State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
JAMA Ophthalmol. 2024 Mar 1;142(3):180-186. doi: 10.1001/jamaophthalmol.2023.6319.
Individuals with high myopia younger than 18 years are at relatively high risk of progressively worsening myopic maculopathy. Additional studies are needed to investigate the progression of myopic maculopathy in this age group, as well as the risk factors associated with progression.
To investigate the 4-year progression of myopic maculopathy in children and adolescents with high myopia, and to explore potential risk factors.
DESIGN, SETTING, AND PARTICIPANTS: This hospital-based observational study with 4-year follow-up included a total of 548 high myopic eyes (spherical power -6.00 or less diopters) of 274 participants aged 7 to 17 years. Participants underwent comprehensive ophthalmic examination at baseline and 4-year follow-up. Myopic maculopathy was accessed by the International Photographic Classification and Grading System. The data analysis was performed from August 1 to 15, 2023.
The progression of myopic maculopathy progression over 4 years and associated risk factors.
The 4-year progression of myopic maculopathy was found in 67 of 548 eyes (12.2%) of 274 participants (138 girls [50.4%] at baseline and 4-year follow-up) with 88 lesion changes, including new signs of the tessellated fundus in 16 eyes (18.2%), diffuse atrophy in 12 eyes (13.6%), patchy atrophy in 2 eyes (2.3%), lacquer cracks in 9 eyes (10.2%), and enlargement of diffuse atrophy in 49 eyes (55.7%). By multivariable analysis, worse best-corrected visual acuity (odds ratio [OR], 6.68; 95% CI, 1.15-38.99; P = .04), longer axial length (AL) (OR, 1.73; 95% CI, 1.34-2.24; P < .001), faster AL elongation (OR, 302.83; 95% CI, 28.61-3205.64; P < .001), and more severe myopic maculopathy (diffuse atrophy; OR, 4.52; 95% CI, 1.98-10.30; P < .001 and patchy atrophy; OR, 3.82; 95% CI, 1.66-8.80; P = .002) were associated with myopic maculopathy progression.
In this observational study, the progression of myopic maculopathy was observed in approximately 12% of pediatric high myopes for 4 years. The major type of progression was the enlargement of diffuse atrophy. Risk factors for myopic maculopathy progression were worse best-corrected visual acuity, longer AL, faster AL elongation, and more severe myopic maculopathy. These findings support consideration of follow-up in these individuals and trying to identify those at higher risk for progression.
年龄在 18 岁以下的高度近视患者，其近视性黄斑病变逐渐加重的风险相对较高。需要进一步研究该年龄组近视性黄斑病变的进展情况，以及与进展相关的危险因素。
探讨儿童和青少年高度近视患者 4 年的近视性黄斑病变进展情况，并探讨潜在的危险因素。
设计、地点和参与者：这是一项基于医院的观察性研究，随访时间为 4 年，共纳入 274 名参与者的 548 只高度近视眼（球镜屈光度-6.00 或以下），年龄 7 至 17 岁。参与者在基线和 4 年随访时接受了全面的眼科检查。近视性黄斑病变采用国际照相分类和分级系统进行评估。数据分析于 2023 年 8 月 1 日至 15 日进行。
4 年内近视性黄斑病变的进展情况和相关的危险因素。
在 274 名参与者（138 名女孩[50.4%]在基线和 4 年随访时）的 548 只眼中（12.2%）发现了 67 只眼（88 处病变改变）的近视性黄斑病变进展，包括 16 只眼（18.2%）出现新的棋盘格眼底征象、12 只眼（13.6%）出现弥漫性萎缩、2 只眼（2.3%）出现斑片状萎缩、9 只眼（10.2%）出现漆裂纹和 49 只眼（55.7%）出现弥漫性萎缩扩大。多变量分析显示，最佳矫正视力更差（比值比[OR]，6.68；95%置信区间[CI]，1.15-38.99；P=0.04）、眼轴（AL）更长（OR，1.73；95%CI，1.34-2.24；P<0.001）、AL 伸长更快（OR，302.83；95%CI，28.61-3205.64；P<0.001）和更严重的近视性黄斑病变（弥漫性萎缩；OR，4.52；95%CI，1.98-10.30；P<0.001和斑片状萎缩；OR，3.82；95%CI，1.66-8.80；P=0.002）与近视性黄斑病变的进展相关。
在这项观察性研究中，4 年内约有 12%的儿科高度近视患者出现了近视性黄斑病变的进展。主要的病变类型是弥漫性萎缩的扩大。近视性黄斑病变进展的危险因素是最佳矫正视力更差、AL 更长、AL 伸长更快以及更严重的近视性黄斑病变。这些发现支持对这些患者进行随访，并尝试识别那些进展风险较高的患者。
