Reduced Visual Acuity in Myopia Attributed to Refractive Components, Lesions

Both refractive components and pathologic lesions can reduce visual acuity in patients with myopia, even after full optical correction, according to a study published in Ophthalmic & Physiological Optics.

Researchers retrospectively analyzed data from 11,258 patients with myopia (47% women, mean spherical equivalent [SE], −3.2  diopters [D]) consisting of individuals without pathologic myopia lesions (n=10,528) and those with lesions (n=730). All participants underwent cycloplegic refraction and were stratified into 1 of 2 groups based on best-corrected visual acuity (BCVA), which included individuals with normal visual acuity (BCVA ≤0.10 logarithm of the minimum angle of resolution[logMAR]) and individuals with reduced visual acuity (BCVA ≥0.18 logMAR).

Among the cohort 6.4% of participants had a reduction in BCVA. High sphere (≤−6.0 diopters [D]; odds ratios [OR], 16.1; 95% CI, 2.1–126.5), high cylinder (<−2.0 D; OR, 2.5; 95% CI, 1.8–3.4), against-the-rule (OR, 1.5; 95% CI, 1.1–2.0) and oblique astigmatism (OR, 1.6; 95% CI, 1.2–2.1) were significantly associated with reduced visual acuity patients who did not have pathologic myopia lesions (P ≤.008). Additionally, both moderate and high myopic SE were associated with reduced visual acuity.

A tessellated fundus (OR, 6.9; 95% CI, 3.5–14.1), chorioretinal atrophy (OR, 7.7; 95% CI, 2.6–19.9) and choroidal neovascularization (OR, 37.4; 95% CI, 3.3–419.3) were significantly associated with reduced visual acuity in patients who had lesions (P ≤.003). Lesions occurring in the retinal periphery that were white without pressure or white with pressure and lattice degeneration were not associated with reduced visual acuity.

“Both refractive components and pathologic myopia lesions are associated with reduced best corrected visual acuity, regardless of the degree of myopia,” according to the researchers. “Our findings indicate that reduced visual acuity is associated with various optical factors and this reduction is not limited to individuals with high myopia or those having pathologic myopia lesions.”

Study limitations include its retrospective nature, and failure to determine whether the myopia was refractive or axial.