Myopic maculopathy risk factors and progression in children

Paper title: Four-Year Progression of Myopic Maculopathy in Children and Adolescents With High Myopia

Authors: Jiang, Feng (1), Wang, Decai (1), Xiao, Ou (1), Guo, Xinxing (2), Yin, Qiuxia (1), Luo, Lixia (1), He, Mingguang (1,3), Li, Zhixi (1)

1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.

2. Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
3. Experimental Ophthalmology, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.

Date: Mar 24

Reference: Jiang F, Wang D, Xiao O, Guo X, Yin Q, Luo L, He M, Li Z. Four-Year Progression of Myopic Maculopathy in Children and Adolescents With High Myopia. JAMA Ophthalmol. 2024 Mar 1;142(3):180-186

[Link to abstract]

The International Myopia Institute white paper on Pathological Myopia states that the prevalence of pathological myopia is 1-19% in low to moderate myopia (up to -3.00D) but has a prevalence of 50-70% for high myopia. Although there is a lower prevalence in children and adolescents, it increases along with myopia severity and age.¹

This hospital-based observational study in China investigated progression of myopic maculopathy in children and teenagers with high myopia over four years and explored the potential risk factors. The study included 247 participants (548 eyes) aged 7 to 17yrs with myopia of -6.00D or stronger. Comprehensive eye examinations were carried out at baseline and at 4-yr follow-up and myopic maculopathy was assessed using the International Photographic Classification and Grading System. The participants had a mean axial length of 27.08mm, a mean spherical equivalent of -9.12D and 50.4% were girls.

After 4yrs, progression of myopic maculopathy occurred for 12.2% of the cohort (67 eyes). The most commonly found progressive change was the enlargement of diffuse atrophy for 55.7% (49 eyes). However, there were also 88 various other new signs of new lesion changes including: tessellated fundus (16 eyes, 18.2%), diffuse atrophy (12 eyes, 13.6%), lacquer cracks (9 eyes, 10.2%) and patchy atrophy (2 eyes, 2.3%).

Multivariate analysis revealed that odds ratios for risk factors associated with progression of myopic maculopathy were:

• Faster axial elongation (OR 302.83)
• Worst best-corrected visual acuity (OR 6.68)
• More severe myopic maculopathy at baseline (diffuse atrophy OR 4.52 and patchy atrophy OR 3.82)
• Longer axial length OR 1.73

Myopic maculopathy progressed for 1 in 8 in children under 18yrs in this study cohort. The study outcomes highlighted the need to identify and regularly monitor patients under 18yrs who have high and/or progressing myopia due to their higher risk of progressing myopic maculopathy. Faster AL elongation, worse best-corrected visual acuity, more severe myopic maculopathy at baseline and longer axial length were all associated risk factors for progression of myopic maculopathy.

Actively taking steps to limit axial elongation and myopia progression in clinical practice reduces the risk of children developing high myopia and its associated pathologies and improves visual outcomes. 

Further study is needed to investigate the progression and stages of myopic maculopathy in highly myopic children and teenagers. The results could contribute to research in management and treatment strategies.

Wider research into the use of classification and grading systems and Optical Coherence Tomography (OCT) in clinical practice to will confirm their role in observing and monitoring retinal changes.

Title: Four-Year Progression of Myopic Maculopathy in Children and Adolescents With High Myopia

Authors: Jiang, Feng; Wang, Decai; Xiao, Ou; Guo, Xinxing; Yin, Qiuxia; Luo, Lixia; He, Mingguang; Li, Zhixi

Purpose:  To investigate the 4-year progression of myopic maculopathy in children and adolescents with high myopia, and to explore potential risk factors.

Methods: This hospital-based observational study with 4-year follow-up included a total of 548 high myopic eyes (spherical power −6.00 or less diopters) of 274 participants aged 7 to 17 years. Participants underwent comprehensive ophthalmic examination at baseline and 4-year follow-up. Myopic maculopathy was accessed by the International Photographic Classification and Grading System. The data analysis was performed from August 1 to 15, 2023.

Results: The 4-year progression of myopic maculopathy was found in 67 of 548 eyes (12.2%) of 274 participants (138 girls [50.4%] at baseline and 4-year follow-up) with 88 lesion changes, including new signs of the tessellated fundus in 16 eyes (18.2%), diffuse atrophy in 12 eyes (13.6%), patchy atrophy in 2 eyes (2.3%), lacquer cracks in 9 eyes (10.2%), and enlargement of diffuse atrophy in 49 eyes (55.7%). By multivariable analysis, worse best-corrected visual acuity (odds ratio [OR], 6.68; 95% CI, 1.15-38.99; P = .04), longer axial length (AL) (OR, 1.73; 95% CI, 1.34-2.24; P < .001), faster AL elongation (OR, 302.83; 95% CI, 28.61-3205.64; P < .001), and more severe myopic maculopathy (diffuse atrophy; OR, 4.52; 95% CI, 1.98-10.30; P < .001 and patchy atrophy; OR, 3.82; 95% CI, 1.66-8.80; P = .002) were associated with myopic maculopathy progression.

Conclusions: In this observational study, the progression of myopic maculopathy was observed in approximately 12% of paediatric high myopes for 4 years. The major type of progression was the enlargement of diffuse atrophy. Risk factors for myopic maculopathy progression were worse best-corrected visual acuity, longer AL, faster AL elongation, and more severe myopic maculopathy. These findings support consideration of follow-up in these individuals and trying to identify those at higher risk for progression.

[Link to abstract]