Current advances in dome-shaped macula and associated conditions

Dome-shaped macula (DSM) is a distinctive anatomical entity characterized by an inward convexity of the macula, initially described in highly myopic eyes within posterior staphyloma, but is now recognized as occurring across a broader spectrum of refractive conditions, including mild myopia and even emmetropia. Since its initial description in 2008, advances in imaging technologies and longitudinal studies have significantly improved our understanding of DSM. We analyzed the recent literature, focusing on publications from the last 10 years. DSM affects about 0.2 % of the general population, with a prevalence reaching 10-20 % in highly myopic eyes. Its pathophysiology involves complex mechanisms ranging from emmetropization processes in non-myopic eyes to differential scleral biomechanics and asymmetric posterior segment growth in high myopia. Polarization-sensitive optical coherence tomography provided new insights into scleral fiber architecture, showing horizontal interpapillomacular fibers corresponding to the typical horizontal DSM configuration. DSM plays a dual role in myopic complications, potentially protecting against foveal retinoschisis while predisposing to serous retinal detachment (SRD) and retinal pigment epithelium (RPE) atrophy when the dome height exceeds specific thresholds. SRD, the most common (8-50 % of cases), and RPE atrophy are the main complications directly related to DSM. There are numerous treatment approaches for SRD with variable success rates. Longitudinal studies have described DSM evolution over time and shown that an increased dome height correlated with the axial elongation. We provide updated information on the epidemiology, pathophysiology, clinical presentation and management of DSM to improve the diagnosis and treatment of this increasingly recognized condition.