Abstract
PurposeThis study had three aims: (1) correlate axial length (AL), age and best-corrected visual acuity in high myopic patients scored on the ATN grading system; (2) determine AL cut-off values to distinguish between pathologic myopia (PM) and severe PM; and (3) identify clinical differences between PM and severe PM.MethodsThis is a cross-sectional, non-interventional study. All patients underwent complete ophthalmologic examination, ATN grading and multimodal imaging (colour fundus photography, swept-source OCT, fundus autofluorescence, OCT angiography and fluorescein angiography).ResultsSix hundred forty-four eyes from 345 high myopic patients were included. The eyes were graded on the ATN system and classified as PM (≥ A2) or severe PM (≥ A3, ≥ T3 and/or N2). Significant between-group (PM vs. severe PM) differences (p < 0.05) were observed on the individual ATN components (atrophic [A], tractional [T] and neovascular [N]), age, BCVA and AL. AL was also linearly correlated with the A, T and N components (r = 0.53, p < 0.01; r = 0.24, p < 0.01; r = 0.20, p < 0.01; respectively). ROC curve analysis showed the optimal AL cut-off value to distinguish between PM at 28 mm (AUC ROC curve: 0.813, specificity: 75%, sensitivity: 75%) and severe PM at 29.50 mm (AUC ROC curve: 0.760, specificity: 75%, sensitivity: 70%).ConclusionAL is the main variable associated with myopic maculopathy. Due to the clinical differences found between PM and severe PM, there is need to create an objective cut-off point to distinguish these two different entities being the optimal cut-off points for AL 28 mm and 29.5 mm, respectively. These objective AL cut-off values should be taken into account for determining a correct follow-up, ophthalmic management and treatment.
Highlights
High myopia is a leading cause of central and peripheral vision loss, especially in Mediterranean and Asian countries [1, 2]
This study shows the importance of establishing objective cut-off points for these entities within high myopia, due to the differences shown by the objective parameters analysed in these groups and the consequent clinical repercussion in these patients and in their clinical management
Axial length was positively correlated with the A, T and N components of the ATN grading system
Summary
High myopia is a leading cause of central and peripheral vision loss, especially in Mediterranean and Asian countries [1, 2]. This condition is associated with various eye diseases, including glaucoma, retinal detachment, macular hole (MH), epiretinal membrane, choroidal neovascularization and chorioretinal atrophy. Most of these alterations are probably due to excessive elongation of the ocular globe, commonly associated with posterior staphyloma. The ATN classification system, which is based on fundus photography and optical coherence tomography (OCT) scans, has proven to be highly reproducible [6]
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