Prognostic factors associated with pathological myopia in young patients with high myopia

Abstract

 

Purpose

 

Various kinds of retinochoroidal complications, such as chorioretinal atrophy and choroidal neovascuralization, are caused by pathological myopia. Most of these complications occur in middle-aged and elderly patients. However, to the extent of our knowledge there are no predictive factors associated with development of pathological changes in young patients with high myopia. Thus, the aim of this study is to find predictive factors for pathological myopia.

 

Methods

 

We retrospectively analyzed the medical records of highly myopic patients who were <30 years old at initial visit with a follow up period >10 years. According to the age at initial visit, patients were divided into 2 groups (Group1: <19 years old; Group2: 20-29 years old). Considering fundus photographs at final visit, we also subdivided each group into 2 subgroups; progressive [presence of diffuse chorioretinal atrophy (DA), patchy chorioretinal atrophy (PA), lacquer cracks, or choroidal neovascuralization], non-progressive [no fundus lesions (N) or tessellated fundus (T) only]. In addition, patients’ demographics, clinical characteristics and fundus findings at initial visit were compared between each subgroups.

 

Results

 

Finally, 138 eyes of 71 patients were included. In Group1 (74 eyes of 38 patients), 38 eyes (51.4%) were classified as progressive [DA: 36 eyes (94.7%); PA: 5 eyes (13.2%)], and 36 eyes (48.7%) were classified as non-progressive [N: 12 eyes (33.3%); T: 24 eyes (66.7%)]. In Group2 (64 eyes of 33 patients), 32 eyes (50.0%) were classified as progressive [DA: 31 eyes (96.9%); PA: 7 eyes (21.9%)], and 32 eyes (50.0%) were classified as non-progressive [N: 7 eyes (21.9%); T: 25 eyes (78.1%)]. In both Groups, spherical equivalents were more myopic (both Groups, P<0.001), and axial lengths were longer (both Groups, P<0.001) in progressive subgroups than in non-progressive ones. In Group2, visual acuities were worse (P=0.021) and optic disc shapes were more oval (P=0.034) in progressive subgroup than in non-progressive one. Importantly, 25 eyes (69.4%) in progressive subgroup of Group1 and 30 eyes (93.8%) in progressive subgroup of Group2 showed a DA mainly around the optic disc, even at initial visit.

 

Conclusions

 

Presence of a DA around optic disc at a young age may be a strong indicator for development of pathological myopia. In addition, more severe myopia and longer axial length may be related to pathological changes.

 

Keywords: 605 myopia • 688 retina • 494 degenerations/dystrophies