Color Fundus Photography Research Articles

Genetic Distinctions Between Reticular Pseudodrusen and Drusen: A Genome-Wide Association Study.

Genetic Distinctions Between Reticular Pseudodrusen and Drusen: A Genome-Wide Association Study.

A novel founder variant in BEST1 gene causing autosomal recessive bestrophinopathy

BackgroundAutosomal recessive bestrophinopathy (ARB) is a rare retinal dystrophy caused by homozygous or compound heterozygous null variants in the BEST1 gene. Clinically, ARB presents with variable features including central visual impairment, global photoreceptor dysfunction (as indicated by abnormal full-field ERG), and a significantly reduced electro-oculogram (EOG) light rise, a hallmark of bestrophinopathy. Fundus examination reveals widespread retinal pigment epithelial (RPE) disturbance, vitelliform deposits in the posterior pole (more clearly visualized with fundus autofluorescence), and macular fluid accumulation. Angle-closure glaucoma, secondary to anterior chamber dysgenesis, is a potential complication. This work aims at documenting the founder effect of a novel variant in the BEST1 gene causing autosomal recessive bestrophinopathy and determining its variable clinical features.MethodsTwelve members of nine unrelated, consanguineous Egyptian families with a history of impaired central vision underwent comprehensive ophthalmological examination, fundus color photography, fundus autofluorescence (FAF), spectral-domain optical coherence tomography (SD-OCT) of the macula, and electrophysiological studies. Variant screening of coding exons of the BEST1 gene and some flanking regions was performed using the Sanger sequencing technique. The pathogenicity of the variants was tested using different in silico functional analysis tools.ResultsThe clinical examination and investigations confirmed the ARB phenotype. All twelve patients exhibited (c.365 G > C, p. Arg122Pro) a novel BEST1 gene variant in a homozygous form. On top of the classical retinal phenotype of ARB, some patients had other ocular associations: four patients were found to have angle-closure glaucoma, one patient had associated corneal dystrophy, one developed a macular hole, and one patient developed uveitis.ConclusionThe identification of the same, novel homozygous BEST1 missense variant in twelve patients from nine unrelated, consanguineous families of Egyptian origin, suggests a founder effect. Angle-closure glaucoma was the most commonly associated ocular abnormality (30%). Our finding expands the molecular spectrum of ARB-associated variants, and identification of this founder variant can simplify genetic testing in the presence of limited resources and lead to better counseling.

Prevalence of central serous chorioretinopathy in Denmark.

Central serous chorioretinopathy (CSC) is a prevalent maculopathy, but epidemiological studies are few. In this study, we determined the prevalence of CSC for the first time in a Scandinavian population. This cross-sectional study was based on nationwide opportunistic retinal examination from 79 high street chain optician stores in Denmark. Retinal imaging was made using non-mydriatic colour fundus photography. Any abnormal result in the optometrist-facilitated retinal examination was referred to tele-ophthalmologic evaluation, which was performed by experienced consultant ophthalmologists who diagnosed CSC. During the 4-year study period, a total of 968 610 unique individuals underwent retinal examination, which corresponded to 16.3% of the entire population of Denmark. Of these, 113 individuals were diagnosed with CSC, which corresponded to a prevalence of 14 per 100 000. Individuals with CSC presented at a mean age of 48.2 ± 12.3 years; however, CSC was present in a large age range as both teenagers and the elderly with CSC were identified. Male biological sex was a statistically significant risk factor (odds ratio: 2.33; 95% confidence interval: 1.64-3.33, p < 0.0001). By extrapolating prevalence numbers to population statistics, we estimate that 219 females and 511 males had CSC in Denmark in December 2022. We identified a prevalence of 14 per 100 000, confirmed male biological sex as a significant risk factor for CSC, and found that the disease most commonly occurs among individuals aged 30-60 years. Further studies with multimodal imaging including optical coherence tomography are warranted for better accuracy.

Diagnostic report generation for macular diseases by natural language processing algorithms.

To investigate rule-based and deep learning (DL)-based methods for the automatically generating natural language diagnostic reports for macular diseases. This diagnostic study collected the ophthalmic images of 2261 eyes from 1303 patients. Colour fundus photographs and optical coherence tomography images were obtained. Eyes without retinal diseases as well as eyes diagnosed with four macular diseases were included. For each eye, a diagnostic report was written with a format consisting of lesion descriptions, diagnoses and recommendations. Subsequently, a rule-based natural language processing (NLP) and a DL-based NLP system were developed to automatically generate a diagnostic report. To assess the effectiveness of these models, two junior ophthalmologists wrote diagnostic reports for the collected images independently. A questionnaire was designed and judged by two retina specialists to grade each report's readability, correctness of diagnosis, lesion description and recommendations. The rule-based NLP reports achieved higher grades over junior ophthalmologists in correctness of diagnosis (9.13±1.52 vs 9.03±1.42 points) and recommendations (8.55±2.74 vs 8.50±2.53 points). Furthermore, the DL-based NLP reports got slightly lower grades to those of junior ophthalmologists in lesion description (8.82±1.84 vs 9.12±1.20 points, p<0.05), correctness of diagnosis (8.72±2.36 vs 9.08±1.55 points, p<0.05) and recommendations (8.81±2.52 vs 9.15±1.65 points, p<0.05). For readability, the DL-based reports performed better than junior ophthalmologists, with scores of 9.98±0.17 vs 9.94±0.25 points (p=0.094). The multimodal AI system, coupled with the NLP algorithm, has demonstrated competence in generating reports for four macular diseases compared with junior ophthalmologists.

Temporal Retinal Vessel Angle as a Biomarker for Familial Exudative Vitreoretinopathy.

This study aims to investigate temporal retinal vessel angles (TVA) measured from colour fundus photographs as a biomarker for assessing clinical outcomes in familial exudative vitreoretinopathy (FEVR). The primary objectives were to establish correlations between TVA and key clinical parameters, evaluate the predictive power of TVA for poor visual acuity and foveal hypoplasia, and determine optimal threshold angles for risk stratification. This retrospective case series included 65 patients (117 eyes) at Linkou Chang Gung Memorial Hospital, Taiwan. Ophthalmic examinations, imaging, and TVA measurements were conducted. Statistical analyses included correlation coefficients, logistic regressions, and receiver-operating-characteristic (ROC) curves. TVA exhibited negative correlations with key clinical outcomes including best-corrected visual acuity. Logistic regression analysis revealed associations between narrower TVA and key outcomes such as poor best corrected visual acuity (BCVA) and foveal hypoplasia. ROC curves demonstrated area-under-curve (AUC) values for predicting poor BCVA (0.80, 0.86) and foveal hypoplasia (0.83, 0.82) for temporal retinal artery and vein angle (TRAA and TRVA), respectively. Optimal thresholds were determined (TRAA: 65.02˚, TRVA: 72.87˚). TVAs emerged as sensitive predictors of FEVR outcomes, showcasing robust correlations with disease severity and functional outcomes. It highlights TVA as a potential non-invasive biomarker for prognosis in FEVR, aiding in early detection and facilitating timely interventions. Future research with larger cohorts and longitudinal follow-up is warranted to validate the utility of TVA in clinical practice.

Evaluation of the macula pigment optical density by a psychophysical test in dry age-related macular degeneration.

PurposeTo evaluate the macular pigment optical density (MPOD) in dry age-related macular degeneration (AMD).MethodsThis prospective study included 68 dry AMD patients and, as the control group, 91 healthy volunteers. Age, gender, family history, smoking, alcohol, hypertension, hyperlipidemia, height, weight, dietary lutein intake, and use of lutein-zeaxanthin (L-Z) were questioned. Full ophthalmic examination was performed. Color fundus photography and fundus autofluorescence (FAF) images were recorded. MPOD was measured by color perimetry (CP) every 3 months for 9 months in the dry AMD group, and 1 time at the beginning of the study in the control group. 6 mg/day lutein or 10 mg/day L and 2 mg/day Z were started in non-users.ResultsSmoking, obesity, family history, light iris color, and hyperlipidemia were seen more frequently in the AMD group. Average MPOD values in the AMD group were; 3.69 ± 1.82 (baseline), 4.74 ± 1.29 (3rd month), 4.99 ± 1.27 (6th month), and 5.02 ± 1.35 (9th month) dB, respectively. In the control group, the average MPOD was 4.97 ± 1.27 dB. At the baseline, the MPOD of the AMD group was significantly lower than the control group. Smoking, obesity, poor dietary lutein intake, light iris color, and hyperlipidemia were associated with low MPOD.DiscussionThe relationship between MPOD and AMD is controversial in the literature. Low MPOD and AMD may be related depending on our results. Quit smoking, and having a rich dietary L-Z intake are important for preventing AMD progression. The results of the CP are consistent with the other psychophysical tests.

Sectoral Changes in Neuroretinal Rim Pallor Across Refractive Error.

Sectoral Changes in Neuroretinal Rim Pallor Across Refractive Error.

Validation of artificial intelligence algorithm LuxIA for screening of diabetic retinopathy from a single 45° retinal colour fundus images: the CARDS study.

This study validated the artificial intelligence (AI)-based algorithm LuxIA for screening more-than-mild diabetic retinopathy (mtmDR) from a single 45° colour fundus image of patients with diabetes mellitus (DM, type 1 or type 2) in Spain. Secondary objectives included validating LuxIA according to the International Clinical Diabetic Retinopathy (ICDR) classification and comparing its performance between different devices. In this multicentre, cross-sectional study, retinal colour fundus images of adults (≥18 years) with DM were collected from five hospitals in Spain (December 2021-December 2022). 45° colour fundus photographs were captured using non-mydriatic Topcon and ZEISS cameras. The Discovery platform (RetinAI) was used to collect images. LuxIA output was an ordinal score (1-5), indicating a classification as mtmDR based on an ICDR severity score. 945 patients with DM were included; the mean (SD) age was 64.6 (13.5) years. The LuxIA algorithm detected mtmDR with a sensitivity and specificity of 97.1% and 94.8%, respectively. The area under the receiver-operating characteristic curve was 0.96, indicating a high test accuracy. The 95% CI data for overall accuracy (94.8% to 95.6%), sensitivity (96.8% to 98.2%) and specificity (94.3% to 95.1%) indicated robust estimations by LuxIA, which maintained a concordance of classification (N=829, kappa=0.837, p=0.001) when used to classify Topcon images. LuxIA validation on ZEISS-obtained images demonstrated high accuracy (90.6%), specificity (92.3%) and lower sensitivity (83.3%) as compared with Topcon-obtained images. AI algorithms such as LuxIA are increasing testing feasibility for healthcare professionals in DR screening. This study validates the real-world utility of LuxIA for mtmDR screening.

BOUCHER-NEUHAUSER SYNDROME: CHORIORETINAL CHANGES IN A SINGLE CASE OVER TIME.

The aim of this study was to describe chorioretinal changes in a single case of Boucher-Neuhauser syndrome over 45 years of follow-up. Retrospective chart review was performed. Color fundus photography from 1977 to 2003 was obtained and digitized. Current fundus photography was obtained with widefield imaging. High-resolution spectral-domain optical coherence tomography was performed. Genetic analysis was performed using an inherited retinal disorders panel. Fundus examination demonstrated central chorioretinal atrophy with sclerotic choroidal vessels. Short posterior ciliary arteries became more prominent and tortuous over time. Mid-peripheral atrophy extends to the equator and demonstrates a scalloped pattern with islands of atrophy intervening with areas of normal retina. The far periphery remained minimally affected. High-resolution optical coherence tomography demonstrated outer retinal atrophy and choriocapillaris loss. Genetic testing showed a homozygous variant for patatin-like phospholipase domain-containing 6 and a heterozygous variant for tyrosinase-related protein 1. Chorioretinal changes in Boucher-Neuhauser syndrome vary in onset and severity. It is important to diagnose this condition to begin timely management of visual and systemic sequelae.

CO-OCCURRING USHER SYNDROME TYPE 1 AND RENAL FAILURE.

The aim of this study was to describe a patient with a rare co-occurrence of Usher syndrome type 1C and renal disease, suspected to be secondary to Alport syndrome. This was a case report and literature review of cases with Usher syndrome and renal failure. Clinical examination, color fundus photography, visual field tests, electroretinography, and whole-exome sequencing were used to diagnose and document the patient's clinical presentation. An 18-year-old female patient with a known history of congenital hearing loss and chronic renal failure presented with progressive night and peripheral visual impairment, suspicious for an inherited retinal disease. Visual field testing, fundus examination, and electroretinography findings supported the diagnosis of Usher syndrome. Whole-exome sequencing identified a novel homozygous frameshift variant (c.238del) in USH1C gene. Whole-exome sequencing also identified a homozygous COL4A3 variant of unknown significance, which may be responsible for concomitant Alport syndrome. By presenting this rare case of co-occurring Usher syndrome Type 1 and renal failure, the authors highlight the importance of conducting further investigations that could reveal an additional underlying etiology when these entities are present.

How Foundational Is the Retina Foundation Model? Estimating RETFound's Label Efficiency on Binary Classification of Normal versus Abnormal OCT Images.

How Foundational Is the Retina Foundation Model? Estimating RETFound's Label Efficiency on Binary Classification of Normal versus Abnormal OCT Images.

Low-Rank Fine-Tuning Meets Cross-modal Analysis: A Robust Framework for Age-Related Macular Degeneration Categorization.

Age-related macular degeneration (AMD) is a prevalent retinal degenerative disease among the elderly and is a major cause of irreversible vision loss worldwide. Although color fundus photography (CFP) and optical coherence tomography (OCT) are widely used for AMD diagnosis, information from a single modal is inadequate to fully capture the complex pathological features of AMD. To address this, this study proposes an innovative multi-modal deep learning framework that fine-tunes pre-trained single-modal retinal models for efficient application in multi-modal AMD categorization tasks. Specifically, two independent vision transformer models are used to extract features from CFP and OCT images, followed by deep canonical correlation analysis (DCCA) to perform nonlinear mapping and fusion of features from both modalities, maximizing cross-modal feature correlation. Moreover, to reduce the computational complexity of multi-modal integration, we introduce the low-rank adaptation (LoRA) technique, which uses low-rank decomposition of parameter matrices, achieving superior performance compared to full fine-tuning with only about 0.49% of the trainable parameters. Experimental results on the public dataset MMC-AMD validate the framework's effectiveness. The proposed model achieves an overall F1-score of 0.948, AUC-ROC of 0.991, and accuracy of 0.949, significantly outperforming existing single-modal and multi-modal baseline models, particularly excelling in recognizing complex pathological categories.

FOVEA: Preoperative and intraoperative retinal fundus images with optic disc and retinal vessel annotations

The performance and scope of computer vision methods applied to ophthalmic images is highly dependent on the availability of labelled training data. While there are a number of colour fundus photography datasets, FOVEA is to the best of our knowledge the first dataset that matches high-quality annotations in the intraoperative domain with those in the preoperative one. It comprises data from 40 patients collected at Moorfields Eye Hospital (London, UK) and includes preoperative and intraoperative retinal vessel and optic disc annotations performed by two independent clinical research fellows, as well as short video clips showing the retinal fundus though biomicroscopy imaging in the intraoperative setting. The annotations were validated and converted into binary segmentation masks, with the code used available on GitHub. We expect this data to be useful for deep learning applications aimed at supporting surgeons during vitreoretinal surgery procedures e.g. by localising points of interest or registering additional imaging modalities.

A Novel Effect of Microaneurysms and Retinal Cysts on Capillary Perfusion in Diabetic Macular Edema: A Multimodal Imaging Study.

Background/Objectives: The aim of this study was to investigate the potential contribution of microaneurysms (MAs) and retinal cysts to the pathogenesis of macular non-perfusion in patients with diabetic macular edema (DME) using multimodal imaging. Methods: In this cross-sectional study, 42 eyes with DME were analyzed using color fundus photography, fluorescein angiography (FA) and optical coherence tomography (OCT). Macular non-perfusion within the central 3000 µm was categorized by location and extent into foveal avascular zone enlargement (FAZE), focal non-perfusion (FNP) and diffuse non-perfusion (DNP). A custom-developed software was used to assess the colocalization of retinal cysts on OCT with areas of non-perfusion on the corresponding FA images. Also, the presence of leaky MAs adjacent to retinal cysts on FA was verified. Results: Colocalization between retinal cysts and non-perfusion was observed in 32 of 42 (76%) eyes: 19 of 23 (83%) eyes with FAZE and 13 of 16 (81%) eyes with FAZE+FNP. No cysts colocalization was found in all three eyes (100%) presenting with DNP. None of the eyes presented with FNP alone. In the remaining seven eyes (four eyes with FAZE and three eyes with FAZE+FNP), no colocalization was noticed. At least one leaky MA adjacent to retinal cysts was identified in all eyes presented with colocalization. Conclusions: Retinal cysts may contribute to the development of limited non-perfusion in DME. Leaky MAs appear to be the primary source of cyst formation, which may lead to localized capillary occlusion in the macula.

Detection of Center-Involved Diabetic Macular Edema with Visual Impairment using Multimodal Artificial Intelligence Algorithms.

Detection of Center-Involved Diabetic Macular Edema with Visual Impairment using Multimodal Artificial Intelligence Algorithms.

Adaptive Optics-Transscleral Flood Illumination Imaging of Retinal Pigment Epithelium in Dry Age-Related Macular Degeneration.

Adaptive optics-transscleral flood illumination (AO-TFI) is a novel imaging technique with potential for detecting retinal pigment epithelium (RPE) changes in dry age-related macular degeneration (AMD). This single-center prospective study evaluated its ability to visualize pathological features in AMD. AO-TFI images were acquired using the prototype Cellularis® camera over six 5 × 5° macular zones in patients with good fixation and no exudative changes. Conventional imaging modalities, including spectral-domain optical coherence tomography (OCT), color fundus photography and fundus autofluorescence, were used for comparison. AO-TFI images were correlated with OCT using a custom method (Fiji software, v. 2.9). Eleven eyes of nine patients (70 ± 8.3 years) with early (n = 5), intermediate (n = 1) and atrophic (n = 5) AMD were analyzed. AO-TFI identified relevant patterns in dry AMD. RPE cell visibility was impaired in affected eyes, but AO-TFI distinguished cuticular drusen with hyporeflective centers and bright edges, large ill-defined drusen and stage 3 subretinal drusenoid deposits as prominent hyperreflective spots. It provided superior resolution for small drusen compared to OCT and revealed crystalline structures and hyporeflective dots in atrophic regions. Atrophic borders remained isoreflective unless RPE displacement was absent, allowing precise delineation. These findings highlight AO-TFI's potential as a sensitive imaging tool for characterizing early AMD and clinical research.

Intraretinal Fibrosis in Macular Telangiectasia Type-2 (MacTel): Clinical and Multimodal Imaging Features.

To explore the clinical and multimodal imaging characteristics of Intraretinal Fibrosis (IRFib) in Macular Telangiectasia Type-2 (MacTel). MacTel eyes with IRFib that had multimodal imaging with color fundus photography, multicolor (MC), blue reflectance, spectral-domain optical coherence tomography (OCT), OCT-angiography (OCTA) and fluorescein angiography. Seven eyes of 6 patients were included. Clinically, all cases had grayish-white fibrosis at macula, with retinal vessel tortuosity in two cases best characterized on MC. Two eyes each belonged to Gass and Blodi stages 3 and 4, three eyes were stage 5 MacTel. The mean lesion area at presentation was 1.36 ± 0.81 mm2 (range 0.56-2.99 mm2). The defining OCT finding for IRFib was hyper-reflective distortion intraretinally (involving different layers). Other accompanying findings in decreasing order were collapse sign (7 eyes); epiretinal membrane (6 eyes); pigment clumping and migration (5 eyes); serrated internal limiting membrane and outer-retinal hyper-reflectivity (4 eyes); and lamellar macular hole (1 eye). On OCTA, IRFib was associated with right-angled vessels, vascular invasion and distortion of foveal avascular zone (FAZ), and vessel dilatation and tortuosity in superficial vascular complex; telangiectasia, FAZ distortion and invasion, vessel drag, capillary looping, and abnormal vascular structures in deep capillary plexus; and nodular tuft or twig-like hyper-reflective vascular lesions in outer-retina choriocapillaris slab. The incidence of IRFib on MC in our MacTel cohort was 1.75% with characteristic findings on OCT and OCTA. They are associated with advanced MacTel and probably implicate Müller cell dysfunction, activated glial cells, and vascular changes during the disease process.

Survey of Australian primary eyecare management of choroidal nevus patients.

Our survey found that clinical imaging is widely utilized by many Australian eyecare practitioners for detecting and monitoring choroid nevus and highlighted knowledge gaps for risk factors and features of choroid nevus and early primary eye melanoma. Continuing education related to early detection could improve multidisciplinary management of these patients. The aim is to survey Australian primary eyecare practitioners on their management of patients with choroidal nevus. A random sample of optometrists and ophthalmologists registered to practice in Australia was surveyed using a purpose-designed questionnaire including demographics, types of imaging techniques used, and practitioner choroid nevus knowledge (K), attitude (A), and practice (P). Ninety-three optometrists and 82 ophthalmologists responded. More than 50% practiced independently, most in metropolitan centers (n = 113/175). Multiple imaging techniques were used to detect and monitor choroidal nevus; >72% of practitioners routinely used optical coherence tomography and color fundus photography. KAP scores indicated moderate knowledge about choroid nevus risk factors and clinical features (mean = 5.2/9, standard deviation [SD] = 1.8). Clinical mnemonics that summarized signs of risk for nevus-to-melanoma transformation were used by <50% of practitioners overall. Scores indicated a very positive attitude to nevus management (mean = 6.5/8, SD = 1.2) but a moderate practice score (mean = 13.9/25, SD = 2.9). A significant difference between optometrists and ophthalmologists was found for knowledge, but not for attitude or practice scores. Choroid nevus patients were referred to a specialist ophthalmologist by ~30% of all practitioners. The majority of Australian primary eyecare practitioners used multiple imaging techniques to detect and monitor choroidal nevi. There were, however, gaps in knowledge associated with identifying risk factors for choroidal nevus growth. Our findings align with recent UK studies that highlight the importance of diligent screening and review, timely referral for potential melanoma-related risks, and encourage multidisciplinary care for choroidal nevus patients.

Fluorescence Lifetime Imaging Ophthalmoscopy, Vision, and Chorioretinal Asymmetries in Aging and Age-Related Macular Degeneration: ALSTAR2.

Eyes with age-related macular degeneration (AMD) and some healthy aged eyes exhibit risk-indicating delays in rod-mediated dark adaptation (RMDA) and prolonged long spectral channel (LSC) lifetimes by fluorescence lifetime imaging ophthalmoscopy (FLIO) in the Early Treatment Diabetic Retinopathy Study (ETDRS) outer ring, especially nasally. To learn FLIO's potential for AMD detection, we correlate FLIO to RMDA. The ALSTAR2 follow-up cohort underwent FLIO, color fundus photography, two-wavelength autofluorescence (for macular pigment optical density [MPOD]), visual function testing, including RMDA (rod intercept time [RIT]). AMD was staged by the Age-Related Eye Disease Study (AREDS) 9-step at baseline and follow-up. In pseudophakic eyes with high-quality FLIO, mean intensity maps and meridian plots were created. Vision data were analyzed using linear regression and Spearman's r. Of 155 eyes (155 participants [75 ± 5.0 years; 60.7% female participants]), 67 eyes were healthy, 38 had early (e)AMD, and 50 had intermediate (i)AMD (P = 0.02). LSC lifetimes were longest in iAMD in all ETDRS regions (P < 0.01) and short spectral channel (SSC) lifetimes in inner and outer rings (P < 0.01). The LSC pattern manifested in 65 of 88 AMD eyes and 30 of 67 healthy eyes. Lifetimes were longest on the nasal meridian and shortest on temporal. LSC lifetimes in the inner and outer rings correlated strongly with RIT (r = 0.68). A stable subgroup had short LSC lifetimes and short RIT. SSC correlated weakly with MPOD. Prolonged lifetimes in AMD exhibit spatial asymmetry, suggesting mechanisms beyond retinal cells and including choroid. Lifetimes correlate with delayed RMDA, potentially indicating risk for AMD onset and early progression. Further research into SSC signal sources is warranted.

Macular curvature in vertical cross sections of optical coherence tomography in school age children

Although the underlying mechanism of macular curvature remains unclear, it has been linked to various ocular diseases. However, changes in macular curvature during growth have not been thoroughly investigated. This study aimed to investigate macular curvature in children of different ages and its association with axial length. A total of 122 right eyes of healthy elementary school students (Group E; 8–9 years old; 61 males and 61 females) and 173 right eyes of healthy junior high school students (Group J; 12–13 years old; 83 males and 90 females) were included. Axial length, color fundus photographs, and optical coherence tomographic vertical cross-sectional images of the macula were obtained and used for analysis. The macular curvature was plotted as the retinal pigment epithelium and fitted to a second-degree polynomial equation using ImageJ software, to calculate the macular curvature. The Mann-Whitney U test compared macular curvature and axial length between the E and J Groups. The association between the macular curvature and axial length was determined using Spearman’s correlation analysis. Group J’s axial length and macular curvature were significantly greater than Group E’s (p < 0.001). Macular curvature was significantly positively correlated with axial length in Group J (r = 0.40, P < 0.001) but not in Group E (r = 0.08, P = 0.40). These findings suggest a possible increase in macular steepness during this period. Further longitudinal cohort studies are needed to confirm these results.