ConditionEyes & vision
Myopic Maculopathy (Pathologic Myopia)
Myopic maculopathy is damage to the macula, the center of the retina, caused by high or pathologic myopia (severe nearsightedness). In highly myopic eyes, the eyeball is too long, which stretches and thins the retina and the layers beneath it. This can cause patches of atrophy, cracks, abnormal blood vessels (myopic CNV) and splitting of the retina, leading to blurred or distorted central vision. It is a leading cause of visual impairment in East Asia and is increasing worldwide as myopia becomes more common.
Also called: Myopic macular degeneration, pathologic myopia, degenerative myopia, myopic choroidal neovascularization (myopic CNV)
At a glance
- What it is
- Degeneration of the macula in highly nearsighted eyes.
- Who is at risk
- People with high myopia (usually −6.00 diopters or more, or eye length over 26 mm), older age, East Asian ancestry.
- Main problems
- Atrophy, lacquer cracks, myopic CNV, myopic traction maculopathy, macular holes.
- Warning signs
- New distortion, a dark or blurry spot in central vision.
- Treatment
- Anti-VEGF injections for myopic CNV; surgery for traction or holes; regular dilated exams.
When to get help
See a doctor within a day or two
- Sudden distortion (straight lines bending), a new dark spot or sudden blurring in central vision (possible myopic CNV). See an eye doctor within days
- New flashes of light, a shower of floaters or a shadow across vision (possible retinal detachment); seek same-day care
Book a routine appointment
- Gradual decline in central vision despite updated glasses or contacts
- High myopia without a dilated retinal exam in the past 1 to 2 years
- A child whose myopia is increasing quickly
How high myopia damages the macula
Most myopia occurs because the eyeball grows too long from front to back. In high myopia, this elongation stretches the back of the eye. The retina, the choroid (its blood supply layer) and the sclera (the outer white coat) become thin. Sometimes the back of the eye bulges outward into a pouch called a posterior staphyloma.
This stretching causes several types of damage:
| Finding | What it is | Effect |
|---|---|---|
| Tessellated (tigroid) fundus | Thinning lets choroidal vessels show through | Early sign; usually no symptoms |
| Diffuse atrophy | Widespread thinning around the optic nerve and macula | Mild vision reduction |
| Patchy atrophy | Well-defined areas where retina and choroid are lost | Blind spots |
| Lacquer cracks | Breaks in Bruch's membrane under the retina | May lead to CNV or small bleeds |
| Myopic CNV | Abnormal blood vessels grow through cracks and leak | Sudden distortion and blurred vision |
| Macular atrophy | Loss of the central retina | Severe central vision loss |
| Myopic traction maculopathy | Splitting (schisis) of retinal layers from stretching | Gradual distortion; can progress to a hole or detachment |
Doctors grade myopic maculopathy using the META-PM classification, from category 0 (no changes) to category 4 (macular atrophy), plus "plus lesions" (lacquer cracks, CNV, Fuchs spot).
Risk factors
- degree of myopia and eye length (the higher, the greater the risk)
- older age
- East Asian ancestry
- family history of high myopia
- presence of a posterior staphyloma
Symptoms
- gradually blurred central vision not corrected by glasses
- distorted vision (straight lines look wavy)
- a dark or empty spot in the center of vision
- reduced contrast and difficulty reading
- with myopic CNV, symptoms often appear suddenly in one eye
Peripheral vision is generally preserved, unless retinal detachment or glaucoma, both more common in high myopia, develops.
Diagnosis
- Dilated retinal exam by an ophthalmologist
- Optical coherence tomography (OCT): cross-sectional images of the retina showing atrophy, CNV, schisis and holes
- OCT angiography or fluorescein angiography to confirm myopic CNV
- Fundus photography and autofluorescence to monitor atrophy
- Axial length measurement of the eye
- Amsler grid for home monitoring of distortion
Treatment
Myopic choroidal neovascularization
Anti-VEGF injections (ranibizumab, aflibercept, bevacizumab) into the eye stop abnormal vessels from leaking. Myopic CNV often responds to fewer injections than age-related macular degeneration. Early treatment preserves vision best. See choroidal neovascularization.
Myopic traction maculopathy and macular holes
Vitrectomy surgery, sometimes with peeling of the inner retinal membrane or a macular buckle, for progressive schisis, foveal detachment or macular hole.
Atrophy
There is no treatment to reverse atrophy. Low vision rehabilitation helps people make the most of remaining vision: magnifiers, good lighting, large print and electronic aids.
Refractive correction
Glasses or contact lenses correct the focusing error but do not stop maculopathy. Refractive surgery (LASIK, lens implants) also does not change the risk, because eye length stays the same.
Slowing myopia in children
Because maculopathy risk rises with myopia severity, slowing myopia progression in children may reduce future risk:
- low-dose atropine eye drops
- myopia control spectacle lenses and soft multifocal contact lenses
- orthokeratology (overnight reshaping lenses)
- more time outdoors, around 2 hours a day, which reduces the risk of developing myopia
Prevention and monitoring
- have a dilated eye exam every 1 to 2 years if you have high myopia, or as advised
- check each eye separately with an Amsler grid weekly if you have maculopathy
- seek prompt care for new distortion, dark spots, flashes or floaters
- avoid smoking and protect overall eye health
Frequently asked questions
What is myopic maculopathy?
It is damage to the macula, the central part of the retina, caused by severe nearsightedness. The elongated eye stretches and thins the retina and its supporting layers, which can cause atrophy, abnormal blood vessels and splitting of the retina, affecting central vision.
Can high myopia cause blindness?
Severe myopic maculopathy can cause significant central vision loss, and high myopia raises the risk of retinal detachment and glaucoma. However, peripheral vision is usually preserved, and regular eye exams and prompt treatment of complications prevent much vision loss.
How is myopic CNV treated?
Myopic choroidal neovascularization is treated with anti-VEGF injections into the eye, which stop abnormal blood vessels from leaking. Many people need only a few injections, and early treatment gives the best visual outcome.
Does LASIK reduce the risk of myopic maculopathy?
No. LASIK and other refractive surgeries correct the focus of the eye but do not change its length or the stretching of the retina. People with high myopia still need regular retinal exams after surgery.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology: Pathologic myopia; Preferred Practice Pattern, refractive errors
- International Myopia Institute: White papers on pathologic myopia
- National Eye Institute: Nearsightedness (myopia)
- World Health Organization: The impact of myopia and high myopia
- American Academy of Ophthalmology EyeWiki: Myopic choroidal neovascularization