Distribution and Severity of Myopic Maculopathy Among Highly Myopic Eyes

Purpose: The purpose of this study was to document the distribution of the severity of myopic maculopathy in a cohort of highly myopic patients and to explore the associated risk factors.

Methods: A total of 890 Chinese highly myopes aged between 7 and 70 years (median age 19 years) and with spherical refraction -6.00 diopter (D) or worse in both eyes were investigated. All participants underwent detailed ophthalmic examination. Myopic maculopathy was graded into 5 categories according to the International Photographic Classification and Grading System using color fundus photographs: category 0, no myopic retinal lesions, category 1, tessellated fundus only; category 2, diffuse chorioretinal atrophy; category 3, patchy chorioretinal atrophy; category 4, macular atrophy. Category 2 or greater were further classified as clinically significant myopic maculopathy (CSMM).

Results: Data from 884 of 890 right eyes were available for analysis. The proportions of category 1, category 2, category 3, and category 4 were 20.0% (177 eyes), 20.2% (178 eyes), 2.6% (23 eyes), and 0.2% (2 eyes), respectively. The proportion of CSMM increased with more myopic refraction (odds ratio 1.57; 95% confidence interval: 1.46-1.68), longer axial length (odds ratio 2.97; 95% confidence interval: 2.50-3.53), and older age (40-70 years compared to 12-18 years, odds ratio 6.77; 95% confidence interval: 3.61-12.70). However, there was a higher proportion of CSMM in children aged 7 to 11 years than those aged 12 to 18 years (20.9% vs. 11.0%, P = 0.008).

Conclusions: Older age, more myopic refraction, and longer axial length were associated with more severe myopic maculopathy. Although CSMM was uncommon among younger participants, children with early-onset high myopia have a disproportionately increased risk.