Mild Fundus Lesions May Predict Myopic Maculopathy Progression in Youth

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Approximately 1 in 8 children and adolescents exhibited myopic maculopathy change over a 4-year period, with enlargement of the diffuse atrophy the most common progression pattern.

Approximately 1 in 8 children and adolescents with high myopia experienced progression of myopic maculopathy over a 4-year follow-up period, according to new research.1

Results from the hospital-based observational study in China revealed the risk factors for myopia maculopathy progression included worsening best-corrected visual acuity (BCVA), longer axial length (AL), faster axial length elongation, and more severe myopia maculopathy.

“The 4-year incidence rate of myopia maculopathy progression in Chinese children and adolescents found in this study was 12.2%, which was lower compared with previous investigations in an older population, ranging from 19.6% to 58.6%,” wrote the investigative team, led by Mingguang He, MD, PhD of the department of experimental ophthalmology at The Hong Kong Polytechnic University.

Current estimates posit that visual impairment due to myopia maculopathy will affect nearly 56 million people, with an estimated 18.5 million globally affected by blindness.2 However, despite its importance, the progression pattern of myopic maculopathy is poorly understood in individuals younger than 18 years of age. Knowledge of progression patterns could benefit timely intervention in those at risk of developing pathologic fundus lesions.1

He and colleagues assessed the 4-year progression of myopic maculopathy to explore the factors associated with progression. The hospital-based study recruited children and adolescents with bilateral high myopia who underwent examination at the Zhongshan Ophthalmologic Center. A total of 426 individuals with high myopia aged 7 to 17 years initially examined between 2011–2012 were identified, of whom 277 participants (65%) received a 4-year follow-up examination.

Each study participant completed an ophthalmic examination at baseline and the 4-year follow-up visit. Myopic maculopathy was classified and graded into five categories: absence of myopic-related fundus lesions (category 0 [C0]), tessellated fundus (category 1 [C1]), diffuse chorioretinal atrophy (category 2 [C2]), patchy chorioretinal atrophy (category 3 [C3]), and macular atrophy (category 4 [C4])

Investigators defined the progression of myopia maculopathy as the development of new categories of myopic maculopathy, such as the new presence of plus lesions, the emergence of new categories, the enlargement of existing atrophic lesions, and an increasing number of existing plus lesions. They performed data analysis from August 1 to 15, 2023.

At the baseline visit, the study included 426 participants. After exclusions due to declining participation and corrective surgery, 548 eyes from 274 participants were examined in the analysis (52%). Overall, the progression of myopia maculopathy was found in 67 of 548 eyes (12.2%) with 88 lesion changes.

Among these lesion changes, investigators observed the new development of tessellated fundus in 16 eyes (18.2%), diffuse atrophy in 12 eyes (13.6%), and patchy atrophy in 2 eyes (2.3%). The study team found the first appearance of lacquer cracks in 9 eyes (10.2%) and the enlargement of diffuse atrophy in 49 eyes (55.7%).

The multivariable logistic regression model adjusting for covariates revealed factors associated with an increased risk of the presence of maculopathy progression over 4 years. According to multivariable analysis, worse BCVA (odds ratio [OR], 6.68; 95% CI, 1.15 - 38.99; P = .04), longer AL (OR, 1.73; 95% CI, 1.34 - 2.24; P <.001), faster AL elongation (OR, 302.38; 95% CI, 28.61 - 3205.64; P <.001), diffuse atrophy (OR, 4.52; 95% CI, 1.98 - 10.30; P <.001), and patchy atrophy (OR, 3.82; 95% CI, 1.66 - 8.80; P = .002) were each associated with progression.

Based on these data, He and colleagues indicated children and adolescents with myopic maculopathy of C1 or C2 have a greater risk of progression. They noted these data differ from that of the SEED cohort study, which suggested an adult population with myopia maculopathy of C3 or C4 experience a greater progression risk.

“Therefore, it is imperative to closely monitor and implement proactive interventions for young individuals who just have mild fundus lesions and are likely to deteriorate further,” investigators wrote.


  1. Jiang F, Wang D, Xiao O, et al. Four-Year Progression of Myopic Maculopathy in Children and Adolescents With High Myopia. JAMA Ophthalmol. Published online January 25, 2024. doi:10.1001/jamaophthalmol.2023.6319
  2. Fricke TR, Jong M, Naidoo KS, et al. Global prevalence of visual impairment associated with myopic macular degeneration and temporal trends from 2000 through 2050: systematic review, meta-analysis and modelling. Br J Ophthalmol. 2018;102(7):855-862. doi:10.1136/bjophthalmol-2017-311266