Myopia-Related Fundus Changes in Singapore Adults With High Myopia

doi:10.1016/j.ajo.2013.01.016

American Journal of Ophthalmology

Volume 155, Issue 6, June 2013, Pages 991-999.e1

https://doi.org/10.1016/j.ajo.2013.01.016 Get rights and content

Purpose

To examine the pattern of myopia-related macular and optic disc changes in Singapore adults with high myopia (spherical equivalent ≤−6.00 diopters).

Design

Asian adults with high myopia from 3 population-based surveys.

Methods

Adults 40 years and older (n = 359) with high myopia were pooled from 3 population-based surveys in Singapore Asians: (1) the Singapore Prospective Study Program (SP2, n = 184); (2) the Singapore Malay Eye Study (SiMES, n = 98); and (3) the Singapore Indian Eye Study (SINDI, n = 77). All study participants underwent standardized refraction and fundus photography, and SiMES and SINDI subjects also completed ocular biometry measurements. Myopia-related macular (posterior staphyloma, lacquer cracks, Fuchs spot, myopic chorioretinal atrophy, and myopic choroidal neovascularization) and optic disc (optic nerve head tilt, optic disc dimensions, and peripapillary atrophy) changes were evaluated.

Results

The most common myopia-related macular finding in adults with high myopia was staphyloma (23%), followed by chorioretinal atrophy (19.3%). There were few cases of lacquer crack (n = 6, 1.8%), T-sign (n = 6, 1.8%), retinal hemorrhage (n = 3, 0.9%), active myopic choroidal neovascularization (n = 3, 0.9%), and no case of Fuchs spot. The most common disc finding associated with high myopia was peripapillary atrophy (81.2%), followed by disc tilt (57.4%). Staphyloma and chorioretinal atrophy increased in prevalence with increasing age, increasing myopic refractive error, and increasing axial length (all P < .001). Ethnicity comparisons demonstrated the highest proportion of staphyloma (P = .04) among Malays, the highest proportion of peripapillary atrophy (P = .01) and disc tilt (P < .001) among Chinese, and the largest cup-to-disc ratio (P < .001) among Indians.

Conclusions

Staphyloma and chorioretinal atrophy lesions were the most common fundus findings among Asian adults with high myopia. In this population, tilted discs and peripapillary atrophy were also common, while choroidal neovascularization and Fuchs spot were rare. In contrast with Singapore teenagers, in whom tilted disc and peripapillary atrophy were common while staphyloma and chorioretinal atrophy were rare, pathologic myopia appears to be dependent on the duration of disease and, thus, age of the individual.

Section snippets

Methods

We included Singapore adults 40 years and older with high myopia (spherical equivalent [SE] ≤−6.00 D) from 3 population-based surveys: (1) the Singapore Prospective Study Program (SP2), (2) the Singapore Malay Eye Study (SiMES), and (3) the Singapore Indian Eye Study (SINDI). The selection of adults 40 years and older with high myopia (SE ≤−6.00 D) was done in order to increase the yield of those with fundus changes and still allow for comparison with other published population-based studies.

Results

There were a total of 424 subjects older than 40 years and with ≤−6.00 D of myopia from the 3 population-surveys, of which 359 were identified to have fundus photographs. This represents 84.7% of all subjects older than 40 years and with ≤−6.00 D of myopia in the 3 population surveys. Of the subjects with fundus photographs, 332 subjects (92.5%) had gradable photographs. The eye with the highest magnitude of myopic refractive error was used for analyses. Table 1 shows subject distribution with

Discussion

Among Singapore adults with high myopia from population-based surveys, fundus pallor and tessellation (90%), peripapillary atrophy (81.2%), and optic disc tilt (57.4%) are very common findings. The major pathologic findings are staphyloma (23.0%) and chorioretinal atrophy (19.3%). Lacquer crack (1.8%) and T-sign (1.8%) are present in a few individuals. Fuchs spot (0%) and choroidal neovascularization (0.9%) are relatively rare complications of high myopia. The presence of staphyloma and

Lan Chang received her medical degree from the University of Michigan Medical School and completed residency at the Duke Eye Center, Durham, North Carolina. She recently completed a pediatric ophthalmology and adult strabismus fellowship at Harvard Medical School, Boston Children’s Hospital, Massachusetts. She currently practices with the Eye Associates of New Mexico.

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Original articleMyopia-Related Fundus Changes in Singapore Adults With High Myopia

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Long-term pattern of progression of myopic maculopathy: a natural history study

Ophthalmology

Prevalence and characteristics of myopic retinopathy in a rural Chinese adult population: the Handan Eye Study

Arch Ophthalmol

Is there a clear threshold for fasting plasma glucose that differentiates between those with and without neuropathy and chronic kidney disease?: the Singapore Prospective Study Program

Am J Epidemiol

Retinal vascular caliber and diabetes in a multiethnic Asian population

Microcirculation

Rationale and methodology for a population-based study of eye diseases in Malay people: The Singapore Malay eye study (SiMES)

Ophthalmic Epidemiol

Original article
Myopia-Related Fundus Changes in Singapore Adults With High Myopia