Comparison of Clinical Features in Highly Myopic Eyes with and without a Dome-Shaped Macula

Abstract

Purpose: To compare the clinical features of highly myopic eyes with a dome-shaped macula (DSM) with those without a DSM and to identify the funduscopic clues to suspect the presence of DSM.

Design: Retrospective case series.

Patients: A total of 586 patients (1118 eyes) with high myopia (refractive error <-8 diopters [D] or axial length ≥26.5 mm) who had optical coherence tomography (OCT) examinations through the central fovea at our High Myopia Clinic between February 2012 and November 2013.

Methods: Vertical and horizontal OCT scans across the central fovea were retrospectively analyzed. A DSM was defined by the presence of an inward bulge of >50 μm in the vertical OCT image. Fundus photographs also were analyzed to identify the funduscopic clues to suspect the presence of DSM.

Main outcome measures: The rate of DSM in 1118 highly myopic eyes. The rate of DSM in highly myopic eyes with macular complications. Funduscopic features to suggest the presence of DSM.

Results: Among the 1118 eyes, 225 (20.1%) had a DSM. A DSM was present in both vertical and horizontal OCT sections in 20% of eyes, along only the vertical section in 77% of eyes, and in only the horizontal section in 2% of eyes. The results of multiple regression analyses showed that serous retinal detachment and foveal and extrafoveal retinoschisis were significantly associated with the presence of DSM and that choroidal neovascularization was not. Ophthalmoscopically, 91.4% of the eyes with the appearance of a horizontal ridge connecting the optic disc and the fovea had a DSM.

Conclusions: A DSM is found in as many as 20% of highly myopic individuals. Horizontal ridges connecting the optic disc and the fovea might be an important clue to suspect the presence of a DSM on the basis of fundus photographs.