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Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN).
Prog Retin Eye Res 2019; 69:80-115PR

Abstract

Myopia is a highly frequent ocular disorder worldwide and pathologic myopia is the 4th most common cause of irreversible blindness in developed countries. Pathologic myopia is especially common in East Asian countries. Ocular alterations associated with pathologic myopia, especially those involving the macular area-defined as myopic maculopathy-are the leading causes of vision loss in patients with pathologic myopia. High myopia is defined as the presence of a highly negative refractive error (>-6 to -8 diopters) in the context of eye elongation (26-26.5 mm). Although the terms high myopia and pathologic myopia are often used interchangeably, they do not refer to the same eye disease. The two key factors driving the development of pathologic myopia are: 1) elongation of the axial length and 2) posterior staphyloma. The presence of posterior staphyloma, which is the most common finding in patients with pathologic myopia, is the key differentiating factor between high and pathologic myopia. The occurrence of staphyloma will, in most cases, eventually lead to other conditions such as atrophic, traction, or neovascular maculopathy. Posterior staphyloma is for instance, responsible for the differences between a myopic macular hole (MH)-with and without retinal detachment-and idiopathic MH. Posterior staphyloma typically induces retinal layer splitting, leading to foveoschisis in myopic MH, an important differentiating factor between myopic and emmetropic MH. Myopic maculopathy is a highly complex disease and current classification systems do not fully account for the numerous changes that occur in the macula of these patients. Therefore, a more comprehensive classification system is needed, for several important reasons. First, to more precisely define the disease stage to improve follow-up by enabling clinicians to more accurately monitor changes over time, which is essential given the progressive nature of this condition. Second, unification of the currently-available classification systems would establish standardized classification criteria that could be used to compare the findings from international multicentric studies. Finally, a more comprehensive classification system could help to improve our understanding of the genetic origins of this disease, which is clearly relevant given the interchangeable-but erroneous-use of the terms high and pathologic myopia in genetic research.

Authors+Show Affiliations

Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain.Department of Ophthalmology, Rio Hortega University Hospital, Valladolid, Spain; Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Retina Unit, Oftalvist, Madrid, Spain.Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain.Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain.Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain.Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain; Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain; Vissum Corporation, Spain. Electronic address: josemaria.ruiz@uclm.es.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

30391362

Citation

Ruiz-Medrano, Jorge, et al. "Myopic Maculopathy: Current Status and Proposal for a New Classification and Grading System (ATN)." Progress in Retinal and Eye Research, vol. 69, 2019, pp. 80-115.
Ruiz-Medrano J, Montero JA, Flores-Moreno I, et al. Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN). Prog Retin Eye Res. 2019;69:80-115.
Ruiz-Medrano, J., Montero, J. A., Flores-Moreno, I., Arias, L., García-Layana, A., & Ruiz-Moreno, J. M. (2019). Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN). Progress in Retinal and Eye Research, 69, pp. 80-115. doi:10.1016/j.preteyeres.2018.10.005.
Ruiz-Medrano J, et al. Myopic Maculopathy: Current Status and Proposal for a New Classification and Grading System (ATN). Prog Retin Eye Res. 2019;69:80-115. PubMed PMID: 30391362.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN). AU - Ruiz-Medrano,Jorge, AU - Montero,Javier A, AU - Flores-Moreno,Ignacio, AU - Arias,Luis, AU - García-Layana,Alfredo, AU - Ruiz-Moreno,José M, Y1 - 2018/11/01/ PY - 2018/07/31/received PY - 2018/10/18/revised PY - 2018/10/22/accepted PY - 2018/11/6/pubmed PY - 2019/5/2/medline PY - 2018/11/5/entrez KW - ATN classification system KW - High myopia KW - Myopic choroidal neovascularization KW - Myopic maculopathy KW - Myopic maculopathy classification KW - Myopic traction maculopathy KW - Pathologic myopia KW - Staphyloma SP - 80 EP - 115 JF - Progress in retinal and eye research JO - Prog Retin Eye Res VL - 69 N2 - Myopia is a highly frequent ocular disorder worldwide and pathologic myopia is the 4th most common cause of irreversible blindness in developed countries. Pathologic myopia is especially common in East Asian countries. Ocular alterations associated with pathologic myopia, especially those involving the macular area-defined as myopic maculopathy-are the leading causes of vision loss in patients with pathologic myopia. High myopia is defined as the presence of a highly negative refractive error (>-6 to -8 diopters) in the context of eye elongation (26-26.5 mm). Although the terms high myopia and pathologic myopia are often used interchangeably, they do not refer to the same eye disease. The two key factors driving the development of pathologic myopia are: 1) elongation of the axial length and 2) posterior staphyloma. The presence of posterior staphyloma, which is the most common finding in patients with pathologic myopia, is the key differentiating factor between high and pathologic myopia. The occurrence of staphyloma will, in most cases, eventually lead to other conditions such as atrophic, traction, or neovascular maculopathy. Posterior staphyloma is for instance, responsible for the differences between a myopic macular hole (MH)-with and without retinal detachment-and idiopathic MH. Posterior staphyloma typically induces retinal layer splitting, leading to foveoschisis in myopic MH, an important differentiating factor between myopic and emmetropic MH. Myopic maculopathy is a highly complex disease and current classification systems do not fully account for the numerous changes that occur in the macula of these patients. Therefore, a more comprehensive classification system is needed, for several important reasons. First, to more precisely define the disease stage to improve follow-up by enabling clinicians to more accurately monitor changes over time, which is essential given the progressive nature of this condition. Second, unification of the currently-available classification systems would establish standardized classification criteria that could be used to compare the findings from international multicentric studies. Finally, a more comprehensive classification system could help to improve our understanding of the genetic origins of this disease, which is clearly relevant given the interchangeable-but erroneous-use of the terms high and pathologic myopia in genetic research. SN - 1873-1635 UR - https://www.unboundmedicine.com/medline/citation/30391362/Myopic_maculopathy:_Current_status_and_proposal_for_a_new_classification_and_grading_system__ATN__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(18)30050-8 DB - PRIME DP - Unbound Medicine ER -