Myopic Maculopathy

People who are very near-sighted could be at risk of certain eye conditions, including myopic maculopathy.

What is Myopic Maculopathy? 

Eyes that have short-sightedness of more than 600 degrees are classified as having high myopia. Myopia occurs when the eyeball is too long and light rays entering the eye cannot focus on the light-sensitive part of the eye called the retina. In high myopia, the excessive elongation of the eyeball leads to degeneration of the retina, in particular, to a central part of the retina called the macula. The macula has the highest concentration of cones (light-sensitive cells that interpret colour images) in the retina and plays a central role in processing detailed images. 

Highly myopic eyes are at increased risk of pathologic myopia, a sight-threatening condition characterised by degeneration (myopic macular degeneration), stretching of the retinal layers (myopic retinoschisis) and bleeding in the macula (choroidal neovascularization, or CNV).

Myopic Maculopathy Symptoms

There may be vision loss or distortion of vision. This can occur acutely or slowly over a long period.

Ways to Prevent Myopic Maculopathy 

There is currently no treatment to prevent myopic maculopathy. However, there are several treatments being studied in the research setting to halt eye elongation and prevent the formation and progression of myopic maculopathy.

Causes and Risk Factors of Myopic Maculopathy

For general myopia, studies have shown that a strong family history of short-sightedness and not enough time outdoors during youth are risk factors of myopia. The higher the level of myopia, the greater the likelihood of forming pathologic myopia, outpouchings (staphyloma) in the back wall of the eye, and myopic maculopathy.

Diagnosis of Myopic Maculopathy 

Myopic maculopathy is diagnosed by careful examination by an ophthalmologist. This is supplemented by detailed imaging geared toward assessing for subtle thinning of the retina and the underlying blood layer (choroid) and deformability of the eyewall (sclera).

Myopic Maculopathy Treatment

Treatment for myopic maculopathy depends on the type of problem that arises. For example, choroidal neovascularization can be treated with intravitreal injections of anti-VEGF (vascular endothelial growth factors). For myopic foveoschisis (with foveal detachment) and macular hole, the treatment of choice is surgery, including vitrectomy, membrane peel and intraocular gas. Note that repair of myopic foveoschisis (with foveal detachment) and myopic macular holes would usually require patients to maintain a face-down position to allow the intraocular gas to perform its function and help the repair’s success.

What Should I Do if I Have High Myopia?

Singapore has one of the highest prevalence of high myopia in the world, particularly among the younger working population. As these individuals grow older, the burden of myopia-related blindness will increase exponentially. The High Myopia Clinic at Singapore National Eye Centre (SNEC) was set up to meet this emerging healthcare need. It is a specialised clinic for patients with high myopia and/or pathologic myopia.

Tests for High Myopia

The goal of the High Myopia Clinic is to identify patients who are at the greatest risk of permanent vision loss from pathologic myopia and to guide research on novel treatments for the prevention of sight-threatening complications.

On a typical visit to the high myopia clinic, the patient undergoes vision and eye pressure measurements similar to any other SNEC clinic. This is followed by measurements of the eye length and a series of advanced, noninvasive imaging of the optic nerve, retina and choroid to diagnose pathologic myopia-related complications like glaucoma, myopic choroidal neovascularization, myopic retinoschisis and myopic macular degeneration.

These tests include swept-source optical coherence tomography that allows high-resolution 3D imaging of the macula and the optic nerve and optical coherence tomographic angiography for noninvasive imaging of the retinal and choroidal blood flow.

Patients may also undergo biomechanical testing to measure the stiffness of the posterior eyewall with ultrasonography to assess the risk of further eye elongation and worsening myopia. They will then be examined by one of our subspecialty experts who focuses specifically on the diseases and needs of patients with high myopia. Those with treatable conditions can be identified early and receive treatment in a timely manner to preserve or improve vision. Stable patients will be monitored on an annual basis for progression.

By caring for a large number of highly myopic patients, coupled with our sophisticated imaging techniques, we can determine which patients are at the highest risk of permanent vision loss from pathologic myopia and make advancements in the way we treat sight-threatening complications of high myopia.

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