We read with great interest the article by Ahn et al.,
1 which described decreased subfoveal choroidal thickness in patients with myopic choroidal neovascularization (CNV) following anti-VEGF treatment in nonrecurrent eyes. The article raised awareness about choroidal thinning associated with anti-VEGF treatment for high myopia, which may be applicable to another condition frequently associated with severe myopia and recently detected choroidal thinning, notably patients with a previous history of retinopathy of prematurity (ROP), at times also treated with anti-VEGF therapy.
A number of reports have recently documented choroidal thinning in patients with a history of ROP,
2–4 as well as in the well-established rodent model of ROP.
5 Choroidal thickness decreased in patients with threshold ROP compared with those with spontaneously regressed ROP. Moreover, involution of the choroid was correlated with a poor best-corrected visual acuity.
3 In a separate study, choroid was markedly thinner in subfoveal and macular regions even in patients with regressed ROP.
4 High myopia, defined as a refractive error of −6.0 diopters or worse, is a common sequela associated with ROP.
6 Among patients with high-risk prethreshold ROP as defined by the International Committee for Classification of ROP (typically defined as zone I any ROP less than threshold, zone II stage 2 with plus disease, zone II stage 3 without plus, or zone II stage 3 less than 5 contiguous clock hours or less than 8 noncontiguous clock hours with plus
7), 70% developed myopia as early as 6 months of age, and the proportion with high myopia increased steadily as the subjects got older.
6 Converging lines of evidence also indicate a correlation between the severity of ROP and the presence of myopia.
8,9
With increasing survival of extremely premature neonates (<28 weeks) and very low birthweight (<1500 g at birth) infants,
10 long-term changes afflicting the subretina are now being detected in older children and young adults with former history of ROP and those at risk of ROP.
11,12 This is especially true in emerging economies, such as China and India
13,14; interestingly, these countries also have a high incidence of myopia.
15 In addition to ROP and myopia,
16,17 several other ophthalmic conditions, notably diabetic retinopathy,
18 geographic atrophy,
19 and nonarteritic anterior ischemic optic neuropathy
20 display progressive choroidal atrophy (
Table). We, therefore, advise to further stratify patients with myopic CNV according to preexisting and current ophthalmic disorder, to guide treatment decisions. For instance, one could perform optical coherence tomography to rule out preexisting choroidal involution in patients who formerly had ROP and should carefully consider if anti-VEGF is appropriate at this time.