Current advances in dome-shaped macula and associated conditions

Area of Science:

• Ophthalmology
• Retinal Imaging
• Myopia Research

Background:

• Dome-shaped macula (DSM) is an anatomical variation initially observed in highly myopic eyes.
• DSM is now recognized across a spectrum of refractive errors, including emmetropia and mild myopia.
• Recent literature (last 10 years) has advanced understanding of DSM's epidemiology, pathophysiology, and clinical implications.

Purpose of the Study:

• To provide updated information on the epidemiology, pathophysiology, clinical presentation, and management of DSM.
• To synthesize recent findings on DSM, particularly from the last decade.
• To enhance the diagnosis and treatment of DSM.

Main Methods:

• Literature review focusing on publications from the last 10 years.
• Analysis of epidemiological data, including prevalence in general and myopic populations.
• Review of studies on pathophysiology, including imaging insights and biomechanical factors.
• Examination of clinical presentations and management strategies for DSM-related complications.

Main Results:

• DSM prevalence is ~0.2% in the general population, rising to 10-20% in highly myopic eyes.
• Pathophysiology involves emmetropization, scleral biomechanics, and asymmetric posterior segment growth.
• Polarization-sensitive OCT reveals horizontal interpapillomacular fibers correlating with DSM.
• DSM has a dual role: protection against retinoschisis but predisposition to serous retinal detachment (SRD) and RPE atrophy (>8-50% of cases).
• Increased dome height correlates with axial elongation and disease progression.

Conclusions:

• DSM is an increasingly recognized condition with diverse pathophysiology and refractive associations.
• Serous retinal detachment and RPE atrophy are significant complications of DSM, particularly with increased dome height.
• Continued research and advanced imaging are crucial for improving DSM diagnosis and management.