Prevalence and progression of myopic retinopathy in an older population

Abstract

Objective To determine the prevalence and progression of myopic retinopathy in an older community-based population sample. Design Population-based epidemiologic study. Participants Eligible residents aged 49 years or older (n = 3654) who attended the Blue Mountains Eye Study, west of Sydney, Australia. Methods Participants had a detailed eye examination including measurement of logarithm of the minimum angle of resolution (logMAR) visual acuity, standardized refraction, and retinal stereophotography. All patients were invited to attend follow-up examinations after 5 years. Main outcome measures Myopic retinopathy was defined to include staphyloma, lacquer cracks, Fuchs’ spot and myopic chorioretinal atrophy. β-peripapillary atrophy was assessed separately. Results Signs of myopic retinopathy were found in 67 eyes from 44 participants (1.2%), a prevalence of 1.4% in women and 1.0% in men; this increased from 1% in right eyes with myopia <3 diopters to over 50% in right eyes with myopia ≥9 diopters. There was a nonsignificant age-related trend in prevalence. The average spherical equivalent refraction was –6.1 diopters and the average visual acuity was 20/40 in eyes with myopic retinopathy. Visual impairment (<20/40) was present in 38.8% of affected eyes. Myopic retinopathy was bilateral in 52% of cases. Staphyloma was present in 26 participants (0.7%), bilateral in 35%, with a strong concordance of staphyloma location. Lacquer cracks were seen in 8 participants (0.2%), Fuchs’ spot in 3 (0.1%), and chorioretinal atrophy in 7 (0.2%). Forty-six eyes (68.7%) with myopic retinopathy were reexamined after 5 years; 8.7% had new or increased numbers of lacquer cracks and 15.2% had new or expanded areas of chorioretinal atrophy. In those eyes developing lacquer cracks or chorioretinal atrophy, best-corrected visual acuity decreased by a mean of two LogMAR lines. Conclusions This study documented the age and sex-specific prevalence of myopic retinopathy and 5-year progression in an older white population.