Four-Year Progression of Myopic Maculopathy in Children and Adolescents With High Myopia

Abstract

ImportanceIndividuals with high myopia younger than 18 years are at relatively high risk of progressively worsening myopic maculopathy. Additional studies are needed to investigate the progression of myopic maculopathy in this age group, as well as the risk factors associated with progression.ObjectiveTo investigate the 4-year progression of myopic maculopathy in children and adolescents with high myopia, and to explore potential risk factors.Design, Setting, and ParticipantsThis hospital-based observational study with 4-year follow-up included a total of 548 high myopic eyes (spherical power −6.00 or less diopters) of 274 participants aged 7 to 17 years. Participants underwent comprehensive ophthalmic examination at baseline and 4-year follow-up. Myopic maculopathy was accessed by the International Photographic Classification and Grading System. The data analysis was performed from August 1 to 15, 2023.Main Outcomes and MeasuresThe progression of myopic maculopathy progression over 4 years and associated risk factors.ResultsThe 4-year progression of myopic maculopathy was found in 67 of 548 eyes (12.2%) of 274 participants (138 girls [50.4%] at baseline and 4-year follow-up) with 88 lesion changes, including new signs of the tessellated fundus in 16 eyes (18.2%), diffuse atrophy in 12 eyes (13.6%), patchy atrophy in 2 eyes (2.3%), lacquer cracks in 9 eyes (10.2%), and enlargement of diffuse atrophy in 49 eyes (55.7%). By multivariable analysis, worse best-corrected visual acuity (odds ratio [OR], 6.68; 95% CI, 1.15-38.99; P = .04), longer axial length (AL) (OR, 1.73; 95% CI, 1.34-2.24; P < .001), faster AL elongation (OR, 302.83; 95% CI, 28.61-3205.64; P < .001), and more severe myopic maculopathy (diffuse atrophy; OR, 4.52; 95% CI, 1.98-10.30; P < .001 and patchy atrophy; OR, 3.82; 95% CI, 1.66-8.80; P = .002) were associated with myopic maculopathy progression.Conclusions and RelevanceIn this observational study, the progression of myopic maculopathy was observed in approximately 12% of pediatric high myopes for 4 years. The major type of progression was the enlargement of diffuse atrophy. Risk factors for myopic maculopathy progression were worse best-corrected visual acuity, longer AL, faster AL elongation, and more severe myopic maculopathy. These findings support consideration of follow-up in these individuals and trying to identify those at higher risk for progression.

Forecasting Myopic Maculopathy Risk Over a Decade: Development and Validation of an Interpretable Machine Learning Algorithm

“…Evidence from our cohorts and previous studies indicated that MMD development can occur as early as childhood in patients with high myopia, which emphasized early risk identification in this stage. 31 , 32 Such accurate long-term predictions were of significance given that targeted screening and timely intervention for preventing visual impairment from MMD in the mild stage was critically important to maximum healthcare benefits.…”

A Novel Grading System for Diffuse Chorioretinal Atrophy in Pathologic Myopia

“…Among children and adolescents with high myopia, a relatively high proportion exhibited the presence of DCA. Surprisingly, Jiang et al [ 8 ] observed that 14.05% of the participants developed DCA during a follow-up period exceeding 4 years, with the enlargement of DCA being identified as the primary progression pattern in myopic maculopathy. Similarly, Yokoi et al [ 9 ] proposed that DCA around the optic disc in childhood serves as a pivotal predictor for the development of pathologic myopia in adulthood, highlighting the importance of early detection and diagnosis of DCA.…”

“…Diffuse chorioretinal atrophy represents one of the most prevalent pathological conditions associated with myopia and an early category of myopic maculopathy, the most common type of maculopathy in patients with pathological myopia [5,6]. Importantly, the presence of DCA in childhood is more predisposed to developing new lesions of myopic maculopathy and progressing toward a more severe form of the condition [7][8][9][10]. Among children and adolescents with high myopia, a relatively high proportion exhibited the presence of DCA.…”