Optic disc, macular changes common in highly myopic young Asian adults

Changes in the optic disc and macula were prevalent in highly myopic eyes in a young Asian adult population, a study found.

Perspective from Roberto Warman, MD

Investigators prospectively analyzed 593 highly myopic subjects and a comparator group of 156 emmetropic subjects. All subjects were men. Mean age was 21.1 years in the myopic group and 21.5 years in the emmetropic group.

Subjects underwent medical interviews, ophthalmic examinations and color fundus photography. The photographs were used to determine the presence of optic disc and macular lesions.

Mean spherical equivalent refraction was –8.87 D in the myopic group and 0.40 D in the emmetropic group; the between-group difference was statistically significant (P < .001).

Axial length was 27.45 mm in the myopic group and 23.83 mm in the control group; the difference was significant (P < .001).

Optic disc tilt, peripapillary atrophy, posterior staphyloma, chorioretinal atrophy and myopic maculopathy were significantly more prevalent in the myopic group (P < .001).

Older age, decreased choroidal thickness and greater axial length were associated with myopic maculopathy, which was found in 8.3% of highly myopic eyes.

For each year of increasing age, the risk of developing myopic maculopathy increased by 1.66 times (P = .001), and for each 1 mm increase in axial length, the risk increased by 1.52 times (P = .02). Myopic maculopathy development was also associated with decreased choroidal thickness (P < .001). – by Matt Hasson

Disclosure: The authors report no relevant financial disclosures.

Perspective

Roberto Warman, MD

Myopia is a popular subject, particularly with epidemiologic studies regarding prevalence, economic impact and potential preventive measures to stop rapid progression. This issue is a major concern worldwide but particularly in Asia and Southeast Asia, where it is in epidemic proportions.

This paper by Koh and colleagues in American Journal of Ophthalmology, titled Myopic maculopathy and optic disc changes in highly myopic young Asian eyes and impact on visual acuity, is significant. The bottom line is this prospective cross-sectional well-designed study confirms suspicions that myopia-related changes of the optic disc and macula were not only common in highly myopic eyes but were detected at a relatively early age (average study population 21 years old), and some of these changes have produced reduced central visual function even before structural changes were noted. Of course increased age is a significant risk factor, but axial length increases and reduced choroidal thickness were also demonstrated as risk factors.

Hopefully, this study with many others will not only increase our awareness of this epidemic condition but will increase our efforts and resources to find appropriate preventive measures soon, particularly now that there is good evidence that very low-dose atropine (0.01%) can not only slow progression but sustain its reduction effect on progressive myopia. Will Big Pharma and the FDA promote development of this medication and make it available in the USA in the near future?

Roberto Warman, MD

OSN Pediatrics/Strabismus Board Member

Disclosures: Warman reports no relevant financial disclosures.

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Source:

Koh V, et al. Am J Ophthalmol. 2016;doi:10.1016/j.ajo.2016.01.005.