Myopic maculopathy shows high rate of progression, appreciable vision loss

Ophthalmol. 2010;117(8):1595-1611.

Myopic maculopathy progressed in approximately 40% of highly myopic eyes, and the pattern of progression correlated with poor visual prognosis, according to a study.

"The impact of myopic maculopathy on visual impairment is important because the maculopathy is often bilateral, irreversible, and frequently affects individuals during their most productive years," the study authors said. "Preventive therapy targeting posterior staphyloma should be considered to prevent the visual impairment caused by the progression of myopic maculopathy."

Myopic maculopathy is attributable to axial elongation, development of posterior staphyloma, and thinning of the retina and choroid, the authors said.

The retrospective study included 806 eyes of 429 patients with refractive error of more than –8 D or axial length of 26.5 mm or greater. Patients were followed for 5 to 32 years; mean follow-up was 12.7 years.

Complete ophthalmologic examination included best corrected visual acuity, axial length, fluorescein angiography and color fundus photography.

Patients had undergone no treatment for maculopathy.

Study results showed that the most commonly identified progression patterns were tessellated fundus, lacquer cracks, diffuse atrophy, patchy atrophy and choroidal neovascularization.

Eyes with tessellated fundus, lacquer cracks, diffuse atrophy and patchy atrophy at initial examination showed progression to the development of CNV. Macular atrophy was identified in eyes with CNV. The fusion of patchy atrophy, development of CNV and macular atrophy were associated with significant vision loss.

Posterior staphyloma was identified more often in eyes that showed progression from tessellated fundus, diffuse atrophy, and patchy atrophy than those without progression, the authors reported.