longer axial length (mean difference 2 mm, range 2.29 to 1.71 mm). Eyes with tessellated fundus generally exhibited a significant decrease in choroidal thickness compared to eyes with no maculopathy. In mostly older individuals, eyes with tessellated fundus had a better outcome with respect to visual acuity, degree of myopia and axial length compared to other severe myopic maculopathies, but had a worse outcome for choroidal thickness and degree of myopia, compared to eyes with no myopic maculopathy. The features such as reduced choroidal thickness combined with a predilection to infra-temporal and parapapillary regions may indicate regions of stress that are prone to more stretching/atrophic changes. This systematic review demonstrated an association of tessellated fundus with visual acuity, refractive error, axial length and choroidal thickness and hence emphasises the documentation of the presence and location of tessellated fundus appearance that may help in predicting the progression of myopia.

Prevalence and Associations of Fundus Tessellation Among Junior Students From Greater Beijing

“…Our study is in agreement with previous investigations in that thinner choroidal thickness was strongly associated with a higher degree of fundus tessellation. 9,[12][13][14][15][16][17][18] In the Beijing Eye Study, a higher degree of fundus tessellation was mostly associated with longer axial length and older age, in addition to male sex, lower body mass index, worse best corrected visual acuity, thinner subfoveal choroidal thickness, larger parapapillary beta zone, lower prevalence of intermediate age-related macular degeneration, and lower prevalence of late age-related macular degeneration. 9 In our young study population, the prevalence and degree of fundus tessellation were mostly correlated with a thinner subfoveal choroid, whereas the associations with age, sex, body mass index, and uncorrected visual acuity were nonsignificant in the multivariable model.…”

“…The location and morphologic parameters of fundus tessellation have been described in recent studies on healthy adults or on highly myopic patients, but only a few investigations have addressed the prevalence and distribution of fundus tessellation in the eyes of children. 9,[12][13][14][15][16][17][18] Fundus tessellation may be of significance in children, particularly in China, because the ophthalmoscopic feature of fundus tessellation is associated with axial myopia, and China has witnessed a marked increase in the prevalence and severity of axial myopia in the younger generation. [1][2][3] In addition, it is of interest to determine whether fundus tessellation is a marker for visual performance as well as the degree and progression of myopia.…”

Posterior segment conditions associated with myopia and high myopia

“…• Tessellated fundus [31][32][33] • Diffuse chorioretinal atrophy 34,35 • Patchy chorioretinal atrophy 34,36 • Macular atrophy 33,34 • Foveal retinoschisis or retinoschisis [37][38][39] • Lacquer cracks 33,34 • Choroidal neovascularisation 40,41 • Fuchs spot 34,42 • Myopic maculopathy 7,34,36,[43][44][45] • Myopic traction maculopathy [46][47][48][49] 72.7% (myopia < −6.00 D) 50 • Macular holes 51 • Macular defects in Bruch's membrane 52,53 • Dome-shaped macula 54,55 • Posterior staphyloma [56][57][58][59][60] 12.7% (myopia −10.8 AE 2.9 D) 61…”

“…31 The prevalence of tessellated fundus varies from 34.2 to 67.0 per cent in high myopes, with the prevalence greater in those with longer axial lengths. 32,33 Characteristically, tessellation is noticed around the optic disc but in certain cases, may also involve the fovea and arcade vessels. Although tessellations are a common feature of severe forms of myopic maculopathy, tessellations can be observed in young myopes and also with low to moderate myopia with no other pathognomic signs.…”

“…Although tessellations are a common feature of severe forms of myopic maculopathy, tessellations can be observed in young myopes and also with low to moderate myopia with no other pathognomic signs. 32 Visual acuity was reported to be normal in myopic eyes with tessellations alone. 95,96 Other than routine monitoring, no intervention is required for eyes with tessellated fundus.…”