Morphological Characteristics and Visual Acuity of Highly Myopic Eyes With Different Severities of Myopic Maculopathy

Abstract

Purpose: To investigate the morphological feature, visual acuity, and prevalence of macular complications in highly myopic eyes with different categories of myopic maculopathy (MM) according to the META-PM classification system. Methods: The clinical records of 1,132 consecutive patients (1,841 eyes) with high myopia (refractive error ≤ −6D and axial length ≥26.5 mm), who visited the High Myopia Clinic at the Zhongshan Ophthalmic Center from January 2014 to July 2017, were reviewed. Fundus photograph, optical coherence tomography, axial length, refractive error, and best-corrected visual acuity were measured in each patient. Myopic maculopathy was graded from fundus photographs according to the META-PM classification, including tessellated fundus (C1), diffuse chorioretinal atrophy (C2), patchy atrophy (C3), and macular atrophy (C4). Other macular complications, including foveoschisis, extrafoveal schisis, full-thickness macular hole, epiretinal membrane, lacquer cracks, Fuchs spot, choroidal neovascularization, macular hemorrhage, and dome-shaped macula, were also investigated. Results: Among the 1,841 eyes, 58 (3.15%) had no MM (C0), 779 (42.31%) had tessellated fundus only (C1), 524 (28.46%) had diffuse chorioretinal atrophy (C2), 352 (19.12%) had patchy chorioretinal atrophy (C3), and 128 (6.95%) had macular atrophy (C4). Age increased and best-corrected visual acuity became worse with the severity of MM (P < 0.01). Axial length was significantly longer with the severity of MM from C0 to C3 (P < 0.01), and spherical equivalent was greater with the severity of MM from C0 to C3 (P < 0.01) but was not different between C3 and C4 (P > 0.05). Subfoveal and parafoveal choroidal thicknesses were significantly thinner from C0 to C3 (P < 0.01). However, no significant difference was found between C3 and C4 in parafoveal choroidal thickness (P > 0.05). The complications were different among C0 to C4 correlated with MM (P < 0.01). The complications of foveoschisis, choroidal neovascularization, hemorrhage, lacquer cracks, Fuchs spot, dome-shaped macula, and epiretinal membrane were different between C1 and C2 (P < 0.01), but none of the complications were different between C3 and C4 (P > 0.05) except Fuchs spot (P = 0.009). Conclusion: The morphological and functional characteristics in eyes with high myopia were positively correlated with the severity of C0 to C3 MM. However, no morphological difference was found between C3 and C4. The absence of the progressive relationship between C3 and C4 might be determined.

Morphological Characteristics and Risk Factors of Myopic Maculopathy in an Older High Myopia Population—Based on the New Classification System (ATN)

“…11,12,21 Patchy atrophy and macular atrophy may be different types of MM rather than a relationship of progress. 23 We also found some CNV-related macular atrophy eyes in which the atrophic lesion was limited, and no obvious atrophic changes were found around the lesion. Hence, in these cases it may be inappropriate to classify macular atrophy into the atrophic group.…”

“…Several studies had reported a negative correlation between mChT and MM severity. 23,31 The thinning of choroidal thickness may contribute to various myopic pathologic changes, such as chorioretinal atrophy, LCs, and CNV. 20,[32][33][34][35] However, the definition of MM in these studies was based on atrophic and neovascular changes, and there are no studies reporting a correlation between choroidal thinning and myopic tractional changes.…”

The Complications of Myopia: A Review and Meta-Analysis

“… 33 , 37 The first study was performed in a very young population, Singaporean men aged 19 to 25 years, and the second study was performed in asymptomatic Chinese patients aged 18 years and older, possibly explaining the low prevalence. 33 , 37 The study of Zhao et al 36 included the most myopic and oldest participants of which 96.9% had at least a tessellated fundus, and 54.5% also had diffuse, patchy, or macular atrophy.…”

Posterior segment conditions associated with myopia and high myopia

“…34 The appearance of Fuchs spot is positively correlated with the severity of maculopathy from Category 0 to Category 4. 103 In highly myopic adults, the prevalence of Fuchs spot was moderate, with a study reporting 14.5 per cent prevalence in highly myopic adults. 42 The Handan study reported that Fuchs spot was less prevalent (14.3 per cent) when compared to other lesions such as staphyloma (86.9 per cent), chorioretinal atrophy (56 per cent) and lacquer crack (36.9 per cent).…”