Dome-shaped macula in high myopia: Prevalence and clinical characteristics in a French cohort

To determine the prevalence of dome-shaped macula (DSM) in high myopia (HM) and to compare the clinical characteristics of eyes with and without DSM.

This retrospective, longitudinal, single-centre cohort study included patients with HM, with or without DSM. Baseline demographic and clinical characteristics were collected. Multimodal imaging was performed at baseline and during follow-up to assess the presence of macular neovascularization (MNV) and serous retinal detachment (SRD).

A total of 1133 eyes of 619 HM patients (67% of women; mean [standard deviation] age: 48.9 [16.9] years) were analyzed. The eye-level and patient-level prevalences of DSM were 15% (173/1133 eyes) and 19% (117/619 patients), respectively. Compared to non-DSM eyes, DSM eyes showed a longer axial length (p < 0.001), a worse baseline visual acuity (VA) (p = 0.016) and a higher prevalence of diffuse chorioretinal atrophy (p = 0.013). The longitudinal analysis was limited to DSM eyes, with a mean follow-up of 28.0 (44.2) months. At the final visit, MNV was found in 47 eyes (27%) and SRD in 10 eyes (6%). MNV incidence was 4.02 (95% confidence interval [CI]: 1.79-6.70) per 100 eye-years. The presence of SRD at baseline was associated with a greater dome height (odds ratio = 1.007; p < 0.001). Vitreoretinal interface abnormalities were more frequently observed in eyes with lower dome height.

DSM was detected in approximately 15% of HM eyes. Patients with DSM showed a worse baseline VA compared to those without DSM. MNV was the most common and vision-threatening complication, while SRD was relatively uncommon, occurring only in cases of significant bulging.