Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN)

Myopia is a highly frequent ocular disorder worldwide and pathologic myopia is the 4th most common cause of irreversible blindness in developed countries. Pathologic myopia is especially common in East Asian countries. Ocular alterations associated with pathologic myopia, especially those involving...

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Bibliographic Details
Published in:Progress in retinal and eye research 2019-03, Vol.69, p.80-115
Main Authors: Ruiz-Medrano, Jorge, Montero, Javier A., Flores-Moreno, Ignacio, Arias, Luis, García-Layana, Alfredo, Ruiz-Moreno, José M.
Format: Article
Language:English
Subjects:
ATN classification system
Choroidal Neovascularization - pathology
High myopia
Humans
Myopia, Degenerative - classification
Myopia, Degenerative - diagnostic imaging
Myopia, Degenerative - pathology
Myopic choroidal neovascularization
Myopic maculopathy
Myopic maculopathy classification
Myopic traction maculopathy
Pathologic myopia
Retinal Detachment - pathology
Retinal Diseases - classification
Retinal Diseases - diagnostic imaging
Retinal Diseases - pathology
Retinal Neovascularization - pathology
Staphyloma
Tomography, Optical Coherence
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Summary:Myopia is a highly frequent ocular disorder worldwide and pathologic myopia is the 4th most common cause of irreversible blindness in developed countries. Pathologic myopia is especially common in East Asian countries. Ocular alterations associated with pathologic myopia, especially those involving the macular area—defined as myopic maculopathy—are the leading causes of vision loss in patients with pathologic myopia. High myopia is defined as the presence of a highly negative refractive error (>−6 to −8 diopters) in the context of eye elongation (26–26.5 mm). Although the terms high myopia and pathologic myopia are often used interchangeably, they do not refer to the same eye disease. The two key factors driving the development of pathologic myopia are: 1) elongation of the axial length and 2) posterior staphyloma. The presence of posterior staphyloma, which is the most common finding in patients with pathologic myopia, is the key differentiating factor between high and pathologic myopia. The occurrence of staphyloma will, in most cases, eventually lead to other conditions such as atrophic, traction, or neovascular maculopathy. Posterior staphyloma is for instance, responsible for the differences between a myopic macular hole (MH)—with and without retinal detachment—and idiopathic MH. Posterior staphyloma typically induces retinal layer splitting, leading to foveoschisis in myopic MH, an important differentiating factor between myopic and emmetropic MH. Myopic maculopathy is a highly complex disease and current classification systems do not fully account for the numerous changes that occur in the macula of these patients. Therefore, a more comprehensive classification system is needed, for several important reasons. First, to more precisely define the disease stage to improve follow-up by enabling clinicians to more accurately monitor changes over time, which is essential given the progressive nature of this condition. Second, unification of the currently-available classification systems would establish standardized classification criteria that could be used to compare the findings from international multicentric studies. Finally, a more comprehensive classification system could help to improve our understanding of the genetic origins of this disease, which is clearly relevant given the interchangeable—but erroneous—use of the terms high and pathologic myopia in genetic research. •Progression of high myopia and the appearance of the staphyloma are the most
ISSN:1350-9462
1873-1635
DOI:10.1016/j.preteyeres.2018.10.005