Correlation of Visual Acuity and Outer Retinal Thickness in Myopic Atrophic Maculopathy: A Retrospective Review

Cheng-Yung Lee; Yun Hsia; Mei-Chi Tsui; Shih-Wen Wang; Chien-Jung Huang; I-Hsin Ma; Kuo-Chi Hung; Muh-Shy Chen; Tzyy-Chang Ho

doi:10.1007/s40123-023-00710-3

Correlation of Visual Acuity and Outer Retinal Thickness in Myopic Atrophic Maculopathy: A Retrospective Review

Ophthalmol Ther. 2023 Aug;12(4):1989-2003. doi: 10.1007/s40123-023-00710-3. Epub 2023 May 12.

Authors

Cheng-Yung Lee¹, Yun Hsia^{1

2}, Mei-Chi Tsui¹, Shih-Wen Wang^{1

3}, Chien-Jung Huang^{1

4}, I-Hsin Ma^{1

2}, Kuo-Chi Hung^{1

5}, Muh-Shy Chen^{1

6}, Tzyy-Chang Ho⁷

Affiliations

¹ Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, No 7, Chung-Shan S. Rd., Taipei, 10002, Taiwan.
² Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu, Hsinchu, Taiwan.
³ Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
⁴ Department of Ophthalmology, Fu Jen Catholic University Hospital, New Taipei City, Taiwan.
⁵ Universal Eye Clinic, Taipei, Taiwan.
⁶ Department of Ophthalmology, Cardinal Tien Hospital, New Taipei City, Taiwan.
⁷ Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, No 7, Chung-Shan S. Rd., Taipei, 10002, Taiwan. hotchang@ntu.edu.tw.

Abstract

Introduction: Myopic atrophic maculopathy is prevalent among patients with pathologic myopia and frequently leads to relentless vision loss. Several grading systems were established to facilitate the understanding of myopic atrophic maculopathy. However, the anatomical details in different stages of myopic maculopathy are so far not clearly elucidated. This study aims to investigate the visual acuity and retinal sublayer features in highly myopic eyes with varying severities of myopic atrophic maculopathy (MAM).

Methods: The clinical records of 111 consecutive patients (158 eyes) with high myopia (refractive error ≤ -6.0 D and axial length ≥ 26.0 mm) were reviewed. Fundus photography, optical coherence tomography (OCT), and best-corrected visual acuity (BCVA) were measured. MAM was graded according to the META-analysis for Pathologic Myopia (META-PM) classification system. Myopic choroidal neovascularization (mCNV) and dome-shaped macula (DSM) were also investigated.

Results: Among the 158 eyes, 18 (11%), 21(13%), 24 (15%), 25 (16%), 23 (15%), and 24 (15%) had tessellated fundus, diffuse chorioretinal atrophy, diffuse chorioretinal atrophy with DSM, patchy atrophy, patchy atrophy with DSM, and MAM with mCNV, respectively. A total of 23 (15%) eyes had macular atrophy without mCNV. Progressive thinning in the Henle's fiber and outer nuclear layers, myoid and ellipsoid zone (MEZ), outer segment (OS), and interdigitation zone and retinal pigmented epithelium based on the severity of MAM (p-value < 0.001) was found. MEZ and OS were most significantly reduced in thickness (p-value < 0.001). The presence of mCNV demonstrated significant outer retinal layer thinning compared with that of the tessellated fundus (p-value = 0.031). Patchy atrophy with DSM showed statistically poorer BCVA compared with that without (p-value = 0.008).

Conclusion: Visual acuity and outer retinal sublayer characteristics were correlated with the severity of MAM. Outer retinal sublayer analysis by spectrum-domain OCT shed some light on the mechanisms of MAM progression.

Keywords: Best-corrected visual acuity; Dome-shape macula; Myopic atrophic maculopathy; Myopic choroidal neovascularization; Optical coherence tomography; Pathologic myopia; Retinal thickness.