Pathologic Myopia: Complications and Visual Rehabilitation

Abstract

High myopia, defined as refractive error of at least −6.00D or an axial length of 26.5 mm or more, can induce many modifications in eye's anatomy that can lead to complications. When high myopia is able to decrease best corrected visual acuity (BCVA) due to its complications, it is called pathologic myopia. Pathologic myopia is one of the major causes of blindness, and it represents a serious issue, since incidence of myopia and high myopia is constantly rising. For educational purposes, in this chapter, complications of pathologic myopia will be divided into anterior (when structures external to the globe or anterior to the ora serrata are involved, such as motility disturbances and cataract) and posterior (when structures posterior to the ora serrata are involved, such as lacquer cracks, chorioretinal atrophy, Fuchs maculopathy, myopic choroidal neovascularization, and retinal detachment). Many treatments are available for pathologic myopia complications depending on their type, such as vascular endothelial growth factor (anti-VEGF) injections and surgery. We will focus on visual rehabilitation interventions, such as visual biofeedback and visual aids that in many cases are the only chance that the ophthalmologist has in order to help patients suffering from pathologic myopia to use at their maximum their residual vision.

Foveal Retinoschisis: Case Report and Clinical Review

“…Despite the etiology of the foveoschisis, indications for treatment depend on the significance of the patient's symptoms and other potential complications associated with the condition, including development of subretinal fluid. 4,5,6 Expected outcomes of treatment are dependent on the patient's initial presentation. 7,8 Case Presentation An 81-year-old African American male presented to the clinic in January 2020 for his yearly comprehensive eye exam complaining of mildly reduced vision through his habitual glasses at all ranges with both eyes.…”

“…Often, these degenerative findings are a result of pathological myopia, defined as a myopic refractive error of at least six diopters with degenerative fundus changes and an axial length of greater than 26.5 millimeters. 4,6 The root cause of degenerative myopic changes involves congenital scleral weakness which leads to progressive globe enlargement, axial lengthening, and finally the formation of a posterior staphyloma. 4,15 In many patients with pathological myopia, focal retinoschisis in the macula can develop.…”

“…Univariate analysis showed significant association of increasing age and presence of posterior staphyloma with development of MF. 6 The severity of the myopic foveoschisis varies depending on the presence of other factors, such as epiretinal membranes that cause inner retinal traction. A retrospective case series of 29 eyes by Gaucher et al found the presence of epiretinal membranes on OCT testing resulted in slow visual decline and further splitting of the inner retinal layers.…”

“…Surgeons must also determine the necessity for an internal limiting membrane (ILM) peel. 4,6 Marked progression of symptoms including a reduction in visual acuity or increased metamorphopsia signifies an "unstable" foveoschisis. 4,5 A 2005 study published in the British Journal of Ophthalmology evaluated nine eyes in patients who had been treated with Diagnostically, two factors that play a pivotal role in confirming the presence of optic disc pits are FA and OCT imaging.…”