IMI Report on Pathologic Myopia

Authors: Kyoko Ohno-Matsui, Pei-Chang Wu, Kenji Yamashiro, Kritchai Vutipongsatorn, Yuxin Fang, Chui Ming Gemmy Cheung, Timothy Y.Y. Lai, Yasushi Ikuno, Salomon Yves Cohen, Alain Gaudric, Jost B. Jonas

Date: April 2021

Reference: Ohno-Matsui K, Wu PC, Yamashiro K, Vutipongsatorn K, Fang Y, Cheung CMG, Lai TYY, Ikuno Y, Cohen SY, Gaudric A, Jonas JB. IMI Pathologic Myopia. Invest Ophthalmol Vis Sci. 2021 Apr 28;62(5):5. (Link to open access paper)

Pathological myopia is a major cause of visual impairment worldwide. It affects up to 3% of the world’s population and causes vision impairment or blindness in 0.2% to 1.5% of Asians and 0.1% to 0.5% of Caucasians. Notably, pathological and high myopia are not the same. High myopia is a high degree of myopic refractive error, whereas pathological myopia is defined by a presence of fundal complications, such as posterior staphyloma or myopic maculopathy equal to or more serious than diffuse choroidal atrophy. While pathological myopia often occurs in eyes with high myopia, its complications (especially posterior staphyloma) can also occur in eyes without high myopia. It is one of the major causes of low vision in working-aged populations.

The prevalence of both myopia and high myopia is increasing worldwide. However, it remains unclear whether or not pathologic myopia will increase in parallel with an increase of myopia itself. Genome-wide association studies (GWASs) have identified more than hundreds susceptibility genes for myopia. However, the genetic background for pathologic myopia has not been elucidated fully. It is not clear whether genes responsible for pathological myopia are the same as those for myopia in general, or whether pathological myopia is genetically different from other myopia. 

Advances in ocular imaging, especially optic coherence tomography (OCT) have allowed accurate diagnosis of pathological myopia and revealed novel lesions like dome-shaped macula and myopic tractional maculopathy. The article provides an in- depth assessment of the features of pathological myopia, including posterior staphyloma, myopic choroidal atrophy, myopic macular neovascularisation, tractional maculopathy and glaucoma.

The effectiveness of new therapies for complications are discussed, such as anti-VEGF therapies for myopic macular neovascularization and vitreoretinal surgery for myopic traction maculopathy.

This provides eye care practitioners with a better understanding of pathological myopia and its characteristics, allowing for better diagnosis and management.

While diagnostic methods and therapries for pathological myopia have been greatly advancing, therapeutic approaches for choroidal atrophies and optic nerve damage are not sufficient. The diagnosis of glaucoma in the context of pathological myopia is challenging and further advances are required. Clarification is required regarding the genes responsible for pathological myopia, in order to identify which children will become pathologically myopic. Lastly, future studies regarding the global prevalence of pathological myopia and its impact on vision and quality of life should be undertaken.

Title: IMI Pathological Myopia

Authors: Kyoko Ohno-Matsui, Pei-Chang Wu, Kenji Yamashiro, Kritchai Vutipongsatorn, Yuxin Fang, Chui Ming Gemmy Cheung, Timothy Y.Y. Lai, Yasushi Ikuno, Salomon Yves Cohen, Alain Gaudric, Jost B. Jonas

Pathologic myopia is a major cause of visual impairment worldwide. Pathologic myopia is distinctly different from high myopia. High myopia is a high degree of myopic refractive error, whereas pathologic myopia is defined by a presence of typical complications in the fundus (posterior staphyloma or myopic maculopathy equal to or more serious than diffuse choroidal atrophy). Pathologic myopia often occurs in eyes with high myopia, however its complications especially posterior staphyloma can also occur in eyes without high myopia.

Owing to a recent advance in ocular imaging, an objective and accurate diagnosis of pathologic myopia has become possible. Especially, optical coherence tomography has revealed novel lesions like dome-shaped macula and myopic traction maculopathy. Wide-field optical coherence tomography has succeeded in visualizing the entire extent of large staphylomas. The effectiveness of new therapies for complications have been shown, such as anti-VEGF therapies for myopic macular neovascularization and vitreoretinal surgery for myopic traction maculopathy.

Myopia, especially childhood myopia, has been increasing rapidly in the world. In parallel with an increase in myopia, the prevalence of high myopia has also been increasing. However, it remains unclear whether or not pathologic myopia will increase in parallel with an increase of myopia itself. In addition, it has remained unclear whether genes responsible for pathologic myopia are the same as those for myopia in general, or whether pathologic myopia is genetically different from other myopia.