Myopic Maculopathy

If you have high myopia (severe short-sightedness), usually over 600 degrees, you may be at risk of developing complications in the macula (the part of the retina used for central vision), which are often termed "myopic maculopathy" or "pathologic myopia".  

What is pathologic myopia and myopic maculopathy?

Patients with short-sightedness of over 600 degrees are considered to have "high myopia". Myopia occurs when the eyeball is too long, and light rays entering the eye are unable to focus sharply on the light-sensitive part of the eye called the retina (Find out more about myopia). The macula is the part of the retina that has the highest concentration of cones (a type of light sensitive cell) and is essential for sharp central vision. (Read more on how the eye works)

In high myopia, excessive elongation of the eyeball results in stretching and thinning of the retina, especially at the macula. Various complications can occur in the macula that cause vision loss, including retinal degeneration (myopic macular degeneration), splitting of the retinal layers (myopic foveoschisis), and bleeding from abnormal blood vessels (myopic choroidal neovascularisation).

Retinal photograph showing severe degeneration of the macula in a highly myopic eye. Cases with degeneration like this are likely to have severe, irreversible vision loss.

OCT scan showing retinal thinning and degeneration in myopic maculopathy

Retinal photograph showing a highly myopic eye with bleeding and retinal edema (swelling) from growth of abnormal blood vessels (myopic choroidal neovascularization), which is a complication of myopic maculopathy

OCT scan showing splitting of the retinal layers (myopic foveoschisis) due to high myopia

Patients with myopic maculopathy may experience blurring of vision, or distortion of vision with straight lines appearing abnormally curved. These symptoms can come on suddenly or develop gradually over months.

There are currently effective treatments to prevent worsening myopia in childhood, while the eye is still growing. It is thought that such treatments, by reducing the severity of myopia, should also reduce the risk of developing the complications of high myopia.  In adulthood, however, there is currently no treatment to prevent the development of myopic maculopathy. This is an area of ongoing research, to develop and test treatments to prevent the development and worsening of myopic maculopathy.

Studies have shown that having a strong family history of short-sightedness, too much time spent on near activities, and not enough time spent outdoors during youth are risk factors for developing higher degrees of myopia or short-sightedness. Consequently, the higher the degree of myopia, the greater the likelihood of developing complications of high myopia, including myopic maculopathy or pathologic myopia.

Myopic maculopathy is diagnosed by careful dilated eye examination by an ophthalmologist. Examination is usually supplemented by detailed imaging such as optical coherence tomography (OCT) scans, geared toward assessing for thinning of the retina as well as other layers of the eye, such as the choroid and sclera.

Treatment for myopic maculopathy depends on the type of complication or problem that arises. For example, cases of bleeding from abnormal blood vessels (myopic choroidal neovascularization) can be treated with injection of medications into the eye (intravitreal injections). In cases where myopia causes splitting of the retinal layers (myopic foveoschisis), retinal detachment or macular holes, retinal surgery (vitrectomy) may be required.