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Progression of diffuse chorioretinal atrophy among patients with high myopia: a 4-year follow-up study
  1. Zhixi Li1,
  2. Ran Liu1,2,
  3. Ou Xiao1,
  4. Xinxing Guo1,3,
  5. Jian Zhang1,
  6. Decai Wang1,
  7. Monica Jong4,5,
  8. Padmaja Sankaridurg4,5,
  9. Kyoko Ohno-Matsui6,
  10. Mingguang He1
  1. 1 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  2. 2 New England College of Optometry, Boston, USA
  3. 3 Wilmer Eye Institute, Johns Hopkins University, Baltimore, USA
  4. 4 Brien Holden Vision Institute, Sydney, Australia
  5. 5 School of Optometry and Vision Science, UNSW, Sydney, Australia
  6. 6 Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
  1. Correspondence to Mingguang He, Stata Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, People’s Republic of China; mingguang_he{at}


Aims To investigate the progression pattern of diffuse chorioretinal atrophy (DCA) among Chinese participants with high myopia.

Methods This is a longitudinal, non-interventional study. Participants with high myopia, defined as ≤−6 diopters spherical power, were included and followed up for 4 years, and underwent cycloplegic autorefraction, best-corrected visual acuity (BCVA) and fundus photography examinations. Newly established DCA, enlargement of existing DCA and development of other lesions of myopic maculopathy were regarded as DCA progression.

Results Of the 484 participants with a mean age of 21.5±12.7 years (range, 6.8–69.7 years), 68 eyes (14.0%) showed DCA progression, with 88 lesion changes. The first appearance of DCA was identified in 21 eyes (23.9%). Of 88 eyes with DCA at baseline, 47 eyes (53.4%) showed progression, with 67 lesion changes, including 45 eyes (67.2%) with enlargement of DCA, 17 (25.3%) with a first appearance of lacquer cracks, 4 (6.0%) with development of patchy chorioretinal atrophy and 1 (1.5%) with increased numbers of lacquer cracks. Longer axial length (p<0.001), baseline DCA (p=0.005) and baseline DCA closer to the fovea (p=0.013) predicted DCA progression. Eyes had poorer BCVA at the follow-up if DCA was enlarging (p<0.001) or DCA was closer to the fovea at baseline (p=0.028) after adjusting for age,gender and cataract.

Conclusion Approximately half of the participants with DCA had progression over a 4-year follow-up. Enlargement and newly developed DCA were common progression patterns. Larger areas of DCA and foveal involvement with DCA could be indicators of a worse BCVA later.

  • Retina
  • Epidemiology
  • Optics and Refraction

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  • Contributors MH had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: ZXL, MH. Data acquisition, analysis or interpretation: all authors. Drafting of the manuscript: ZXL. Critical revision of the manuscript for important intellectual content: MH. Statistical analysis: ZXL, JZ. Obtained funding: MH. Study supervision: JZ, MH.

  • Funding This work was supported by the National Key R&D Program of China (2018YFC0116500), the Fundamental Research Funds of the State Key Laboratory in Ophthalmology, National Natural Science Foundation of China (81420108008) and Science and Technology Planning Project of Guangdong Province in China (2013B20400003). The sponsor or funding organiszation had no role in the design or conduct of this research.

  • Competing interests None declared.

  • Ethics approval Ethics approval (2012KYNL002) was obtained from the Board Ethics Committee of Zhongshan Ophthalmic Center, Sun Yat-sen University in China. The research adhered to the Declaration of Helsinki and Chinese law, and informed consent was acquired from all subjects.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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