Abstract
Purpose: To explore the characteristics and associated factors of fundus tessellation, especially the alternation of choroidal thickness among different degrees of tessellated fundus in young adults.Design: Cross-sectional, population-based study.Methods: A total of 796 students were included in the study and underwent comprehensive ophthalmic examinations, including anterior segment examinations and swept-source optical coherence tomography (OCT) measurements. The degree of tessellated fundus was assessed by fundus photographs applying an early treatment of diabetic retinopathy study grid to evaluate the location of fundus tessellation and then divided into five groups. The topographic variation and factors, tilted disc ratio, parapapillary atrophy (PPA), retinal thickness (ReT), choroidal thickness (ChT), and subfoveal scleral thickness (SST) related to tessellated fundus were analyzed.Results: Compared to normal fundus, tessellated fundus had a lower spherical equivalent (SE) (p < 0.0001), worse best-corrected visual acuity (BCVA)(p = 0.043), longer axial length (AL) (p < 0.0001), thinner retina (p < 0.0001), thinner (p < 0.0001) choroid, and thinner sclera in center fovea (p = 0.0035). Among all subfields of macular and peripapillary regions, center fovea and macula-papillary region showed the most significant decrease in choroidal thickness. The proportion of fundus tessellation significantly increased with lower body weight index (BMI) (p = 0.0067), longer AL (p < 0.0001), larger PPA(p = 0.0058), thinner choroid (p < 0.0001), and thinner sclera (p < 0.0001).Conclusions: Eyes showed more severe myopic morphological alternation with the increasement of proportion of fundus tessellation to the center fovea, including a significant decrease in both choroid and scleral thickness. Choroidal thinning may progress most rapidly in the macula-papillary region as fundus tessellation approaches to the center fovea.
Highlights
The high prevalence of myopia and high myopia in young adults worldwide, especially in East and Southeast Asia, has led to a significant public health burden of visual impairment and blindness [1,2,3,4,5,6,7,8]
Among the 828 students enrolled in the study, were excluded due to diffuse chorioretinal atrophy, nine due to other retinopathy, because of IOP > 21 mmHg
There were no significant differences in age, sex, BMI, blood pressure, intraocular pressure, anterior chamber depth and lens thickness between the two groups
Summary
The high prevalence of myopia and high myopia in young adults worldwide, especially in East and Southeast Asia, has led to a significant public health burden of visual impairment and blindness [1,2,3,4,5,6,7,8]. A revised classification system for myopic maculopathy has been proposed to standardize the definition among epidemiological studies [6, 9]. According to this International Photographic Classification and Grading System for myopic maculopathy (META-PM) classification, as well as previous studies, tessellated fundus has been defined as the visualization of large choroidal vessels at the posterior fundus pole, which is the first stage of pathological myopia (PM) retinopathy (category 1) [6, 9, 10]. Some tessellated fundus can progress to diffuse atrophy and macular atrophy, which cause severe and irreversible impairment of visual acuity, while others could be stable at this stage for long-term [9, 11]. Factors associated with fundus tessellation in elderly population have been studied using fundus photographs [12, 13], age-based choroidal thinning and age-related retinopathy can be interference factors for examining fundus tessellation in pathological myopia [14,15,16,17]
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