Current and predicted demographics of high myopia and an update of its associated pathological changes.

Abstract

Excessive axial elongation of the eye in high myopia can cause biomechanical stretching leading to various ocular complications. The purpose of this review is to provide an update on various pathologic changes, especially in the chorio-retina and sclera that have been reported recently using advanced ophthalmic bio-imaging modalities such as optical coherence tomography, magnetic resonance imaging and fundus photography. The prevalence rates of pathologic myopia (myopic retinopathy and maculopathy) mirror the prevalence rates of high myopia as the risks of pathologic myopia increase with high myopia. Peripapillary and sub-foveal choroidal thinning, scleral thinning, and deformed/irregular eye shapes were found to be strongly associated with various pathologic myopic lesions, especially with posterior staphyloma and chorio-retinal atrophy. Considering the increasing prevalence rate of myopia and pathologic myopia, these degenerative changes are likely to increase dramatically over the next few decades due to the rapid growth in the number of individuals with high myopia and the ageing population. The current prevalence rates of pathologic myopia in older adults might have significantly underestimated the future prevalence rates and warrants age of onset of myopia being considered a major risk factor for pathologic myopia. Using advanced technology, identification of novel quantifiable chorio-retinal and scleral parameters in pathologic myopia would help to identify people at risk of developing pathologic myopia and potentially may revolutionise the management of myopia especially in risk prognostication and monitoring of disease progression.