Myopic Maculopathy Biomarkers Include Chorioretinal Thinning Changes

Myopic maculopathy biomarkers include choroidal thinning and expansion of the peripapillary atrophy (PPA) area, according to research published in Eye.

Investigators included 1947 participants (mean age, 42.79 years; 44.43% men) with and without myopic maculopathy (n=351 and n=1596, respectively) from the Shanghai High Myopia Study for Adults (SHMSA; ClinicalTrials.gov Identifier: NCT03446300), an ongoing investigation of individuals with high myopia, in the analysis. Study participants underwent comprehensive ophthalmic examinations and optical coherence tomography (OCT) to identify potential myopic maculopathy biomarkers. 

Individuals with myopic maculopathy were older (64.58 vs 38 years), had worse visual acuity (0.42 vs 0.05 logarithm of the minimum angle of resolution [logMAR]), higher spherical equivalent refraction (-10.43 vs -4.44 diopters [D]), longer axial length (28.97 vs 25.4 mm), lower tilt ratio (0.69 vs 0.82), lower torsion (-6.21 vs 5.98), a more enlarged PPA area (8.37 vs 0.99 mm²), and thinner macular choroidal thickness (74.17 vs 200.31 µm; P <.001 for all) compared with those who did not have myopic maculopathy.

The team subdivided macular myopathy into 4 subtypes, which included Bruch membrane defects, choroidal neovascularization, myopic tractional maculopathy, and thin choroid. Women were more likely to have macular myopathy and Bruch membrane defects, and a lower tilt ratio was associated with choroidal neovascularization and macular tractional maculopathy. 

The best cutoff values for PPA area and mean macular choroidal thickness for predicting myopic maculopathy were 2.12 mm² and 105.72 μm (area under the curve [AUC], 0.9678), 2.37 mm² and 104.56 μm for thin choroid (AUC, 0.9279), 2.66 mm² and 96.31 μm for Bruch membrane defects (AUC, 0.9531), 2.36 mm² and 95.14 μm for myopic tractional maculopathy (AUC, 0.9317), 3.74 mm², and 64.43 μm choroidal neovascularization (AUC, 0.9213), respectively.

“With the advancement of artificial intelligence in fundus diagnosis, PPA area and average [macular choroidal thickness] can be automatically acquired for quantitative analysis,” according to the researchers. “Therefore, a combination of PPA area and average [macular choroidal thickness] could be widely used for screening [myopic maculopathy] for community and physical examination in the future.”

Study limitations include baseline measurements without follow-up and the potential for referral bias due to recruitment that was not population-based.