Visual Prognosis of Disciform Degeneration in Myopia

doi:10.1016/S0161-6420(83)80018-9

Ophthalmology

Volume 90, Issue 8, August 1983, Pages 923-926

https://doi.org/10.1016/S0161-6420(83)80018-9 Get rights and content

A retrospective study was done on a consecutive series of patients presenting to the Moorfields Eye Hospital with visual reduction secondary to angiographically proven subretinal neovascularization associated with myopia (Förster-Fuchs' spot), with a short history of visual loss, and free of other ocular disease. The visual acuity at follow-up was compared to that at presentation, and related to size and location of the neovascular complex, as well as patient age, and duration of follow-up. The results show a generally poor prognosis in that 43% of the patients lost two or more lines of vision, while 60% were ≤6/60 at last follow-up. As expected there was a direct relationship between visual acuity and the distance of the neovascular tissue from the fovea, and an inverse relationship between acuity and the size of the lesion. There seems to be a short neovascular growth phase, with early visual loss.

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Cited by (138)

Novel Predictors of Visual Outcome in Anti-VEGF Therapy for Myopic Choroidal Neovascularization Derived Using OCT Angiography
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To explore novel prognostic factors associated with visual function and number of anti–vascular endothelial growth factor (VEGF) treatments in eyes with active myopic choroidal neovascularization (mCNV) using OCT angiography (OCTA).
Prospective case series.
Twenty-eight treatment-naïve eyes with active mCNV from 27 consecutive patients (mean age, 64.4 ± 11.1 years).
All eyes received through injection a single loading dose of intravitreal aflibercept (IVA), followed by additional IVA on a pro re nata (PRN) basis during the subsequent 12 months. At baseline, OCTA images of a 3 × 3-mm macular cube were acquired using an OCTA scanner. On binarized and skeletonized OCTA images of the outer retinal layer, OCTA-derived baseline parameters of mCNV—including lesion size, vessel density, vessel length density (VLD), vessel diameter index, and fractal dimension (FD)—were measured and evaluated for correlation with 12-month best-corrected visual acuity (BCVA) and number of additional injections.
The primary and secondary outcomes were BCVA 12 months after initial treatment and number of additional injections, respectively.
There was no significant difference between baseline and 12-month BCVA (0.37 ± 0.30 and 0.30 ± 0.35 logarithm of the minimal angle of resolution, respectively; P = 0.23). The number of additional injections was 0.93 ± 1.02 (mean ± standard deviation). Baseline VLD, FD, and BCVA were correlated with 12-month BCVA (P = 0.02, r = 0.46; P = 0.02, r = 0.46; and P = 0.02, r = 0.45, respectively), and VLD also was correlated with the number of additional injections (P = 0.03, r = 0.42).
Exuberant mCNV, which is characterized by high VLD and FD derived using OCTA, is a predictor of poor visual outcomes after a single IVA injection followed by a PRN regimen. Only baseline VLD was correlated with the number of additional IVA injections, which indicates that this parameter could help to determine the optimal anti-VEGF treatment regimen for individual eyes with mCNV.
Myopic Choroidal Neovascularization: Review, Guidance, and Consensus Statement on Management
2017, Ophthalmology
The aim of this article is to review and compile available information on the classification, pathophysiology, and clinical features of myopic choroidal neovascularization (CNV); to describe the latest data on the management of this disease; and to present guidance.
In the United States, myopia affects approximately 34 million people (2010), and similar figures have been reported in Europe. Pathologic myopia (PM), a possible consequence of myopia, is estimated to affect up to 3% of the global population. One of the most serious complications of PM is myopic CNV, which often leads to a sudden onset but progressive decline in central vision and is associated with a poor prognosis unless treated. Furthermore, 35% of patients with myopic CNV develop bilateral disease in the fellow eye within 8 years. Although intravitreal anti–vascular endothelial growth factor (VEGF) therapies have had a major impact on the management of patients with myopic CNV, there remain significant gaps in our understanding of this condition and how to best administer treatment. Additionally, the long-term safety and efficacy of these treatments are largely unknown.
We carried out a literature review (September 2015) of all English-language articles in PubMed resulting from searches of the following terms: “choroidal neovascularization” AND “myopia” OR “myopic macular degeneration” OR “degenerative myopia” OR “myopic maculopathy” OR “myopic retinopathy” OR “pathological myopia” OR “pathologic myopia.”
We screened a total of 566 abstracts, and 250 articles were deemed relevant for full publication review. We excluded a further 71, but an additional 44 articles were identified. This resulted in 223 articles being used to develop this review.
Highly myopic patients experiencing a sudden loss of central vision should be referred for further examination. Once a diagnosis of myopic CNV has been confirmed, after fluorescein angiography, treatment initiation should be prompt and anti-VEGF agents considered as first-line therapy, unless contraindicated. Continued monitoring of patients is required to assess any progression or recurrence of the condition.
The other CNVM: A review of myopic choroidal neovascularization treatment in the age of anti-vascular endothelial growth factor agents
2015, Survey of Ophthalmology
Citation Excerpt :
Studies suggest that CNVM is most frequently subfoveal in myopia, and the rate of recurrence of CNVM is as high as 72% after laser photocoagulation. The scar expansion occurs most frequently at the foveal edge of the laser scar.28,64,69 In fact, one study of 19 eyes with PM demonstrated progressive enlargement of the photocoagulation scar in 89%, with a resulting decrease in VA in 68%.36
Choroidal neovascular membranes (CNVM) associated with pathological myopia (PM) can result in significant vision loss and legal blindness. These membranes usually occur subfoveally and are a major complication of PM, developing in approximately 5–10% of such eyes. PM is the second most common cause of choroidal neovascularization after age-related macular degeneration (AMD), and accounts for nearly 60% of CNVM cases in patients younger than age 50. Vascular endothelial growth factor-A has been implicated as the major angiogenic stimulus responsible for choroidal neovascularization secondary to AMD and several major studies have proved the benefits of anti-VEGF treatment for AMD-related CNVM. Benefits have also been observed in a number of prospective and retrospective studies evaluating PM CNVM. Despite the small differences in molecular properties of ranibizumab and bevacizumab, both drugs showed similar therapeutic effects for CNVM associated with PM. Many studies also highlighted that patient age, previous photodynamic therapy treatment, axial length, and visual acuity prior to treatment may affect treatment prognosis. Although there is a paucity of large randomized controlled trials, this systematic review highlights the large numbers of individual trials that demonstrate a significant improvement in VA. The inferior long-term results of alternative therapies, combined with an excellent safety profile from anti-VEGF treatment, make anti-VEGF the current recommended first-line therapy.
Treatment of myopic choroidal neovascularization: Recommendations of theFederation France
2014, Journal Francais d'Ophtalmologie
Epidemiology and disease burden of pathologic myopia and myopic choroidal neovascularization: An evidence-based systematic review
2014, American Journal of Ophthalmology
Citation Excerpt :
In the Beijing Eye Study, mean BCVA was logMAR 0.88 (41 letters) for individuals with pathologic myopia compared with logMAR 0.56 (57 letters) for individuals without pathologic myopia (P < .001).24 Eleven studies reported on visual outcome for patients with myopic CNV followed up for durations ranging from under 3 months to 21.5 years (Table 6).38–48 At baseline, the proportion of patients with a BCVA of 20/200 or worse ranged from 21%-60% in 8 studies reporting this measure.
To summarize the epidemiology of pathologic myopia and myopic choroidal neovascularization (CNV) and their impact on vision.
Systematic literature review of all English-language studies evaluating the epidemiology and visual burden of pathologic myopia or myopic CNV.
PubMed and EMBASE were searched with no time limits using predefined search strings for English-language studies evaluating the epidemiology and visual burden of pathologic myopia and myopic CNV.
In total, 39 relevant publications were identified. Population-based studies reported pathologic myopia to be the first to third most frequent cause of blindness. The prevalence of pathologic myopia was reported to be 0.9%-3.1%, and the prevalence of visual impairment attributable to pathologic myopia ranged from 0.1%-0.5% (European studies) and from 0.2%-1.4% (Asian studies). The prevalence of CNV in individuals with pathologic myopia was reported to be 5.2%-11.3%, and was bilateral in approximately 15% of patients. All studies of visual outcome in patients with myopic CNV (duration ranging from less than 3 months to 21.5 years) reported deterioration in best-corrected visual acuity over time. Older age, subfoveal CNV location, and larger baseline lesion size were predictors of worse visual outcomes.
Pathologic myopia is an important cause of vision loss worldwide, affecting up to 3% of the population. Of these, a substantial proportion of patients develop myopic CNV, which mostly causes a significant progressive decrease in visual acuity. This condition should therefore be a target for new treatment strategies.
Long-term outcomes of anti-vascular endothelial growth factor therapy with and without posterior scleral reinforcement on myopic maculopathy in myopic choroidal neovascularization eyes
2024, BMC Ophthalmology

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: Presented at the 1982 Eighty-seventh Annual Meeting of the American Academy of Ophthalmology, San Francisco, California, October 30–November 5, 1982.

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Visual Prognosis of Disciform Degeneration in Myopia

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalrnol

Der centrale schwarze Fleck bei Myopie

Z Augenheilkd