IMPORTANCE Highmyopia incidence and prevalence is increasing worldwide, and the visual burden caused bymyopia is expected to rise accordingly. Studies investigating the occurrence ofmyopic... Show moreIMPORTANCE Highmyopia incidence and prevalence is increasing worldwide, and the visual burden caused bymyopia is expected to rise accordingly. Studies investigating the occurrence ofmyopic complications in individuals of European ancestry with highmyopia are scarce, hampering insights into the frequency ofmyopic retinal complications in European individuals and their visual burden.OBJECTIVE To assess the frequency ofmyopic macular features in individuals of European ancestry with highmyopia.DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis of the Dutch Myopia Study (MYST) and individuals with highmyopia from the Rotterdam Study (RS) included 626 patients with highmyopia (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 highmyopia study, a systematic literature review was also performed to compare findings with studies of individuals of Asian ancestry.EXPOSURES Highmyopia, age, and AL.MAIN OUTCOMES AND MEASURES Frequency ofmyopic 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 highlymyopic 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 highmyopia. Show less
PURPOSE. To study the relatively high effect of the refractive error gene GJD2 in human myopia, and to assess its relationship with refractive error, ocular biometry and lifestyle in various age... Show morePURPOSE. To study the relatively high effect of the refractive error gene GJD2 in human myopia, and to assess its relationship with refractive error, ocular biometry and lifestyle in various age groups.METHODS. The population-based Rotterdam Study (RS), high myopia case-control study MYopia STudy, and the birth-cohort study Generation R were included in this study. Spherical equivalent (SER), axial length (AL), axial length/corneal radius (AL/CR), vitreous depth (VD), and anterior chamber depth (ACD) were measured using standard ophthalmologic procedures. Biometric measurements were compared between GJD2 (rs524952) genotype groups; education and environmental risk score (ERS) were calculated to estimate gene-environment interaction effects, using the Synergy index (SI).RESULTS. RS adults carrying two risk alleles had a lower SER and longer AL, ACD and VD (AA versus TT, 0.23D vs. 0.70D; 23.79 mm vs. 23.52 mm; 2.72 mm vs. 2.65 mm; 16.12 mm vs. 15.87 mm; all P < 0.001). Children carrying two risk alleles had larger AL/CR at ages 6 and 9 years (2.88 vs. 2.87 and 3.00 vs. 2.96; all P < 0.001). Education and ERS both negatively influenced myopia and the biometric outcomes, but gene-environment interactions did not reach statistical significance (SI 1.25 [95% confidence interval {CI}, 0.85-1.85] and 1.17 [95% CI, 0.55-2.50] in adults and children).CONCLUSIONS. The elongation of the eye caused by the GJD2 risk genotype follows a dose-response pattern already visible at the age of 6 years. These early effects are an example of how a common myopia gene may drive myopia. Show less
Purpose To determine the long-term longitudinal axial length changes in myopic and hyperopic adults with an iris-fixated phakic intraocular lens (pIOL).Methods The medical records of patients aged ... Show morePurpose To determine the long-term longitudinal axial length changes in myopic and hyperopic adults with an iris-fixated phakic intraocular lens (pIOL).Methods The medical records of patients aged >= 18 years with myopia or hyperopia who were treated with pIOL implantation between 1996 and 2011 for refractive correction with a minimum follow-up of 5 years after pIOL implantation were analyzed. The main outcome measure was change in ocular axial length over time.Results 149 eyes of 149 myopic patients and 27 hyperopic eyes of 27 patients were included in this study. Mean patient age was 37.1 +/- 10.4 years (35% male) in the myopic group and 39.4 +/- 9.4 years (4% male) in the hyperopic group. The eyes of the myopic patients showed a significant mean increase in axial length of 0.45 +/- 0.61 mm after a mean follow-up time of 144 +/- 38 months (p < 0.001). In 26 eyes (17%), the axial length had increased by >= 1 mm. The mean annual axial length increase was 0.04 +/- 0.06 mm. Axial elongation was associated with a higher degree of myopia (p < 0.001) and younger age (p = 0.02). The eyes of the hyperopic patients showed no change in axial length over time.Conclusions Myopic eyes corrected with an iris-fixated pIOL show continuous increase in axial length at an adult age. Although this study is limited to subjects with a pIOL, this is the first time myopization in Caucasian adults has been reported in a large long-term longitudinal study. Show less
