Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN)

Area of Science:

• Ophthalmology
• Medical Genetics

Background:

• Myopia is a global ocular disorder, with pathologic myopia being a significant cause of irreversible blindness, particularly in East Asia.
• Myopic maculopathy, alterations in the macular area, is the primary cause of vision loss in pathologic myopia.
• High myopia and pathologic myopia are distinct conditions, often confused, necessitating clear differentiation.

Purpose of the Study:

• To highlight the critical need for a comprehensive classification system for myopic maculopathy.
• To emphasize the importance of distinguishing between high myopia and pathologic myopia.
• To improve understanding of the genetic basis of these conditions.

Main Methods:

• Review of current understanding of pathologic myopia and its associated ocular alterations.
• Analysis of key differentiating factors between high myopia and pathologic myopia, focusing on axial length and posterior staphyloma.
• Discussion of the limitations of existing classification systems for myopic maculopathy.

Main Results:

• Pathologic myopia is characterized by axial elongation and posterior staphyloma, the latter being a key differentiator from high myopia.
• Posterior staphyloma leads to various maculopathies, including differences in myopic macular holes and foveoschisis.
• Current classification systems inadequately capture the complexity of myopic maculopathy.

Conclusions:

• A unified and comprehensive classification system for myopic maculopathy is essential for precise disease staging and monitoring.
• Standardized criteria will facilitate international research collaboration and comparison.
• Improved classification will aid in understanding the genetic underpinnings of pathologic myopia.