Optic Disc Features in Highly Myopic Eyes: The ZOC-BHVI High Myopia Cohort Study.

SIGNIFICANCE: Some studies reported that optic disc tilt and rotation might be risk factors for the susceptibility of high myopic eyes to develop glaucoma. However, data regarding optic disc manifestations in high myopia participants are few. It is crucial to characterize the features of optic disc manifestations among high myopes. PURPOSE: To describe optic disc characteristics of Chinese highly myopic eyes and to investigate associated factors. METHODS: This cross-sectional, observational study included 890 Chinese with bilateral high myopia (defined as ≤-6.00 diopters spherical power) in 2012. All subjects underwent cycloplegic autorefraction, ocular biometry, and fundus photography. The optic disc tilt ratio, degree of rotation, and ß-zone peripapillary atrophy area were measured from the 45°optic disc-centered fundus photographs. Optic disc tilt was defined as optic disc tilt ratio, the ratio of maximum to minimum diameter of optic disc, exceeding 1.3. The definition of optic disc rotation was using optic disc rotation degree, the angle from long diameter and the vertical meridian, of >15°. RESULTS: Among 890 participants, 2 were excluded by ungradable optic disc-centered fundus photographs. In the 888 studied right eyes, the mean spherical power was -9.36 ± 3.46 diopters with a mean axial length of 27.51 ± 1.63 mm. The proportion of optic disc tilting, rotation, and ß-zone peripapillary atrophy were 81.2%, 48.3%, and 92.8%, respectively. The mean ratio of optic disc tilting and rotation degree was 1.78 ± 0.53 and 21.08 ± 19.91°; the mean area of ß-zone peripapillary atrophy/optic disc head was 1.11 ± 1.22. A multiple linear regression showed that older age (P < .001), female (P = .02), and more myopic spherical equivalent (P = .005) were related to the greater optic disc tilting ratio. CONCLUSIONS: Beta-zone peripapillary atrophy, optic disc tilting, and rotation are very common in highly myopic eyes in Chinese population. Older age, female, and more myopic spherical equivalent are risk factors of higher degree of optic disc tilting.

Design and Baseline Characteristics of the HELP Study: An Extended and Long-Term Observation of Pathological Myopia in Caucasians.

PURPOSE: To assess the natural disease progression of high myopia in Caucasians considered at risk for the development of myopic choroidal neovascularization (mCNV). METHODS: Subjects were recruited in 25 clinical sites between June 2014 and June 2016. Main inclusion criteria included axial length of ≥26 mm, best-corrected visual acuity ≥0.05 decimal equivalent and presence of at least one out of five predefined morphological disease risk criteria. These were (1) subfoveal choroidal thinning < 50 µm, (2) enhanced choroidal curvature length > 6,300 µm, (3) lacquer cracks, (4) patchy atrophy > 5 mm2 and (5) preexisting mCNV in the fellow eye (German Clinical Trial Register DRKS00007761). RESULTS: A total of 150 participants (66% females) with a mean age of 57.2 (±12.7) years (range 21.9-86.2 years) were included. The disease criteria most frequently encountered were choroidal thinning (33.3%) and lacquer cracks (32.7%). Enhanced choroidal curvature length was detected in only 8 subjects and always occurred in combination with other disease criteria. Presence of patchy atrophy was found to be more common in older subjects (p = 0.0012) and also associated with a more severe disease manifestation. CONCLUSION: The baseline data of this study indicate that enhanced choroidal curvature might be less common in Caucasians than in Asian populations. Further, disease severity in patients with high myopia is relatively high in the presence of patchy atrophy.

Morphological and clinical characteristics of myopic posterior staphyloma in Caucasians.

PURPOSE: We aimed to study the morphological characteristics of myopic posterior staphyloma in Caucasians and to evaluate the correlation between posterior staphyloma, myopic macular lesions and visual acuity. METHODS: Ninety eyes of 67 consecutive patients affected by high myopia associated with posterior staphyloma were recruited between January 2012 and December 2013. Posterior staphyloma was classified according to Curtin's criteria. Every patient underwent fundoscopic examination and best corrected visual acuity measurement (BCVA). A and B-scan ultrasound (US), high-resolution, three-dimensional magnetic resonance image (MRI), optical coherence tomography (OCT), fundus autofluorescence (FAF), red free (RF) and color fundus photography studies were performed. RESULTS: The mean age was 64.4 ± 9.48 years (range: 41-82). The mean BCVA was 0.7 ± 0.5 logMAR (range: 0-2). The mean axial length was 29.92 ± 2.39 millimeters (range: 24.25-36.53). The authors found four types of posterior staphyloma according to Curtin's classification: I, II, IV and IX. Significant prevalence of posterior staphyloma in female sex was observed (p = 0.0235). Significant correlation between the depth and the diameters of posterior staphyloma was demonstrated (p < 0.0001). Significant association between posterior staphyloma type and tomographic foveal patterns (p = 0.0230) was highlighted. Posterior staphyloma type I was more frequently associated with peripapillary atrophy and less with macular atrophy compared to type II and IX (p = 0.0169). The prevalence of macular atrophy was more than double in posterior staphyloma type II (33.3 %) in comparison to posterior staphyloma type I (12.5 %). CONCLUSIONS: This study confirms that the type I and II are the most common types of posterior staphyloma, as already highlighted in the literature. A significant association between the type of posterior staphyloma and the MRI ocular shape pattern, the OCT patterns of macular profile and the location of chorioretinal atrophy was highlighted. The correlation between the depth and the width of posterior staphyloma has demonstrated that the deeper the staphyloma, the wider it was. The deepest area of the posterior staphyloma was characterized by a greater thinning of the sclera and by a higher prevalence of chorioretinal atrophy compared to the other parts of the eye. More studies are necessary to support our findings and to add more information on the natural evolution of posterior staphyloma and on its associated complications.

MYOPIC RETINOSCHISIS IN ASIANS: Structural Features and Determinants of Visual Acuity and Prognostic Factors for Progression.

PURPOSE: To describe microstructural changes and schisis extent in eyes with myopic retinoschisis and to determine their influence on visual acuity at baseline and follow-up. METHODS: In this prospective observational study, 50 eyes of 38 patients with myopic retinoschisis were evaluated using spectral domain optical coherence tomography, and the patients were followed for at least 12 months. The presence of microstructural changes and the extent of retinoschisis at baseline on spectral domain optical coherence tomography, and the association between these parameters and the risk of visual acuity deterioration were analyzed. RESULTS: Median presenting visual acuity and central retinal thickness were 0.31 logMAR (≈20/40) and 395 µm, respectively. Twenty-six eyes (52%) had entire macular area retinoschisis. Common microstructural changes included photoreceptor detachment (24%), foveal ellipsoid zone (EZ) disruption (34%), partial-thickness macular hole (26%), and full-thickness macular hole (16%). Visual acuity was poorer in eyes with photoreceptor detachment, EZ disruption, full-thickness macular hole, and central retinal thickness >300 µm. Eyes with entire macular area retinoschisis had the poorest visual acuity and thickest central retinal thickness, and they were more likely to have photoreceptor detachment, EZ disruption, and retinal detachment. Over a mean follow-up of 31.7 ± 7.7 months, 14 eyes (28%) had worsening visual acuity of ≥2 lines. Ten of these 14 eyes had entire macular retinoschisis at baseline. CONCLUSION: Most eyes with myopic retinoschisis remain stable. However, eyes with extensive retinoschisis involving the entire macular area are more likely to progress and have microstructural abnormalities and poorer vision. Early surgery should be considered for these eyes.

Ranibizumab in Myopic Choroidal Neovascularization: A Subgroup Analysis by Ethnicity, Age, and Ocular Characteristics in RADIANCE.

PURPOSE: To assess the impact of ethnicity, age, and ocular characteristics on ranibizumab efficacy in myopic choroidal neovascularization (CNV). METHODS: In this post hoc subgroup analysis from the phase III RADIANCE study, best-corrected visual acuity (BCVA) outcomes and treatment exposure were analyzed in 105 patients treated with ranibizumab 0.5 mg. Baseline categories included ethnicity, age, baseline BCVA, lesion area, CNV lesion area, refraction sphere, axial length, subretinal fluid, and location of CNV. RESULTS: At month 12, the mean change in BCVA was numerically higher in East-Asians than in Caucasians (17.0 vs. 14.1 letters). The median number of injections varied with ethnicity (East-Asians vs. Caucasians: 2 vs. 3), baseline BCVA (highest vs. lowest: 1 vs. 4), CNV lesion area and lesion area (largest vs. smallest: 5 vs. 1 and 5 vs. 2). CONCLUSIONS: East-Asians showed numerically higher BCVA gains than Caucasians. The number of injections varied across subgroups, emphasizing the need for individualized treatment.

Sensitivity and specificity for detecting early glaucoma in eyes with high myopia from normative database of macular ganglion cell complex thickness obtained from normal non-myopic or highly myopic Asian eyes.

PURPOSE: We aimed to determine the sensitivity and specificity of the normative database of non-myopic and highly myopic eyes of the macular ganglion cell complex (mGCC) thickness embedded in the NIDEK RS-3000 spectral-domain optical coherence tomography (SD-OCT) for detecting early glaucoma in highly myopic eyes. METHODS: Forty-seven highly myopic eyes (axial length ≥26.0 mm) of 47 subjects were studied. The SD-OCT images were used to determine the mGCC thickness within a 9-mm diameter circle centered on the fovea. The sensitivity and specificity of the non-myopic database were compared to that of the highly myopic database for distinguishing the early glaucomatous eyes from the non-glaucomatous eyes. The mGCC scans were classified as abnormal if at least one of the eight sectors of the significance map was < 1 % of the normative thickness. RESULTS: Twenty-one eyes were diagnosed to be non-glaucomatous and 26 eyes to have early glaucoma. . The average mGCC thickness was significantly thinner (80.9 ± 8.5 µm) in the early glaucoma group than in the non-glaucomatous group (91.2 ± 7.5 µm; p <1 × 10(-4)). The sensitivity was 96.2 % and specificity was 47.6 % when the non-myopic database was used, and the sensitivity was 92.3 % and the specificity was 90.5 % when the highly myopic database was used. The difference in the specificity was significant (p < 0.01). CONCLUSIONS: The significantly higher specificity of the myopic normative database for detecting early glaucoma in highly myopic eyes will lead to fewer false positive diagnoses. The database obtained from highly myopic eyes should be used when evaluating the mGCC thickness of highly myopic eyes.

Association between a lumican promoter polymorphism and high myopia in the Chinese population: a meta-analysis of case-control studies.

PURPOSE: To evaluate the relationship between lumican polymorphisms and high myopia in Chinese populations. METHODS: An electronic search was conducted in Pubmed, Embase, Cochrane Library and the China Biological Medicine Database for articles published prior to September 30, 2012. A meta-analysis was performed to assess heterogeneity, combine results and determine publication bias. RESULTS: This meta-analysis, including 1,545 subjects from 5 studies, indicated that Chinese lumican rs3759223 C allele carriers had a decreased risk of high myopia in comparison to T allele carriers (odds ratio: 0.531; 95% confidence interval, CI: 0.304-0.925; p = 0.025). There was some heterogeneity between studies. A metaregression showed that the mean axial length of controls weakens the effect of rs3759223 on high myopia (slope: -0.914; 95% CI: -1.490 to 0.337; p = 0.002). Sensitivity analysis confirmed the reliability and stability of this meta-analysis. CONCLUSION: Chinese lumican rs3759223 C allele carriers may be at reduced risk of high myopia.

A genome-wide association study reveals association between common variants in an intergenic region of 4q25 and high-grade myopia in the Chinese Han population.

High-grade myopia (HM) is highly heritable, and has a high prevalence in the Han Chinese population. We carried out a genome-wide association study involving 102 HM cases suffering from retinal degeneration, and 335 controls who were free from HM and fundus diseases. Significant single-nucleotide polymorphisms were replicated in two follow-up studies: stage I involved 2628 independent cases and 9485 controls, and stage II involved a further 263 cases and 586 HM-free controls. The results were combined in a meta-analysis. Cases and controls were drawn from the Chinese Han population. A locus in an intergenic region at 4q25, within MYP11 (4q22-q27, OMIM: 609994), was found to be associated with HM (rs10034228, P(meta) = 7.70 × 10(-13), allelic odds ratio = 0.81, 95% confidence interval 0.76-0.86). There are no known genes in the region but a number of expressed sequence tags (ESTs) have been located there, one of which (BI480957) has been reported to express in the native human retinal pigment epithelium. In addition, a predicted gene was identified in this region. The gene's predicted protein sequence is highly similar to tubulin, beta 8 and beta-tubulin 4Q. Several previous studies have shown that tubulin plays an important role in eye development. Our result is compatible with a previous linkage study in the Han Chinese population (mapping in MYP11, 4q22-q27), and provides a more accurate locus for HM. Although there is insufficient evidence to indicate that expressed EST and the predicted gene play an important role in developing HM, this region merits further study as a candidate for the disease.

The efficacy and safety of modified Snyder-Thompson posterior scleral reinforcement in extensive high myopia of Chinese children.

BACKGROUND: To observe the efficacy and safety of modified Snyder-Thompson posterior scleral reinforcement in extensive high myopia of Chinese children. We had a retrospective design, and included a control group of children with natural progression of high myopia. METHODS: This study included 64 eyes in 41 Chinese children with extensive high myopia who underwent modified Snyder-Thompson posterior scleral reinforcement surgery (PSR group), and 17 eyes in 11 age- and myopia-matched children who wore spectacles (control group). The mean follow-up was 4.99 ± 1.3 years in the PSR group and 4.48 ± 1.3 years in the control group. Axial length, spherical equivalent (SE), uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) and fundus examinations were recorded before and after treatment, and complications were noted. RESULTS: The mean change in SE at the end of the follow-up period was 1.5 ± 1.44 diopters (D) and 3.02 ± 1.57D in the PSR and control groups respectively. These changes were equivalent to an increase in axial length of 1.27 ± 0.54 mm and 2.05 ± 0.91 mm respectively. The PSR group showed less myopic progression and less eye elongation (p < 0.001). A notable increase in UCVA was only found in the PSR group (p = 0.0001). The improvement in BCVA was significantly greater in the PSR group (p = 0.0354). There were no serious complications of PSR surgery. CONCLUSION: The modified Snyder-Thompson PSR surgery was effective and safe in controlling extensive high myopia of Chinese children.

Myopia Progression as a Function of Sex, Age, and Ethnicity.

Purpose: To model juvenile-onset myopia progression as a function of race/ethnicity, age, sex, parental history of myopia, and time spent reading or in outdoor/sports activity. Methods: Subjects were 594 children in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study with at least three study visits: one visit with a spherical equivalent (SPHEQ) less myopic/more hyperopic than -0.75 diopter (D), the first visit with a SPHEQ of -0.75 D or more myopia (onset visit), and another after myopia onset. Myopia progression from the time of onset was modeled using cubic models as a function of age, race/ethnicity, and other covariates. Results: Younger children had faster progression of myopia; for example, the model-estimated 3-year progression in an Asian American child was -1.93 D when onset was at age 7 years compared with -1.43 D when onset was at age 10 years. Annual progression for girls was 0.093 D faster than for boys. Asian American children experienced statistically significantly faster myopia progression compared with Hispanic (estimated 3-year difference of -0.46 D), Black children (-0.88 D), and Native American children (-0.48 D), but with similar progression compared with White children (-0.19 D). Parental history of myopia, time spent reading, and time spent in outdoor/sports activity were not statistically significant factors in multivariate models. Conclusions: Younger age, female sex, and racial/ethnic group were the factors associated with faster myopic progression. This multivariate model can facilitate the planning of clinical trials for myopia control interventions by informing the prediction of myopia progression rates.

Prevalence and predictors of myopic macular degeneration among Asian adults: pooled analysis from the Asian Eye Epidemiology Consortium.

AIMS: To determine the prevalence and predictors of myopic macular degeneration (MMD) in a consortium of Asian studies. METHODS: Individual-level data from 19 885 participants from four population-based studies, and 1379 highly myopic participants (defined as axial length (AL) >26.0 mm) from three clinic-based/school-based studies of the Asian Eye Epidemiology Consortium were pooled. MMD was graded from fundus photographs following the meta-analysis for pathologic myopia classification and defined as the presence of diffuse choroidal atrophy, patchy chorioretinal atrophy, macular atrophy, with or without 'plus' lesion (lacquer crack, choroidal neovascularisation or Fuchs' spot). Area under the curve (AUC) evaluation for predictors was performed for the population-based studies. RESULTS: The prevalence of MMD was 0.4%, 0.5%, 1.5% and 5.2% among Asians in rural India, Beijing, Russia and Singapore, respectively. In the population-based studies, older age (per year; OR=1.13), female (OR=2.0), spherical equivalent (SE; per negative diopter; OR=1.7), longer AL (per mm; OR=3.1) and lower education (OR=1.9) were associated with MMD after multivariable adjustment (all p<0.001). Similarly, in the clinic-based/school-based studies, older age (OR=1.07; p<0.001), female (OR=2.1; p<0.001), longer AL (OR=2.1; p<0.001) and lower education (OR=1.7; p=0.005) were associated with MMD after multivariable adjustment. SE had the highest AUC of 0.92, followed by AL (AUC=0.87). The combination of SE, age, education and gender had a marginally higher AUC (0.94). CONCLUSION: In this pooled analysis of multiple Asian studies, older age, female, lower education, greater myopia severity and longer AL were risk factors of MMD, and myopic SE was the strongest single predictor of MMD.

Progression of Myopic Maculopathy in Highly Myopic Chinese Eyes.

Purpose: To evaluate the 2-year changes in myopic maculopathy and its associations in highly myopic eyes. Methods: This was a longitudinal, observational cohort study involving 657 Chinese participants with bilateral high myopia (≤ -6.00 diopters spherical power), who were followed for 2 years. The worst eye of each participant was considered for the analysis. Myopic maculopathy was graded based on fundus photographs, using the International Photographic Classification and Grading System for Myopic Maculopathy. Results: The mean baseline age was 21.6 ± 12.2 years (range, 6.8-69.7 years). Myopic maculopathy progressed in 97 (14.8%) of 657 eyes, of which 24 eyes progressed to a higher category of myopic maculopathy, including from no maculopathy to tessellated fundus in 17 eyes, from tessellated fundus to diffuse atrophy in 6 eyes, and from diffuse to patchy atrophy in 1 eye. Among 122 lesion changes identified, the most common changes were enlargement of diffuse atrophy (n = 50, 41.0%), appearance of lacquer cracks (n = 28, 23.0%), enlargement of patchy atrophy (n = 10, 8.2%) and development of additional lacquer cracks (n = 7, 5.8%). In addition, we identified 1 eye with enlargement of a Fuch's spot, and 1 eye with active choroidal neovascularization. In multiple logistic regression analysis, myopic maculopathy progression was associated with older age, longer axial length, greater change in myopic spherical equivalent and more severe myopic maculopathy at baseline. Conclusions: Myopic maculopathy progressed in approximately 15% of highly myopic eyes over a 2-year period. Further studies with longer follow up periods are required to confirm identified risk factors for progression.

Photodynamic therapy with verteporfin for choroidal neovascularization of pathologic myopia in Japanese patients: comparison with nontreated controls.

PURPOSE: To examine the effects of photodynamic therapy (PDT) with verteporfin on subfoveal or juxtafoveal choroidal neovascularization (CNV) secondary to pathologic myopia in Japanese patients and to compare the visual outcomes of PDT-treated patients with that of age-matched and visual acuity-matched untreated controls. DESIGN: Prospective, open-label, consecutive, interventional case series. METHODS: We prospectively followed up 43 eyes of 42 consecutive patients with pathologic myopia (>6 diopters or axial length>26.5 mm) who received PDT for myopic CNV. In addition, the visual outcomes of these patients who were followed up for more than one year were compared with those of age- and initial visual acuity-matched untreated controls. RESULTS: The average follow-up was 15.0+/-7.0 months. Patients received an average of 1.40+/-0.73 treatments during follow-up, and 30 eyes (69.8%) required only one treatment. The best-corrected visual acuity (BCVA) improved by more than two Snellen lines in seven eyes (16.3%), decreased in six eyes (14.0%), and remained stable in 30 eyes (69.7%). In three eyes with a juxtafoveal CNV, CNV could not be detected ophthalmoscopically or angiographically after PDT. Statistical analysis showed that the PDT-treated patients had significantly better visual acuity at one year after PDT than the age- and initial BCVA-matched untreated controls. CONCLUSIONS: These results indicate that PDT was beneficial for maintaining vision in Japanese patients with myopic CNV. The visual outcome after PDT was better than the natural course of the disease as determined from untreated controls. The effect on chorioretinal atrophy around CNV should be investigated with a long-term study.

Subthreshold transpupillary thermotherapy in Chinese patients with myopic choroidal neovascularization: one- and two-year follow up.

BACKGROUND: To perform a safety and efficacy study of subthreshold transpupillary thermotherapy (TTT) in Chinese patients with choroidal neovascularization (CNV) secondary to pathologic myopia. METHODS: In a prospective study, patients with subfoveal or juxtafoveal CNV secondary to high myopia underwent subthreholdTTT with fixed treatment and follow-up protocols. From October 2002 to July 2005, 12 and 24 months of follow up were completed for 21 eyes and 13 eyes respectively. RESULTS: The mean best-corrected visual acuities (BCVA) were maintained at the baseline level at 1 and 2 years. Seventy-two per cent of eyes and 63% of eyes had stable or improved BCVA at 12 and 24 months.Thirty-four per cent and 39% of eyes had a moderate gain in vision (improved by three or more lines) at 12 and 24 months respectively.The average number of subthreshold TTT treatments was 1.7. The major complication of subthresholdTTT included laserrelated low-grade retinal pigment epithelium atrophy in two eyes of young patients with clear lenses. The final VA was significantly associated with pretreated VA (r = 0.614, P = 0.003).The final VA improvement was significantly associated with pretreatment VA in negative correlation (r=-0.731, P = 0.0002, Person correlation test). CONCLUSIONS: Subthreshold TTT in Chinese patients with pathologic myopia and subfoveal or juxtafoveal CNV generally maintained vision at 1- and 2-year follow up. Using decreased power of subthreshold TTT, especially in the younger patients with a clear lens, is suggested.

Location of Ocular Tessellations in Japanese: Population-Based Kumejima Study.

Purpose: Tessellation of the ocular fundus is commonly found at a mild stage in myopic eyes, and their locations vary among individuals. We conducted this study to determine the distribution of tessellation locations in a population study. Methods: A cross-sectional, population-based study. Residents of Kumejima older than 40 years were studied. The subjects filled out a comprehensive questionnaire, had their body height (BH) measured, and had an ocular examination. The location of the tessellation was classified into 6 patterns. Correlations between each pattern and the axial length (AL), age, and BH were statistically determined. Results: Reliable measurements of the AL and fundus photographs of the right eyes were obtained from 1670 subjects. Nine hundred eleven eyes had no tessellation, 113 eyes had tessellation in the posterior pole, 118 eyes had tessellation in the macular area, 383 eyes had tessellation in the peripapillary region, 6 eyes had tessellation in the nasal region, and 239 eyes had tessellation in the inferior region. The AL of the "no tessellation" group was significantly shorter than that of the posterior pole and macular groups (P < 0.01). The individuals of the posterior pole and peripapillary groups were significantly older than in all other groups (P < 0.05) except for the nasal group. The individuals in the inferior tessellation group were significantly taller than those in the no tessellation, posterior pole, and peripapillary groups (P < 0.01). Conclusions: The location distribution of the tessellation is important in correctly interpreting and predicting myopic changes.

Peripheral retinal changes in highly myopic young Asian eyes.

PURPOSE: To determine the type and prevalence of peripheral retinal changes and its relationship with axial length (AL) in a population of young Asian adult males. METHODS: This was a cross-sectional study of male subjects aged between 19 and 25 years old. High myopes [spherical equivalent refraction, (SER) < -6.00 D] were recruited and underwent further ocular investigations including dilated retinal photography and binocular indirect ophthalmoscopy by two trained ophthalmologists. The frequency of peripheral retinal changes within high myopes was correlated with axial length and also compared with a group of emmetropes (SER between -0.50 D and +1.00 D). RESULTS: A total of 593 high myopes and 156 emmetropes were recruited. White without pressure (WWOP; n = 458, 46.5%) and lattice degeneration (LD; n = 109, 14.6%) were the commonest findings, and their prevalence was significantly higher among high myopes (LD, 16.9% versus 5.8%; WWOP, 57.2% versus 5.8%; both p < 0.001). Among high myopes, temporal LD was more common (71%) and 35% had more than one area in the same eye. Increasing AL was associated with LD (odds ratio 1.28, p = 0.01) and retinal holes (odd's ratio 1.44, p = 0.02) on multivariate analysis. CONCLUSION: White without pressure (WWOP) and LD were the commonest peripheral retinal changes. One-third of high myopes with LD had more than one area in the same eye. Increasing AL was associated with LD and retinal holes. Studies in older adults should be conducted to develop clinical guidelines for the management of high myopes.

Observational study of clinical characteristics of dome-shaped macula in Chinese Han with high myopia at Zhongshan Ophthalmic Centre.

PURPOSE: To evaluate the prevalence of dome-shaped macula (DSM) in highly myopic eyes among Chinese Han and to detect the correlation with myopic maculopathy and macular complications. METHODS: A total of 736 Chinese Han patients (1384 eyes) with high myopia (refractive error≤6.0 diopters or axial length ≥26.5 mm) are reviewed based on information entered into a high-myopia database at Zhongshan Ophthalmic Centre. Subfoveal choroidal thickness (SFCT) and parafoveal choroidal thickness (PFCT) are measured. The prevalence of DSM in patients with myopic maculopathy is categorised from C0 to C4. Clinical features, including macular complications, SFCT and PFCT, are compared between myopic eyes with and without DSM. RESULTS: Among the 1384 eyes, 149 (10.77%) show DSM. In highly myopic eyes without macular complications, the best corrected visual acuity is significantly worse in patients with DSM (p=0.002), and the ratio between subfoveal and parafoveal choroidal thickness (S/PCT) is significantly elevated in patients with DSM (p=0.021). The proportion of foveal schisis (17.24% vs 62.86%) is much lower in eyes with DSM compared with those without DSM. However, the proportions of extrafoveal schisis (39.66% vs 5.37%), foveal serous retinal detachment (SRD) (5.17% vs 0) and epiretinal membrane (ERM) (24.14% vs 10.74%) are much higher in eyes with DSM. The proportion of DSM was lower in C0 and C1, but higher proportion of DSM was found in C3 and C4. CONCLUSIONS: DSM is found in 10.77% of highly myopic eyes among Chinese Han. DSM might be a protective mechanism for foveal schisis and a risk factor for extrafoveal schisis, SRD and ERM.

Association of IGF1 and IGF1R gene polymorphisms with high myopia in a Han Chinese population.

OBJECTIVES: Insulin-like growth factor 1 (IGF1) and insulin-like growth factor 1 receptor (IGF1R) have been shown to influence the development of form-deprivation myopia. However, genetic association between these two genes and high myopia remains inconsistent in different studies. This study was conducted to investigate the association between IGF1and IGF1R and high myopia in a Han Chinese population. METHODS: Fourteen single nucleotide polymorphisms (SNPs) in the IGF1 and IGF1R genes were genotyped by SNaPshot method in a Han Chinese subject group composed of 1244 high myopia patients and 1380 controls. The genotyping data was analyzed by χ2 test and the linkage disequilibrium block structure was examined by Haploview software. RESULTS: There were no statistically significant differences in the allele frequencies of IGF1 and IGF1R SNPs and genotypes between patients and controls after Bonferroni multiple-correction (p > 0.05). However, the G allele of rs35766 in the IGF1 gene showed a protective effect for high myopia (p = 0.015, corrected p = 0.21, odds ratio [OR] = 0.77, 95% CI = 0.70-0.97). The carriers of rs35766GG and rs35766GG+AG genotypes displayed a decreased risk of high myopia compared with rs35766AA carriers (p = 0.012, OR = 0.65, 95% CI = 0.47-0.91; p = 0.019, OR = 0.68, 95% CI = 0.50-0.94, respectively). CONCLUSIONS: Genetic variants in the IGF1 and IGF1R genes might not be associated with high myopia in Han Chinese. Further studies are needed to verify the possible function of IGF1 and IGF1R in the development of myopia.

Assessment of BicC family RNA binding protein 1 and Ras protein specific guanine nucleotide releasing factor 1 as candidate genes for high myopia: A case-control study.

PURPOSE: The aim is to evaluate the association between high myopia and genetic variant in the BicC family RNA binding protein 1 (BICC1) as well as its association with Ras protein specific guanine nucleotide releasing factor 1 (RASGRF1) genes in a Chinese Han population with a case-control study. METHODS: Five TagSNPs in BICC1 and RASGRF1 genes were selected and genotyped in 821 unrelated subjects, which composed of 419 controls (spherical equivalent within ±1.00 D in both eyes and axial length ≦24.0 mm) and 402 cases (spherical equivalent ≤-6.0D in at least one eye and axial length ≥26.0 mm). Statistical analysis was performed with SNPstats. RESULTS: After an analysis adjusted by age and sex, rs4245599 in BICC1 was found to be significantly associated with high myopia under the codominant, dominant, recessive and log-additive model (P = 0.001, 0.0015, 0.0045 and 2e-04, odds ratio [OR] = 2.15, 1.59, 1.73 and 1.46, respectively), and rs10763559 in BICC1 was associated with high myopia and under the dominant and log-additive model (P = 0.032 and 0.036, OR = 0.72 and 0.78, respectively). Rs4778879 in RASGRF1 was found to be significantly associated with high myopia under codominant, dominant, recessive, and log-additive model (P = 0.0088, 0.0065, 0.026, and 0.0021, OR = 1.87, 1.48, 1.56, and 1.37, respectively). However, no significant association was found between rs745030 in RASGRF1 and high myopia, neither was there any association of rs745029 in RASGRF1. CONCLUSION: The present study indicated that genetic variants in BICC1 and RASGRF1 are closely associated with high myopia, which appears to be a potential candidate for high myopia in Chinese Han population. Considering the small sample size of this study, further work is needed to validate our results. The function of BICC1 and RASGRF1 in the process of developing high myopia needs to be explored in the future.

Corneal Curvature Radius in Myopia of Schoolchildren Versus Adult Myopia.

PURPOSE: To assess whether anterior corneal curvature radius (CCR) is associated with the increased prevalence of myopia in Asia. METHODS: The investigation included the adult populations of the Central India Eye and Medical Study (CIEMS; 4711 adults) and Beijing Eye Study (BES; 3468 adults) and the children and teenager populations of the Shandong Children Eye Study (6026 children; age: 9.7 ± 3.3 years; range: 4-18 years) and Beijing Pediatric Eye Study (681 children; age: 7.7 ± 1.6 years; range: 5-13 years). RESULTS: In both adult study populations, CCR was not significantly (BES: P = 0.60; CIEMS: P = 0.14) associated with the level of education. In highly myopic subgroups, longer CCR was associated with a lower educational level [CIEMS: P = 0.04; standardized regression coefficient ß = -0.23; nonstandardized regression coefficient B: -0.06; 95% confidence interval (CI), -0.11 to 0.01] or showed a tendency toward a lower educational level (BES: P = 0.09; ß = -0.25; B: -0.06; 95% CI, -0.12 to 0.01). In the young study populations, longer CCR was significantly associated with parameters indicating a lower educational level, such as lower educational level of father (P = 0.001; ß: -0.04; B: -0.01; 95% CI, -0.02 to -0.01) and mother (P = 0.0.02; ß: -0.14; B: -0.05; 95% CI, -0.09 to -0.01) and more time spent outdoors (P = 0.001; ß: 0.15; B: 0.05; 95% CI, 0.02 to 0.07) and less time spent indoors (P < 0.001; ß: -0.15; B: -0.04; 95% CI, -0.06 to -0.02). In all study populations, longer CCR was significantly correlated (multivariate analysis) with longer axial length and lower prevalence of high myopia. CONCLUSIONS: Adult study populations and schoolchildren populations did not differ in the associations of longer CCR with parameters indicating a lower educational level, longer axial length, and lower prevalence of high myopia. CCR was not useful for the differentiation between high myopia in schoolchildren and high pathological myopia in adults.