Morphological Characteristics and Risk Factors of Myopic Maculopathy in an Older High Myopia Population—Based on the New Classification System (ATN)

Abstract

•Highly myopic eyes with a larger peripapillary atrophy area were more likely to have myopic atrophy maculopathy (MAM) and myopic neovascular maculopathy (MNM).•Highly myopic eyes with a thicker macular choroidal thickness were less likely to have MAM and MNM.•Highly myopic eyes with a lower tilt ratio were more likely to have myopic tractional maculopathy (MTM).•The pathogenesis of MTM is different from that of MAM and MNM.•A traction component should be considered as a possible component to the myopic macular classification. PurposeTo investigate the characteristics, mergers, and risk factors of different types of myopic maculopathy (MM) in a highly myopic population.DesignPopulation-based, cross-sectional study.MethodsA total of 1086 eyes (762 patients) were enrolled. Each participant underwent detailed ocular examinations. Combining the fundus photographs and optical coherence tomography images, types of MM were assessed as myopic atrophy maculopathy (MAM), myopic tractional maculopathy (MTM), or myopic neovascular maculopathy (MNM) according to the ATN classification system. Peripapillary atrophy (PPA) area, tilt ratio, and macular choroidal thickness (mChT) were measured individually.ResultsEyes with larger PPA area were more likely to have MAM (odds ratio [OR], 1.220; P = .037 per 1-mm2 increase) and MNM (OR, 1.723; P < .001 per 1-mm2 increase), and eyes with thicker mChT were less likely to have MAM (OR, 0.740; P < .001 per 10-μm increase) and MNM (OR, 0.784; P < .001 per 10-μm increase), whereas eyes with higher tilt ratio were less likely to have MTM (OR, 0.020; P < .001 per 1 increase). The severity of MTM and MNM was not precisely consistent with that of MAM.ConclusionsDifferent types of MM have different risk factors; larger PPA area and thinner mChT are risk factors for MAM and MNM, whereas lower tilt ratio is a risk factor for MTM. Our results indicate that the pathogenesis of MTM is different from that of MAM and MNM, and a tractional component should be considered as a possible component to the myopic macular classification. To investigate the characteristics, mergers, and risk factors of different types of myopic maculopathy (MM) in a highly myopic population. Population-based, cross-sectional study. A total of 1086 eyes (762 patients) were enrolled. Each participant underwent detailed ocular examinations. Combining the fundus photographs and optical coherence tomography images, types of MM were assessed as myopic atrophy maculopathy (MAM), myopic tractional maculopathy (MTM), or myopic neovascular maculopathy (MNM) according to the ATN classification system. Peripapillary atrophy (PPA) area, tilt ratio, and macular choroidal thickness (mChT) were measured individually. Eyes with larger PPA area were more likely to have MAM (odds ratio [OR], 1.220; P = .037 per 1-mm2 increase) and MNM (OR, 1.723; P < .001 per 1-mm2 increase), and eyes with thicker mChT were less likely to have MAM (OR, 0.740; P < .001 per 10-μm increase) and MNM (OR, 0.784; P < .001 per 10-μm increase), whereas eyes with higher tilt ratio were less likely to have MTM (OR, 0.020; P < .001 per 1 increase). The severity of MTM and MNM was not precisely consistent with that of MAM. Different types of MM have different risk factors; larger PPA area and thinner mChT are risk factors for MAM and MNM, whereas lower tilt ratio is a risk factor for MTM. Our results indicate that the pathogenesis of MTM is different from that of MAM and MNM, and a tractional component should be considered as a possible component to the myopic macular classification.