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

Annechien E.G. Haarman, Milly S. Tedja, Corina Brussee, Clair A. Enthoven, Gwyneth A. Van Rijn, Johannes R. Vingerling, Jan E.E. Keunen, Camiel J.F. Boon, Annette J.M. Geerards, Gré P.M. Luyten, Virginie J.M. Verhoeven, Caroline C.W. Klaver*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

18 Citations (Scopus)


Importance: High myopia incidence and prevalence is increasing worldwide, and the visual burden caused by myopia is expected to rise accordingly. Studies investigating the occurrence of myopic complications in individuals of European ancestry with high myopia are scarce, hampering insights into the frequency of myopic retinal complications in European individuals and their visual burden. Objective: To assess the frequency of myopic macular features in individuals of European ancestry with high myopia. Design, Setting, and Participants: This cross-sectional analysis of the Dutch Myopia Study (MYST) and individuals with high myopia from the Rotterdam Study (RS) included 626 patients with high myopia (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 high myopia study, a systematic literature review was also performed to compare findings with studies of individuals of Asian ancestry. Exposures: High myopia, age, and AL. Main Outcomes and Measures: Frequency of myopic 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 highly myopic 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 high myopia..

Original languageEnglish
Pages (from-to)115-123
Number of pages9
JournalJAMA Ophthalmology
Issue number2
Publication statusPublished - Feb 2022

Bibliographical note

Funding Information:
Funding/Support: This work was supported by Netherlands Organization for Scientific Research (NWO): grant 91617076 (Dr Verhoeven) and grant 91815655 (Dr Klaver), and European Research Council under the European Union Horizon 2020 research and innovation programme grant 648268 (Dr Klaver). The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. They provided unrestricted grants.

Funding Information:
reported receiving grants from Oogfonds, ODAS, and Uitzicht 2017-28 (LSBS, MaculaFonds, Oogfonds) outside the submitted work. Dr van Rijn reported receiving grants from Stichting blindenhulp and ANVVB and LSBS (through Uitzicht) during the conduct of the study; the funding organizations provided unrestricted grants and had no role in the design or conduct of this research. Dr Klaver reported receiving grants from European Union’s Horizon 2020 and Netherlands Organization for Scientific Research (NWO) VICI during the conduct of the study; and serving as a consultant for Bayer and Thea Pharma outside the submitted work. No other disclosures were reported.

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© 2022 American Medical Association. All rights reserved.

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