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Predictors of myopic macular degeneration in a 12-year longitudinal study of Singapore adults with myopia
  1. Li Lian Foo1,2,3,
  2. Lingqian Xu2,
  3. Charumathi Sabanayagam2,3,
  4. Hla M Htoon2,
  5. Marcus Ang1,2,3,
  6. Jingwen Zhang4,
  7. Kyoko Ohno-Matsui5,
  8. Ching Yu Cheng2,3,
  9. Quan V Hoang1,2,3,6,
  10. Chuen-Seng Tan7,
  11. Seang-Mei Saw2,3,7,
  12. Chee Wai Wong1,2,3,8
  1. 1 Singapore National Eye Centre, Singapore
  2. 2 Singapore Eye Research Institute, Singapore
  3. 3 Duke-NUS Medical School, National University of Singapore, Singapore
  4. 4 GKT School of Medicine, King’s College London, London, UK
  5. 5 Ophthalmology and Visual Science, Tokyo Medical and Dental University, Bunkyo-ku, Japan
  6. 6 Dept. of Ophthalmology, Columbia University, New York, New York, USA
  7. 7 Saw Swee Hock School of Public Health, National University of Singapore, Singapore
  8. 8 Asia Pacific Eye Centre, Gleneagles Hospital, Singapore
  1. Correspondence to Dr Chee Wai Wong, Training and Education, Singapore National Eye Centre, Singapore, Singapore; wongcheewai81{at}


Purpose To investigate the predictive factors for myopic macular degeneration (MMD) and progression in adults with myopia.

Methods We examined 828 Malay and Indian adults (1579 myopic eyes) with myopia (spherical equivalent (SE) ≤–0.5 dioptres) at baseline who participated in both baseline and 12-year follow-up visits of the Singapore Malay Eye Study and the Singapore Indian Eye Study. Eye examinations, including subjective refraction and axial length (AL) measurements, were performed. MMD was graded from fundus photographs following the Meta-Analysis for Pathologic Myopia classification. The predictive factors for MMD development and progression were assessed in adults without and with MMD at baseline, respectively as risk ratios (RR) using multivariable modified Poisson regression models. The receiver operating characteristic curve was used to visualise the performance of the predictive models for the development of MMD, with performance quantified by the area under the curve (AUC).

Results The 12-year cumulative MMD incidence was 10.3% (95% CI 8.9% to 12.0%) among 1504 myopic eyes without MMD at baseline. Tessellated fundus was a major predictor of MMD (RR=2.50, p<0.001), among other factors including age, worse SE and longer AL (all p<0.001). The AUC for prediction of MMD development was found to be 0.78 (95% CI 0.76 to 0.80) for tessellated fundus and increased significantly to an AUC of 0.86 (95% CI 0.84 to 0.88) with the combination of tessellated fundus with age, race, gender and SE (p<0.001). Older age (p=0.02), worse SE (p<0.001) and longer AL (p<0.001) were found to be predictors of MMD progression.

Conclusions In adults with myopia without MMD, tessellated fundus, age, SE and AL had good predictive value for incident MMD. In adults with MMD, 1 in 10 eyes experienced progression over the same period. Older age, more severe myopia and longer AL were independent risk factors for progression.

  • Epidemiology
  • Macula

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Correction notice This paper has been corrected since it was first published. Author Han Nian Marcus Ang has been changed to Marcus Ang.

  • Contributors LLF, JZ, CYC, QVH and CWW contributed to the conception and design of the study. LLF, LX, HMH, CS, C-ST and S-MS contributed to the analysis and interpretation of data. LLF, LX, HMH, HNMA, JZ, QVH and CWW contributed to the drafting of the manuscript. CS, HNMA, C-ST, S-MS and CWW contributed to revising the manuscript critically for important intellectual content. LLF, LX, CYC, C-ST, S-MS and CWW contributed to the approval of the version of the manuscript to be published. CWW is the guarantor of this study.

  • Funding This work was supported by the National Medical Research Council Individual Research Grant (NMRC/CIRG/1466/2017).

  • Competing interests None declared.

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

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