Myopic Degeneration

Myopic Degeneration
SYMPTOMS Typically asymptomatic but can experience visual field loss with involvement of the posterior pole and/or central vision loss with macula involvement
SIGNS Posterior staphyloma, Lacquer cracks, Myopic conus, Tilted optic disc, Vertically elongated optic disc, Areas of chorioretinal atrophy, Fuch spot, Tessellated fundus, Large vitreous floaters, Retinal microfolds, Paravascular cysts, Myopic choroidal neovascular membrane, Myopic traction maculopathy (Vitreomacular traction, Epiretinal membrane, Macular schisis, Lamellar macular hole, Full thickness macular hole, Foveal detachment)
Patients with myopic degeneration have a higher risk of developing glaucoma, retinal tears, and retinal detachments
WORK-UP Full eye exam with dilated retinal exam, Scleral depression, Peripheral 90D, Gonioscopy 3-mirror (using retina mirrors), Visual field, OCT of the macula (Look for the following: Concavity of the macula especially if a posterior staphyloma is present / All retinal layers are typically intact but thinner than normal / Retinal layers will follow any scleral deformation / Thin choroid / 20% of eyes with myopic degeneration have a dome-shaped macula due to scleral thickening / Myopic traction maculopathy / Choroidal neovascular membrane due to lacquer cracks), OCT of the optic nerve (Look for the following: Peripapillary schisis / Peripapillary detachment / Peripapillary choroidal cavities), OCT-Angiography, Fluorescein Angiography, Indocyanine Green Angiography, Fundus Autofluorescence, Fundus photos, Infrared photos, B-scan ultrasound, A-scan ultrasound, Watzke-Allen test, Macular photostress test, Amsler grid
TREATMENT Myopia control
Give take home Amsler grid in order to monitor for change
Myopic degeneration without evidence of a choroidal neovascular membrane and myopic traction maculopathy: No treatment is needed and the retina needs to be monitored
Myopic degeneration with myopic traction maculopathy (vitreomacular traction and/or epiretinal membrane) without any symptoms, loss of vision, and/or significant change in the macula layers: No treatment is needed and the retina needs to be monitored
Myopic degeneration with myopic traction maculopathy (vitreomacular traction and/or epiretinal membrane) with symptoms, loss of vision, and/or significant change in the macula layers: Refer to a retinal specialist for further evaluation and treatment
Myopic degeneration with myopic traction maculopathy (macular schisis, lamellar macular hole, full thickness macular hole, foveal detachment): Refer to a retinal specialist for further evaluation and treatment
Myopic degeneration with a choroidal neovascular membrane: Refer to a retinal specialist for intravitreal anti-VEGF injections
FOLLOW-UP Myopic degeneration without evidence of a choroidal neovascular membrane and myopic traction maculopathy: See patient back in 9-12 months
Myopic degeneration with myopic traction maculopathy (vitreomacular traction and/or epiretinal membrane) without any symptoms, loss of vision, and/or significant change in the macula layers: See patient back in 4-6 months
If patient was seen and treated by a retinal specialist and the retina/macula is stable, the patient should be seen back in 6 months
ADDITIONAL LAB | TESTS None
ETIOLOGY Stretching and thinning of the retina, choroid, and sclera due to increase in axial length
By definition, high myopia is considered a prescription greater than or equal to -6.00D or an axial length greater than or equal to 26.5 mm (typically signs of myopic degeneration are seen in patients with a prescription of greater than or equal to -8.00D or an axial length greater than or equal to 32.5mm)
DIFFERENTIAL DX Age-related macular degeneration, Presumed ocular histoplasmosis, Pattern dystrophy, Angioid streaks, Chorioretinal scars
NOTES Patients with myopic degeneration are more likely to have posterior vitreous detachments and cataracts at an earlier age
30% of patients with a myopic choroidal neovascular membrane in one eye will also develop a myopic choroidal neovascular membrane in the other eye within 8 years
Myopic Degeneration: OCT of the macula demonstrating an epiretinal membrane, myopic schisis, concavity due to a posterior staphyloma, and a thin choroid https://en.octclub.org/question-of-the-month-september-2021/

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