Two-Year Fundus Progression in Highly Myopic Eyes in the Aier-SERI High Myopia Adult Cohort Study

To evaluate 2 year fundus progression and associated factors in adults in the Aier-SERI High Myopia cohort in Changsha, China.

A total of 367 adult high myopes (spherical equivalent [SE] ≤ -5.0D) underwent baseline and 2 year assessments, including colour fundus photography graded by the Meta-analysis for Pathologic Myopia (META-PM) classification. Progression was defined as advancement to a higher category, enlargement of atrophy or development/worsening of plus lesions. Associations were analysed using multivariable generalised estimating equation (GEE) logistic regression adjusting for age, sex, SE or axial length (AL) and baseline META-PM category.

In this cohort (mean age: 45.2 ± 7.3 years), fundus progression occurred in 31/734 eyes (4.2%, 27 participants). Of 37 lesion changes in 31 eyes, the most frequent changes were enlargement of patchy atrophy (51.4%), followed by diffuse atrophy (16.2%) and lacquer crack extension (16.2%). Fuchs' spot expansion and category progression were less common (8.1% each). In GEE models, progression was associated with more myopic SE (per -1D, odds ratio [OR]: 1.21; 95% confidence interval [CI]: 1.14-1.29, p < 0.001), longer AL (per 1-mm, OR: 1.96; 95% CI: 1.64-2.34, p < 0.001) and older age (per year, OR: 1.06; 95% CI: 1.02-1.11, p < 0.01). Eyes with baseline Category 3 lesions had markedly higher odds of progression (OR: 85.55; 95% CI: 25.07-291.93, p < 0.001).

Over 2 years, fundus progression in adult highly myopes occurred mainly in those with advanced atrophy at baseline and was associated with greater myopia, longer AL and older age. Eyes of Categories 0-1 remained stable, suggesting a threshold for accelerated degeneration.