Six-Year Changes in Myopic Macular Degeneration in Adults of the Singapore Epidemiology of Eye Diseases Study

Abstract

To examine the 6-year incidence, progression, associated risk factors, and impact of myopic macular degeneration (MMD) in a myopic population in Singapore. METHODS. We examined myopic (spherical equivalent ≤-0.5 diopters) adults (N = 2157 persons and 3661 eyes) who were phakic at baseline and participated in both baseline and 6-year follow-up visits of the Singapore Epidemiology of Eye Diseases study. Eye examinations, including visual acuity, subjective refraction and axial length (AL) measurements, were performed. MMD was graded from fundus photographs following the META-PM classification. Vision-related quality of life was assessed with Raschtransformed scores from reading, mobility, and emotional domains of the Impact of Vision Impairment questionnaire. RESULTS. The 6-year eye-specific incidence of MMD among myopic eyes was 1.2% (95% CI, 0.9%-1.6%). Older age, worse spherical equivalent, and longer AL at baseline were associated with MMD incidence (all P < 0.001). The 6-year eye-specific progression of MMD in 288 eyes with baseline MMD was 17.0% (95% CI, 12.6%-21.4%). More severe MMD at baseline, worse spherical equivalent, and longer AL (all P < 0.05) were associated with MMD progression. Patients with Meta-PM categories 3 and 4 had worse best-corrected visual acuity and poorer vision-related quality of life outcomes than those without MMD (all P < 0.05). CONCLUSIONS. Over a 6-year period, one in 80 myopic eyes developed MMD and one in six with existing MMD had MMD progression. Myopia severity and AL were strong predictors of MMD development and progression. Eyes with severe MMD were at higher risk of MMD progression than those with less severe MMD, and were associated with poorer visual acuity and vision-related quality of life.

Investigation of Macular Choroidal Thickness and Blood Flow Change by Optical Coherence Tomography Angiography After Posterior Scleral Reinforcement

“…Both CPA and CCPA tend to be lower in eyes with severe MMD compared to eyes with mild MMD, although the difference was not statistically significant in some regions. Previous studies have found that more severe myopia levels were associated with longer axial elongation ( 22 ) and that eyes with severe MMD were at higher risk of MMD progression than eyes with mild MMD ( 23 ). Considering the relationship between CPA and MMD severity, these results may present a role for choroidal vascularity in the myopia development and progression.…”

IMI Impact of Myopia

“… 82 In older individuals, those with advanced MMD had poorer vision-related QOL than those without. 84 …”

“…82 In older individuals, those with advanced MMD had poorer vision-related QOL than those without. 84 Additionally, the impact of myopia on QOL differs by type of myopia. In presbyopic populations, individuals with myopic astigmatism have worse QOL than spherical myopia.…”

Association of Aberrant Posterior Vitreous Detachment and Pathologic Tractional Forces With Myopic Macular Degeneration

“…4,9 MTM is known to be strongly associated with persistent vitreous adhesion, vitreomacular traction, and posterior staphyloma (PS), 8,[12][13][14][15] whereas for MMD, the pathogenic pathway is less clear, aside from its association with ageing and greater axial length (AL). 4,7,16,17 Interestingly, not all highly myopic eyes develop degenerative PM changes, even in the same individual with comparable AL in both eyes. 4 This observation could be attributed to several factors, many of which are tractional in origin.…”

“… 4 , 9 MTM is known to be strongly associated with persistent vitreous adhesion, vitreomacular traction, and posterior staphyloma (PS), 8 , 12 – 15 whereas for MMD, the pathogenic pathway is less clear, aside from its association with ageing and greater axial length (AL). 4 , 7 , 16 , 17 …”