Myopic Maculopathy

What is myopic maculopathy?

Myopic maculopathy is a type of eye damage related to short-sightedness. 

Myopic maculopathy is a condition that affects the back part of the eye, called the retina. Think of your eye like a camera – the retina is the part that helps you see things and plays a very important role in your vision.

People with short-sightedness have difficulties seeing things that are far away. When someone has severe short-sightedness, it means their eye is longer than normal, which can stretch the retina. This stretching can damage the middle part of the retina, known as the macula, and this can cause vision loss in some people. Myopic maculopathy is what we use to describe this damage and vision loss.

Myopic maculopathy is a serious condition that can either develop suddenly or slowly over time.

What are the symptoms?

Symptoms of myopic maculopathy include blurred or patchy vision, central blind spots, or distorted vision where straight lines appear wavy or bent. Symptoms can vary in severity and might develop progressively over time.

Causes and risk factors

Myopic maculopathy tends to affect younger people who are very short-sighted. This differs from age-related macular degeneration, which commonly affects people over the age of 65.

Occasionally, inflammatory retinal disorders can look a lot like myopic maculopathy, and in these cases additional immunosuppression treatment may be available to treat the disease.

Genetics and family history can increase your risk of developing short-sightedness, along with unhealthy lifestyle choices such as smoking or a poor diet. Too much reading and screen time, or not enough time spent outdoors as a youth, can also increase your chances of developing short-sightedness. 

The worse your short-sightedness, the more likely you are to develop myopic maculopathy.

Prevention

There is currently no way to prevent myopic maculopathy in adults, but there are treatments available to help with this condition. These can help to block aberrant blood vessel growth or repair retinal tears, so that your vision is protected for as long as possible.

There are some treatments available in childhood that aim to slow down the worsening of short-sightedness while the eye is still growing.

An early diagnosis and treatment plan can help to preserve your vision. Having regular eye exams and following the advice of your eye care team will help you monitor the degree of myopic maculopathy.

Diagnosis

Myopic maculopathy is diagnosed by an eye specialist, such as Dr Sheck, who is an ophthalmologist.

A thorough eye exam will be performed, during which eyedrops will be used to dilate your pupil and Dr Sheck will examine various parts of your eye, including the retina. Special imaging, such as optical coherence tomography (OCT) scans, can be used to assess the thinning of your retina, the blood layer of the eye (choroid), and to check if there are any abnormal changes to the eyewall.

The severity of your myopic maculopathy can be graded using the ATN classification system. Three key features are assessed: Atrophy(A), refers to the thinness of your retina; Traction (T), refers to the distortion of your retina; and Neovascularisation (N), refers to the degree of abnormal blood vessel growth. This system allows your specialist to determine the severity and monitor the progression of your condition.

An Amsler grid can also be used at home to check your vision, so you can monitor any changes or distortions to your vision on a regular basis. An Amsler grid is available is available here, and Dr Sheck will give you instructions on its use.

Treatment options

The type of treatment you will receive will depend on the complications you are experiencing from your myopic maculopathy.

Early and regular treatment is important for maintaining vision. Injections into the eye (known as an intravitreal injections) can be used to deliver medications such as anti-vascular endothelial growth factor (anti-VEGF), which are effective at helping to stop new blood vessel growth. Most patients only need 1–2 injections. You can find more information on intravitreal injections on Dr Sheck’s website.  

In cases of retinal tearing, detachment, or holes, retinal surgery is required.

‍Side effects of treatment

Intravitreal injections are very effective at stopping the growth of new blood vessels that could affect your vision. However, as with all medical procedures, there is a small risk of experiencing side effects, some of which can be serious. Dr Sheck will only recommend this procedure if the benefits outweigh the risks.

The eye can be gritty for 24 hours after the procedure, and the injection site can be red (like a small patch of blood). These are harmless and will settle over the course of a few days.

A more serious side effect is the small risk of infection inside the eye from the injection (1 in 5,000). There is also a risk of bleeding inside the eye (1 in 5,000) or retinal detachment (1 in 10,000).

You can find more information about intravitreal injections and side effects here. 

Retinal detachment is considered a medical emergency, and you must contact Dr Sheck and his clinic immediately if the eye is very painful or your vision suddenly gets worse.

Your appointment with Dr Sheck

Your first appointment with Dr Sheck will involve a comprehensive assessment of your eyes. A technician will assess your eyesight, dilate your pupils with eye drops, and take images using special instruments to get a detailed view of your eyeball.

Dr Sheck will review all your imaging and discuss the findings with you. If appropriate, Dr Sheck will explain the treatment options available to you, outline the costs, and work with you to create a treatment plan.

Written information about your condition will be provided either in hard copy or electronically. If treatment is needed, you will generally have the option of having it performed right away or at a later date, as you prefer.

Your vision can be blurry and your eyes more sensitive to light for a few hours after your pupils are dilated. This can affect your ability to drive after your appointment. Please consider bringing someone to drive you home if you attend the appointment by car.

You can find more information about your appointment with Dr Sheck on his website.

About Dr Sheck

Dr Sheck is a RANZCO-qualified, internationally trained ophthalmologist. He combined his initial training in New Zealand with a two-year advanced fellowship at Moorfield Eye Hospital, London. He also holds a Doctorate in Ocular Genetics from the University of Auckland and a Master of Business Administration from the University of Cambridge. He specialises in medical retinal diseases (injection therapy), cataract surgery, ocular genetics, uveitis and electrodiagnostics

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