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Lan Chang, Kyoko Ohno-Matsui, Xiaoyu Lin, Gemmy C. Cheung, Victor T. Koh, Gus Gazzard, Paul Mitchell, Terri L. Young, Tien Y. Wong, Seang-Mei Saw; Myopia-Related Optic Disc and Macular Changes in Singapore Adults with High Myopia. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2306.
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To determine the prevalence of myopia-related optic disc and macular changes in Singapore adults with high myopia (spherical equivalence ≤ -6.00 D).
Adults 40 years and older (n=359) with high myopia were pooled from four population-based surveys in Asians: 1) the Singapore Prospective Study Program (SP2, n=135); 2) the Singapore Malay Eye Study (SiMES, n=98); 3) the Singapore Indian Chinese Study (SICC, n=49); and 4) the Singapore Indian Eye Study (SINDI, n=77). All study participants underwent standardized refraction and fundus photography, and SiMES and SINDI subjects also completed ocular biometry. Posterior staphyloma, lacquer cracks, Fuchs’ spot, myopic chorioretinal atrophy, and myopic choroidal neovascularization were evaluated to detail the degree of myopic chorioretinopathy. The presence of optic nerve head tilt, optic disc dimensions, and beta peripapillary atrophy were assessed.
The most common myopic fundus finding was staphyloma (23%), followed by chorioretinal atrophy (19.3%). The most common disc finding associated with high myopia was beta-PPA (81.2%), followed by disc tilt (57.4%). Staphyloma and chorioretinal atrophy increased in prevalence with increasing age, increasing myopic refractive error, and increasing axial length (all p<0.001). Avila grading levels of myopic macular chorioretinopathy also advanced with age, myopic refractive error, and longer axial length (all p<0.001). There were very few cases of myopic choroidal neovascularization (n=3, 0.9%) and no case of Fuchs’ spot. Ethnicity comparisons demonstrated the highest prevalence of staphyloma (p=0.04) among Malays, the highest prevalence of beta-PPA (p=0.01) and disc tilt (p<0.001) among Chinese, and the largest disc dimensions (p<0.001) and largest cup-to-disc ratio (p<0.001) among Indians.
Staphyloma and chorioretinal atrophy lesions were the most common fundus findings among adult high myopes, and increasing prevalence was correlated with increasing spherical equivalence and axial length. Even amongst high myopes, choroidal neovascularization was uncommon. Ethnicity variation was seen within the three Asian groups.
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