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Pathways to Patchy Atrophy in High Myopia: Precursor Patterns, Structural Characteristics, and Long-Term Outcomes
Sebastiano Del Fabbro1,2,3,4,5, Jost B Jonas1, Songhomitra Panda-Jonas1
1French Institute of Myopia, Foundation Adolphe de Rothschild Hospital, Paris, France.
Ophthalmology Science
|June 24, 2026
Summary
Highly myopic eyes develop patchy atrophy (PA) through inflammatory, neovascular, or idiopathic patterns. Recognizing these distinct precursor patterns aids in assessing structural evolution and clinical outcomes for better patient management.
Area of Science:
- Ophthalmology
- Retinal Imaging
- Myopia Research
Background:
- High myopia is a leading cause of visual impairment globally.
- Patchy atrophy (PA) is a significant complication in highly myopic eyes, leading to vision loss.
- Understanding the precursors of PA is crucial for predicting its progression and managing complications.
Purpose of the Study:
- To identify and characterize distinct precursor patterns of patchy atrophy (PA) in highly myopic eyes.
- To analyze the structural evolution and clinical outcomes associated with these PA precursor patterns.
- To provide insights for improved clinical assessment and management of PA in high myopia.
Main Methods:
- A retrospective multicenter cohort study involving highly myopic patients with documented PA onset.
- Multimodal imaging (MMI) data collected prior to PA development were analyzed.
- Eyes were categorized into three precursor patterns: inflammatory, neovascular, and idiopathic PAs.
Main Results:
- Three distinct precursor patterns were identified: inflammatory (32%), neovascular (9%), and idiopathic (59%) PAs.
- Inflammatory and neovascular PAs showed higher baseline lesion counts and more frequent late-stage complications compared to idiopathic PAs.
- Atrophy growth rate (AGR) was fastest in inflammatory PAs, followed by neovascular and idiopathic PAs, with higher baseline lesion numbers correlating with faster AGR.
Conclusions:
- Patchy atrophies in highly myopic eyes develop via three distinct precursor patterns: inflammatory, neovascular, and idiopathic.
- These patterns differ significantly in their structural characteristics, rate of atrophy progression, and associated complications.
- Identifying these PA precursor patterns can enhance the clinical assessment and management strategies for patients with high myopia.
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