Posterior Eye Shape in Myopia

Abstract

PurposeTo explore prevalence and associated factors of abnormalities of the posterior eye shape in dependence of axial length. DesignPopulation-based study. ParticipantsOut of the participants (n=3468) of the Beijing Eye Study, we included all eyes with an axial length of ≥25 mm, and a randomized sample of eyes with an axial length of <25 mm. MethodsUsing 30°-wide, serial horizontal, and fovea-centered radial, optical coherence tomographic (OCT) images, we examined location and depth of the most posterior point of the retinal pigment epithelium/Bruch´s membrane line (PP-RPE/BML). Main Outcome ParametersPrevalence and depth of an extrafoveal PP-RPE/BML. ResultsThe study included 366 eyes (314 individuals;age:63.7±9.7 years). On the radial OCT scans, the PP-RPE/BML was located in the foveola in 190 (51.9%;95%CI:46.9,56.9) eyes, in 121 (33.1%;95%CI:28.1,38.1) eyes in the 6 o´clock part of the vertical meridian at a mean distance of 1.73±0.70mm from the foveola, and in 54 (14.8%;95%CI:11.1,18.4) eyes in the 12 o´clock part of the vertical meridian at a distance of 2.01±0.66mm from the foveola. Deeper PP-RPE/BML depth increased with longer axial length (beta:0.28;B:12.3;95%CI:7.5,17.1;P<0.001), female sex (beta:0.17;B:30.2;95%CI:10.7,49.6;P=0.002), and higher corneal astigmatism (beta:0.12;B:13.9;95%CI:1.50,26.3;P=0.03). On the horizontal OCT scans, the PP-RPE/BML was located in the foveola in 304 (83.1%;95%CI:79.2,86.9) eyes, between the foveola and the optic disc in 36 (9.8%;95%CI:6.8,12.9) eyes (mean depth: 119±142μm; mean distance:1.59±0.76mm from the foveola), and temporal to the foveola in 26 (7.1%;95%CI:4.5,9.8) eyes (depth:71±46μm; distance:1.20±0.60mm). Higher prevalence of an extrafoveal PP-RPE/BML correlated with longer axial length (OR:1.55;95%CI:1.28,1.89;P<0.001), higher corneal astigmatism (OR:1.78;95%CI:1.14,2.79;P=0.01) and female sex (OR:2.74;95%CI:1.30,5.77;P=0.008). The curvature of the RPE/BM line at the posterior pole was similar to the RPE/BM line curvature outside of the posterior pole in 309 (84.4%;95%CI:80.7,88.2) eyes, and it was steeper (i.e., smaller curvature radius) in 57 (15.6%;95%CI:12.1,19.1) eyes. In these eyes, axial length was longer (24.41±1.78mm versus 27.74±1.88mm;P<0.001). ConclusionsWith longer axial length, the foveola is more often located outside of the geometrical posterior pole. It may be of importance for biometric axial length measurements. An extrafoveal location of the PP-RPE/BML may be due to an axial elongation-associated, meridionally asymmetric enlargement of Bruch´s membrane in the fundus midperiphery.