Prevalence of Myopic Macular Degeneration Show Lack of Ancestry Link in European Cohort

Caroline C. W. Klaver, MD, PhD

As the high incidence of myopia continues to increase worldwide, visual burden caused by myopia is expected to swell accordingly.

However, few studies have currently investigated myopic complications in patients of European ancestry with high myopia, hindering potential insights into frequency and burden in these patient populations.

As a result, a recent cross-sectional study assessed the frequency of muopic macular features in individuals of European ancestry with high myopia in the population-based Rotterdam Study (RS) and the Dutch Myopia Study (MYST). Its findings showed the prevalence of myopic macular degeneration (MMD) was associated with axial length (AL), spherical equivalent of refractive error (SER), and age, but not necessarily ancestry.

Methods

Led by Caroline C. W. Klaver, MD, PhD, Department of Ophthalmology, Erasmus Medical Center Rotterdam, a team of investigators included patients with a SER of -6 diopters (D) or less and an AL of ≥26mm or greater from RS (n = 117) and MYST (n = 509).

THE RS consisted of 3 population-based cohorts of patients aged ≥45 years, while MYST was conducted from 2010 - 2012.

Each study used extensive ophthalmological examinations including multimodal retinal imaging. They graded the retinal images utilizing information for all modalities, including fundus photography, OCT, infrared imaging, and autofluorescence.

The main outcomes were considered the frequency of myopic macular and optic disc features, tessellated fundus, myopic macular degeneration (MMD), staphyloma, peripapillary intrachoroidal cavitation, peripapillary atrophy (PPA), and “plus” lesions.

Investigators performed logistic regression analyses in order to assess the association between MMD lesions or META-PM categories and AL or SER and adjusted for sex and SER to assess the association between MMD lesions and age.

Additionally, they conducted a systematic literature review to compare findings with studies of individuals of Asian ancestry.

Findings

Data show participants of RS had a mean age of 69.2 years and 48 (41.0%) were men, with a mean SER of -8.4 D and a mean AL of 26.5 mm. Further, the mean age of MYST was 47.3 years and 191 (37.5%) were men, with a mean SET of -10.3 and a mean AL of 27.5mm.

Of the combined study population, the mean SER was -9.9 D, while the mean age was 51.4 years and 387 (61.8%) were women. The prevalence of MMD was 25.9% and shown to increase with older age (P <.001), lower SER (odds ratio, 0.70; 95% CI, 0.65 - 0.76), and higher AL (OR, 2.53; 95% CI, 2.13 - 3.06).

However, data show MMD was not rare in younger patients, at a rate of 9.2% (6 of 65) in patients with high myopia aged 20 - 29 years and 10.6% (10 of 94) in patients aged 30 - 39 years, and 25.0% (31 of 124) in patients aged 40 - 49 years.

The occurrence of META-OM plus lesions were considered, as choroidal neovascularization or Fuchs spot was present in 2.7% (n = 17), both lesions in 0.3% (n = 2), and lacquer cracks in 1.4% (n = 9). Additionally, data show staphyloma, PPA, and MMD were prevalent in visual impaired and blind eyes at a frequency of 73.9%, 90.5%, and 63.0% of unilateral blind eyes for MMD, staphyloma, and PPA, respectively.

In eyes with a CNV/Fuchs spot, the frequency of lacquer cracks (5.6% versus 1.3%; P = .23), diffuse hypopigmentation (72.2% versus 21%; P < .001), and MMD (100% versus 23.6%; P < .001) was higher than in eyes without a CNV/Fuchs spot.

Investigators also found 7 previous studies in Asian populations had reported a variable MMD frequency ranging from 8.3% to 64%, with similar frequencies for comparable risk profile based on age and SER.

Takeaways

“To save quality of life and productivity, future research needs to focus on development of innovative interventions to prevent these complications, and eye care clinicians should encourage myopia control,” investigators wrote.

The study, “Prevalence of Myopic Macular Features in Dutch Individuals of European Ancestry With High Myopia,” was published in JAMA Ophthalmology.