OCT-Based Diagnostic Criteria for Different Stages of Myopic Maculopathy

Fang, Yuxin; Du, Ran; Nagaoka, Natsuko; Yokoi, Tae; Shinohara, Kosei; Xu, Xiaoyan; Takahashi, Hiroyuki; Onishi, Yuka; Yoshida, Takeshi; Ohno‐Matsui, Kyoko

doi:10.1016/j.ophtha.2019.01.012

Cited by 96 publications

(129 citation statements)

References 34 publications

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“…It is well known that the choroid is markedly thinner in highly myopic eyes than in emmetropic eyes 27,28 . Fang et al 29 demonstrated that the choroidal change does not occur symmetrically and that there is a sequence for thinning. They suggested that this progressive and continuous choroidal thinning plays a crucial role in the development of various degrees of myopic maculopathy.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is uncertain whether the previously described characteristics are the results of axial elongation. For example, Fang et al 29 reported a progressive choroidal thinning with aging in young, highly myopic adults (4.91 μ/year). The subfoveal and peripapillary choroidal thinning found in eyes with enlarged PPA +BM could be a result of the aging process, not a result of axial elongation induced mechanical strain.…”

Section: Discussionmentioning

confidence: 99%

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Parapapillary atrophy and changes in the optic nerve head and posterior pole in high myopia

Sung

Heo

Piao

et al. 2020

Sci Rep

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We investigated the relationship between microstructure of β-parapapillary atrophy (β-ppA) and morphologic features of optic nerve head (onH) and posterior pole in highly myopic eyes. eighty-nine highly myopic eyes were included in this study. Bruch's membrane opening (BMo) area, lamina cribrosa (Lc) thickness, anterior laminar depth, peripapillary and subfoveal choroidal thickness (ct), macular Bruch's membrane (BM) length, and width of β-ppA with and without Bruch's membrane (ppA +BM and ppA −BM ) were evaluated. The mean age and axial length of the included subjects were 26.88 ± 2.44 years and 27.03 ± 0.88 mm, respectively. The width of PPA −BM was larger with increasing BMo area (P = 0.001), whereas the BMO area was not associated with the width of PPA +BM . the large ppA +BM was significantly related to a thinner LC (P = 0.003), deeper anterior lamina surface (P < 0.001), longer macular BM length (P = 0.008), and thinner temporal peripapillary CT (P = 0.034). We found that the morphologic features of the ONH and posterior pole in highly myopic eyes were different based on the microstructure of β-ppA. Whether these features are linked to the development of glaucoma in myopic eyes should be investigated in future studies.Classic funduscopic β-parapapillary atrophy (β-PPA) is a region of visible large choroidal vessels and sclera due to the lack of retinal pigment epithelium (RPE). β-PPA can be histologically subclassified based on the presence or absence of Bruch's membrane (BM): β-PPA with BM (PPA +BM ; β zone) and β-PPA without BM (PPA −BM ; γ zone). It has been known that PPA +BM might be due to age-related atrophy of the RPE and associated with the development of glaucoma 1-4 . Whereas, PPA −BM has been considered as a result of mechanical stretching in the peripapillary sclera and border tissue during axial elongation; hence a significant association between axial length and PPA −BM width has been consistently reported 1-3,5 . However, we previously reported that PPA +BM was also found in 20-30-year-old myopia subjects and suggested that PPA +BM in young myopia patients might be related to axial elongation, not age-related atrophy 6 . In accordance with our report, Lee et al. 7 recently found an enlargement of PPA +BM as myopia progressed and proposed that PPA +BM found in children might be an entirely different entity from PPA +BM in elderly individuals, sharing an etiology with PPA −BM .Several factors might contribute to β-PPA development during axial elongation, but the etiology of PPA +BM and PPA −BM enlargement remains elusive so far. It is unclear why some myopia patients exhibit only PPA −BM , whereas others with a similar degree of myopia exhibit both PPA +BM and PPA −BM . In this study, we hypothesized that morphologic features of the optic nerve head (ONH) and the posterior pole might give clues to the mechanisms of differential developments of β-PPA in myopic eyes. Therefore, the purpose of this work was to investigate the relationship between microstructure of β-PPA and the morphologic featur...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Parapapillary atrophy and changes in the optic nerve head and posterior pole in high myopia

Sung

Heo

Piao

et al. 2020

Sci Rep

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“…18 The presence of fundus tessellation is associated with thinner choroidal thickness, [36][37][38][39] and the latter presents morphologic changes that increases the risk of development of chorioretinal atrophy lesions. 40,41…”

Section: Risk Factors For MMD Developmentmentioning

confidence: 99%

Six-Year Changes in Myopic Macular Degeneration in Adults of the Singapore Epidemiology of Eye Diseases Study

Wong

Sabanayagam

Wong

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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To examine the 6-year incidence, progression, associated risk factors, and impact of myopic macular degeneration (MMD) in a myopic population in Singapore. METHODS. We examined myopic (spherical equivalent ≤-0.5 diopters) adults (N = 2157 persons and 3661 eyes) who were phakic at baseline and participated in both baseline and 6-year follow-up visits of the Singapore Epidemiology of Eye Diseases study. Eye examinations, including visual acuity, subjective refraction and axial length (AL) measurements, were performed. MMD was graded from fundus photographs following the META-PM classification. Vision-related quality of life was assessed with Raschtransformed scores from reading, mobility, and emotional domains of the Impact of Vision Impairment questionnaire. RESULTS. The 6-year eye-specific incidence of MMD among myopic eyes was 1.2% (95% CI, 0.9%-1.6%). Older age, worse spherical equivalent, and longer AL at baseline were associated with MMD incidence (all P < 0.001). The 6-year eye-specific progression of MMD in 288 eyes with baseline MMD was 17.0% (95% CI, 12.6%-21.4%). More severe MMD at baseline, worse spherical equivalent, and longer AL (all P < 0.05) were associated with MMD progression. Patients with Meta-PM categories 3 and 4 had worse best-corrected visual acuity and poorer vision-related quality of life outcomes than those without MMD (all P < 0.05). CONCLUSIONS. Over a 6-year period, one in 80 myopic eyes developed MMD and one in six with existing MMD had MMD progression. Myopia severity and AL were strong predictors of MMD development and progression. Eyes with severe MMD were at higher risk of MMD progression than those with less severe MMD, and were associated with poorer visual acuity and vision-related quality of life.

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“…22 In a recent study on OCT-based classification of myopic maculopathy, PA-related macular atrophy was found to have the thinnest choroidal thickness compared to all other categories of myopic macular degeneration. 23 Choroidal thickness was reported to be positively correlated with visual acuity and retinal sensitivity. 22,24 It was suggested that a thinned or absent choroid may result in a decrease in supply of oxygen and nutrients to the overlying RPE and outer retina, leading to abnormal photoreceptor signal generation or the loss of photoreceptors.…”

Section: Discussionmentioning

confidence: 99%

Patchy Scotoma Observed in Chorioretinal Patchy Atrophy of Myopic Macular Degeneration

Poon

Chen

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To investigate the retinal sensitivity of highly myopic eyes with chorioretinal patchy atrophy (PA) using microperimetry. METHODS. Fifty-two eyes of 32 patients with high myopia were prospectively included. Twenty-two eyes of 16 patients had PA lesions; eyes without PA were analyzed as controls. Testing points on microperimetry in eyes with PA were designated as 3 zones: zone 1 as the PA lesion including its borders; zone 2 including testing points adjoining PA; zone 3 including all other testing points. RESULTS. In the PA group, the mean retinal sensitivity in zone 1 was 2.1 ± 2.8 dB, zone 2 = 8.3 ± 4.3 dB, and zone 3 = 9.4 ± 4.1 dB. Sensitivity in zone 1 was significantly reduced than zones 2 and 3 (P < 0.001). The mean retinal sensitivity in the PA group was lower than controls (6.5 ± 4.3 vs 13.9 ± 4.1 dB, P < 0.001), and combined zone 2 and 3 in the PA group also presented lower retinal sensitivity (8.8 ± 4.0 dB). CONCLUSIONS. Eyes with PA generate patchy scotoma in PA lesions and reduced retinal sensitivity in regions beyond atrophic lesion on microperimetry. The presence of PA may be an indicator to reflect both significantly anatomical and functional alterations on myopic macular degeneration.

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OCT-Based Diagnostic Criteria for Different Stages of Myopic Maculopathy

Cited by 96 publications

References 34 publications

Parapapillary atrophy and changes in the optic nerve head and posterior pole in high myopia

Parapapillary atrophy and changes in the optic nerve head and posterior pole in high myopia

Six-Year Changes in Myopic Macular Degeneration in Adults of the Singapore Epidemiology of Eye Diseases Study

Patchy Scotoma Observed in Chorioretinal Patchy Atrophy of Myopic Macular Degeneration

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