Prevalence of Myopic Macular Features in Dutch Individuals of European Ancestry With High Myopia

IMPORTANCE Highmyopia incidence and prevalence is increasing worldwide, and the visual burden caused bymyopia is expected to rise accordingly. Studies investigating the occurrence ofmyopic complications in individuals of European ancestry with highmyopia are scarce, hampering insights into the frequency ofmyopic retinal complications in European individuals and their visual burden. OBJECTIVE To assess the frequency ofmyopic macular features in individuals of European ancestry with highmyopia. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis of the Dutch Myopia Study (MYST) and individuals with highmyopia from the Rotterdam Study (RS) included 626 patients with highmyopia (spherical equivalent of refractive error [SER] <=-6 diopters [D] or axial length [AL] >= 26 mm) who underwent an extensive ophthalmic examination including multimodal retinal imaging. In addition to this combination of a population-based cohort study and mix-based highmyopia study, a systematic literature review was also performed to compare findings with studies of individuals of Asian ancestry. EXPOSURES Highmyopia, age, and AL. MAIN OUTCOMES AND MEASURES Frequency ofmyopic macular and optic disc features: tessellated fundus, myopic macular degeneration (MMD), staphyloma, peripapillary intrachoroidal cavitation, peripapillary atrophy (PPA), and "plus" lesions (choroidal neovascularization, Fuchs spot, and lacquer cracks). RESULTS The mean (SD) SER of the combined study population (MYST and RS) was -9.9 (3.2) D; the mean (SD) age was 51.4 (15.1) years, and 387 (61.8%) were women. The prevalence of MMD was 25.9% and increased with older age (P for trend <.001), lower SER (odds ratio [OR], 0.70; 95% CI, 0.65-0.76; P <.001), and higher AL (OR, 2.53; 95% CI, 2.13-3.06; P <.001). Choroidal neovascularization or Fuchs spot was present in 2.7%(n = 17), both lesions in 0.3% (n = 2), and lacquer cracks in 1.4%(n = 9). Staphyloma, PPA, and MMD were highly prevalent in visual impaired and blind eyes (frequency was 73.9%[20 of 27], 90.5%[19 of 21], and 63.0%[17 of 27] of unilateral blind eyes for MMD, staphyloma, and PPA, respectively). Seven previous studies in Asian populations reported a variable MMD frequency ranging from 8.3% to 64%, but frequencies were similar for comparable risk profiles based on age and SER. CONCLUSIONS AND RELEVANCE In this cross-sectional study of a highlymyopic Dutch population of European ancestry, myopic retinal features were frequent; were associated with age, SER, and AL; and occurred in all visually severely impaired eyes. The absence of treatment options for most of these retinal complications emphasizes the need for effective strategies to prevent highmyopia.