Myopic maculopathy is an eye condition that affects central vision in individuals with severe nearsightedness. It can lead to significant vision impairment and is often referred to as pathological myopia or degenerative myopia.
What is Myopic Maculopathy?
Myopic maculopathy develops in eyes with high myopia, defined as a refractive error of -6.00 diopters or more, or an axial length greater than 26.5 mm. In such eyes, the eyeball elongates excessively, causing the light-sensitive retina to stretch and thin. This stretching particularly impacts the macula, the central part of the retina responsible for sharp, detailed central vision and color perception.
The stretching of the macula can lead to various structural changes and complications. These include breaks in Bruch’s membrane, a layer between the retina and its underlying blood supply, known as lacquer cracks, which appear as yellowish-white lines. Choroidal neovascularization (CNV) is another complication, where abnormal, leaky blood vessels grow beneath the macula, causing bleeding and fluid leakage. Myopic foveoschisis, or myopic retinoschisis, can also occur, involving the splitting or stretching of the retinal layers, which can sometimes lead to retinal detachment or macular holes.
Recognizing the Signs
Individuals with myopic maculopathy may experience blurred central vision, making it difficult to see fine details or read. This blurring can occur gradually or suddenly.
Distorted vision, known as metamorphopsia, is when straight lines appear wavy or bent. This distortion happens as the macula’s shape changes due to stretching or fluid accumulation. Blind spots, or scotomas, can also develop in the center of the visual field. Any sudden decrease in vision should prompt immediate medical attention, as it could indicate active complications like bleeding from new blood vessels.
Diagnosis and Treatment Options
Ophthalmologists use specialized tools to diagnose myopic maculopathy and monitor its progression. A comprehensive eye exam is the initial step to assess eye health and identify signs of high myopia. Optical coherence tomography (OCT) provides detailed cross-sectional images of the retina and choroid, revealing thinning, fluid accumulation, or structural changes like foveoschisis and macular holes.
Fluorescein angiography (FA) involves injecting a dye into the bloodstream, which highlights blood vessels in the retina, helping to detect leaky vessels associated with choroidal neovascularization. Indocyanine green angiography (ICGA) uses a different dye to visualize deeper choroidal circulation, identifying abnormal vessels or plaques that may not be as clear on FA.
Treatment for myopic maculopathy focuses on managing its complications and preserving vision. For choroidal neovascularization (CNV), anti-vascular endothelial growth factor (anti-VEGF) injections are the primary treatment. These medications, such as bevacizumab and ranibizumab, are injected into the eye to inhibit the growth and leakage of abnormal blood vessels, often leading to improved visual acuity. While anti-VEGF therapy has shown effectiveness in improving vision in the short term, long-term outcomes can vary, and some patients may experience recurrence of CNV. In cases of myopic foveoschisis or macular holes, surgical interventions may be considered to relieve traction on the retina and flatten the macular layers.
Living with Myopic Maculopathy
Living with myopic maculopathy requires ongoing management and adaptation. Regular monitoring by an ophthalmologist is important to detect any new changes or complications early. This proactive approach allows for timely intervention, which can help preserve remaining vision.
Individuals may benefit from low vision aids to assist with daily tasks, including magnifiers, specialized lighting, and electronic devices that enlarge text or images. Visual rehabilitation services can also provide training in compensatory skills and the use of assistive technology to maximize remaining vision and maintain independence. Connecting with support groups can offer emotional support and practical advice from others who share similar experiences, fostering a sense of community and reducing feelings of isolation.