Changes of the Optic Nerve Head and Macula in High Myopia in a 10-Year Follow-Up: The Beijing Eye Study

To assess the incidence of myopic changes of the optic nerve head and macula in highly myopic eyes.

All highly myopic eyes (axial length >26.0 mm or refractive error ≤-6.0 diopters) examined in the longitudinal population-based Beijing Eye Study 2001/2011 underwent fundus photography (2001/2011) and optic coherence tomography (2011).

The study included 89 highly myopic eyes (patient age, 65.0 ± 9.8 years). Progressive macula changes were detected in 63 of 89 eyes (71%), including increases in fundus tessellation (n = 61 [69%]), diffuse chorioretinal atrophy (n = 15 [17%]), lacquer cracks (n = 12 [14%]), patchy atrophies (n = 8 [9%]), macular atrophy (n = 6 [7%]), and overall myopic macular degeneration stage (n = 23 [26%]). Without considering fundus tessellation changes, any macular change was detected in 31 of 80 eyes (35%). Progressive optic nerve head changes were found in 69 of 89 eyes (78%), including optic disc diminution (n = 28 [32%]), disc enlargement (n = 13 [15%]), change in disc shape (n = 36 [40%]), enlargement in beta/gamma zone (n = 68 [76%]) or delta zone (n = 22 [25%]), and lengthening of parapapillary retinal vessels (n = 47 [53%]). Any type of progression of the macula and/or optic nerve head was detected in 74 of 89 eyes (83%), and without considering fundus tessellation changes in 70 of 89 eyes (79%). Higher incidence of any macular change (fundus tessellation change not considered) and of optic nerve head changes correlated with longer axial length (odds ratio [OR], 2.15 [P < 0.001] and OR, 2.20 [P = 0.02], respectively) and older age (OR, 1.11 [P = 0.001] and OR, 1.08 [P = 0.02], respectively). Optic disc diminution correlated with disc shape change from a more circular to an elliptical shape (OR, 37.9; 95% confidence interval, 9.7-148.0; P < 0.001) and in all eyes with beta/gamma zone enlargement.

Over the 10-year follow-up, >75% of highly myopic eyes showed progressive myopic changes of the optic nerve head and macula.