Posterior Segment
Pathologic Myopia (Myopic Maculopathy)
Also known as: pathologic myopia, pathological myopia, myopic maculopathy, myopic macular degeneration, degenerative myopia, high myopia fundus, tessellated fundus, diffuse chorioretinal atrophy
Filed as: Routine
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
Structural change at the macula in a highly myopic eye, where a long axial length (over 26 mm) and/or a posterior staphyloma is the common factor. The changes fall into three groups that can coexist: atrophic, tractional and neovascular. Most atrophic change is monitored at a set interval with OCT and photography. Foveal detachment, a full-thickness macular hole, reduced acuity, structural progression and any sign of neovascularisation are referred.
Recognition
Symptoms: what patients report
- Often none: atrophic change is commonly found at a routine examination.
- Slow reduction in central vision or contrast as atrophy approaches the fovea.
- Distortion or a new central blur raises concern for tractional change or neovascularisation.
- A dome-shaped macula may present with reduced vision and distortion.
Signs: what the examination shows
- Tessellated fundus: choroidal vessels more visible through a thinned pigment epithelium; OCT profile intact.
- Diffuse chorioretinal atrophy: yellowish-white posterior pole, starting at the disc and macula; thin choroid on OCT with an intact retinal profile.
- Patchy chorioretinal atrophy: well-defined grey-white areas at the macula or around the disc with choroidal vessels visible inside; sclera visible when advanced; choriocapillaris lost on OCT. A round patch at the central fovea is macular atrophy.
- Lacquer cracks: yellow-white lines at the macula, usually horizontal, sometimes branching or crossing; OCT shows a break in the pigment epithelium with increased transmission beneath.
- Fuchs spot: a raised round or oval pigmented scar left by a regressed neovascular membrane, often beside a patch of atrophy.
- Tractional change on OCT: outer foveoschisis, inner and outer foveoschisis, shallow foveal detachment, or a full-thickness macular hole.
- Posterior staphyloma: posterior bowing of sclera, choroid and retina on OCT; B-scan shows its posterior extent.
- Dome-shaped macula: convex macular elevation inside a staphyloma, seen only on OCT; scan both vertically and horizontally.
What OptoGuide™ covers for pathologic myopia (myopic maculopathy)
- 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
- Centre for Eye Health — Chair-side Reference: Structural Changes in Myopia
- 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
- Ohno-Matsui K et al. International photographic classification and grading system for myopic maculopathy (META-PM). Am J Ophthalmol 2015;159:877