Certain Factors Increase the Risk of Bilateral Myopic Maculopathy Progression

A 4-year observational study of children and adolescents with bilateral myopic maculopathy, conducted at a single ophthalmic hospital in China, reported that more than 12% of eyes progressed during the time period.

Study Design

The progression of bilateral myopic maculopathy and its associated risk factors were evaluated in 274 children and adolescents (548 eyes) aged 7–17 years (mean 13.7 year) with high myopia, defined as myopic spherical power of −6.0 D or less. Other than wearing glasses for best-corrected visual acuity (BCVA), the participants did not have any treatment for myopia or myopia progression over the consecutive 4-year study period. Ophthalmic examinations were performed at baseline and at the end of the study. Myopic maculopathy classification and grading were determined from macula-centered fundus photography.

Outcomes

During the 4 years, progression of myopic maculopathy was noted in 12.2% of eyes; the most common pathology was diffuse atrophy. A multivariate analysis found that the risk factors most associated with myopic maculopathy progression included faster axial length (AL) elongation (odds ratio [OR] 302.83), worse BCVA (OR 6.68), patchy atrophy (OR 3.82), and longer AL (OR 1.73). These risk factors are similar to those reported in previous studies of myopic progression in Chinese pediatric patients.

Limitations

Limitations include the authors' grading system with macula-centered fundus photography, which could have led to underreporting of peripheral retinal pathology. Also, the classification of myopic maculopathy used here was based upon a 2015 study and is well-known to the authors but not necessarily to other experts in the field. In addition, a 4-year follow-up period in this specific population may be too short a timeline to accurately assess the progression of myopia, extent of myopic retinal pathology, and AL growth/elongation.

Clinical Significance

At this time, the findings from these observational 4-year study in a Chinese pediatric population will not likely change clinical practice management for those of us who take care of children and adolescents with high myopia. However, the study’s value relates to the reporting of myopic diffuse atrophic maculopathy and its association with longer AL, faster AL elongation/growth, and worse BCVA.

Financial Disclosures: Dr. Jennifer Galvin discloses no financial relationships.