Posterior Segment
Myopic Choroidal Neovascularisation
Also known as: myopic CNV, myopic choroidal neovascularisation, myopic choroidal neovascularization, myopic macular neovascularisation, myopic neovascular maculopathy, Fuchs spot, Forster-Fuchs spot, macular haemorrhage in high myopia
Filed as: Urgent
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
New vessel growth from the choroid at the macula of a highly myopic eye, often forming along lacquer cracks or beside patchy atrophy. It presents with reduced vision, distortion or a central scotoma. The fundus signs are subtle: a small grey lesion with little haemorrhage or exudate. OCT shows a hyper-reflective lesion above the pigment epithelium with intraretinal or subretinal fluid. It is treatable and time-sensitive, so the optometry role is recognition, OCT documentation and prompt referral within days.
Recognition
Symptoms: what patients report
- Reduced central vision in one eye.
- Distortion of straight lines.
- A central scotoma when the lesion is close to the fovea.
- Painless; onset over days to weeks.
Signs: what the examination shows
- A small area of grey discolouration at the macula.
- A pigmented border when the lesion is chronic or recurrent.
- Haemorrhage and exudate are often minimal.
- OCT: hyper-reflective lesion above the pigment epithelium with intraretinal or subretinal fluid.
- Autofluorescence patterns vary and change over time.
- Background of high myopia: tessellation, diffuse or patchy atrophy, lacquer cracks, staphyloma.
- After regression: a Fuchs spot — a raised, round or oval pigmented scar, flat and well defined on OCT, often beside a patch of atrophy.
What OptoGuide™ covers for myopic choroidal neovascularisation
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Centre for Eye Health — Chair-side Reference: Myopic Maculopathy
- Wolf S et al. RADIANCE: a randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia. Ophthalmology 2014;121:682
- Ohno-Matsui K et al. Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularisation in pathological myopia. Br J Ophthalmol 2003;87:570