The types and severity of high myopic maculopathy in Chinese patients

To describe the severity and morphological features of high myopic maculopathy in Chinese patients and to evaluate their association with age, refractive error and visual acuity.

Six hundred and four eyes of 337 patients (ages 8-88 years) with high myopia (refractive error ≤ -6.0 D) presenting to the Zhongshan Ophthalmic Center were studied retrospectively. All patients underwent an ophthalmological examination including digital colour fundus photography. Fundus fluorescein angiography was performed in 251 patients (443 eyes) and indocyanine green angiography was performed in 35 patients (63 eyes). The type and severity of myopic degeneration were categorized in each eye. Risk factors associated with high myopic maculopathy were evaluated using General Estimating Equation models.

Two hundred and fifty-one patients (443 eyes) presented with maculopathy in this study. The most common subtype of high myopic maculopathy was lacquer cracks (prevalence 29.1%). The most commonly observed degree was M(3) (choroidal pallor and tessellation, with posterior staphyloma and lacquer cracks). Older age was significantly associated with diffuse chorioretinal atrophy (p = 0.024), patchy chorioretinal atrophy (p < 0.001), choroidal neovascularisation (CNV, p < 0.001) and macular atrophy (p = 0.002). Younger age was associated with lacquer cracks (p < 0.001). A higher degree of myopia was a risk factor for almost all kinds of maculopathy: tessellated fundus (p = 0.001), lacquer cracks (p < 0.001), diffuse chorioretinal atrophy (p < 0.001), patchy chorioretinal atrophy (p = 0.025) and macular atrophy p < 0.001), whereas a lower degree of myopia was associated with CNV (p = 0.001). A worse visual acuity was associated with lacquer cracks (p = 0.001), macular atrophy (p < 0.001) and CNV p < 0.001), while better visual acuity was associated with tessellated fundus (p < 0.001) and diffuse atrophy (p = 0.002). Older age (p < 0.001), more myopic refractive error (p < 0.001) and worse visual acuity (p < 0.001) were significantly associated with a greater severity of maculopathy. There was no gender difference in the type and severity of myopic maculopathy.

Age and refractive error are important risk factors playing different roles in the development of distinct subtypes and varying severities of high myopic maculopathy. Visual acuity is significantly associated with various subtypes and the severity of high myopic maculopathy.