TL;DR
Myopic macular degeneration is a form of macular disease that affects people with severe short-sightedness (high myopia). Unlike age-related macular degeneration (AMD), which develops as you get older, myopic macular degeneration is driven by structural changes in the eye caused by high myopia. It can affect younger people and, without treatment, may lead to permanent central vision loss.
How myopia leads to macular damage
Most people are familiar with myopia as short-sightedness. In the simplest terms, you can see things close up but struggle to focus on objects in the distance. In mild or moderate myopia, corrective lenses or contact lenses can fix the problem and keep your eyes healthy.
High myopia is different. When myopia is severe (typically -6.00 dioptres or more), the eyeball becomes significantly elongated. This stretches the retina, the thin layer of tissue at the back of the eye, making it thinner and more fragile over time.
What actually happens in the macula?
The macula sits at the centre of the retina and is responsible for sharp, detailed central vision. As the retina stretches, the macula can become damaged. As the eye stretches, fine breaks known as lacquer cracks can develop in Bruch’s membrane, a thin barrier layer between the retina and the blood vessels beneath it.
In some cases, abnormal blood vessels start to grow underneath the macula through these breaks. This process is called choroidal neovascularisation (CNV), and it’s similar to what happens in wet AMD. CNV secondary to pathological myopia can cause rapid and irreversible loss of central vision if left untreated.
What are the symptoms for myopic macular degeneration?
Myopic macular degeneration doesn’t always cause noticeable symptoms in its early stages. As the condition progresses, you may start to experience:
- Blurred or distorted central vision
- Straight lines appearing wavy or bent
- A dark or blank spot in the centre of your vision
- Difficulty reading, recognising faces or seeing fine detail
- Gradual worsening of vision even with glasses or contact lenses
If you notice any of these changes, it’s important to see an optician or ophthalmologist as soon as possible. Early detection gives you the best chance of preserving your sight.
How is it different from age-related macular degeneration?
Both conditions affect the macula, but they have different underlying causes. AMD is primarily linked to ageing. It’s most common in people over 50 and develops as the macular tissue breaks down over time, often with a build-up of deposits called drusen.
Myopic macular degeneration, on the other hand, is caused by the physical stretching and thinning of the retina due to high myopia. It can develop in younger adults and even teenagers with severe short-sightedness. Higher levels of myopia carry a greater risk of myopic degeneration, so regular eye checks are particularly important if you have a strong prescription.
Who is most at risk?
The biggest risk factor is high myopia. If your prescription is -6.00 dioptres or stronger, you’ll have a higher chance of developing myopic macular degeneration as your eyes continue to change over time.
There’s also a genetic component. Research suggests that if one or both of your parents are myopic, you’re significantly more likely to develop myopia yourself. A UK study published in PLOS ONE found that children with one myopic parent were almost three times more likely to be myopic by age 13, and that myopia prevalence in UK children has more than doubled since the 1960s.
With myopia rates rising globally, the number of people at risk of myopic macular degeneration is expected to grow. A widely cited meta-analysis published in the journal Ophthalmology projected that around half of the world’s population will be myopic by 2050, with up to 10% having high myopia.
How is myopic macular degeneration diagnosed?
Your eye care professional will carry out a thorough examination if they suspect myopic macular degeneration. This typically involves:
- Dilated eye examination to get a clear view of the retina and macula
- Optical coherence tomography (OCT), which uses light waves to create detailed cross-section images of the retina
- Fundus photography to record the appearance of the back of the eye
- Fluorescein angiography, where a dye is injected into the bloodstream to highlight any leaking blood vessels beneath the macula
You can also monitor changes at home using an Amsler grid. This simple tool helps you spot distortion or blank areas in your central vision between appointments.
Treatment options for myopic macular degeneration
Treatment for myopic macular degeneration depends on how the condition has progressed and whether CNV is present. If the condition hasn’t caused CNV, treatment may focus on correcting the underlying myopia with glasses, contact lenses or refractive surgery. Regular monitoring will be essential to catch any changes early.
When CNV does develop, the most common treatment is anti-VEGF injections. These are given directly into the eye and work by blocking a protein called vascular endothelial growth factor, which drives the growth of abnormal blood vessels. Anti-VEGF drugs like ranibizumab (Lucentis) and aflibercept (Eylea) have shown strong results in slowing or stopping CNV caused by pathological myopia. Early detection and treatment can slow or limit how severe the disease becomes.
In some cases, laser treatment may also be used to seal leaking blood vessels, though this is less common with newer anti-VEGF therapies available.
Can you reduce your risk?
You can’t change the shape of your eyeball once high myopia has developed. But there are steps you can take to protect your eye health and catch problems early:
- Have regular eye exams. If you have high myopia, your optician should be checking for signs of retinal thinning, lattice degeneration and CNV. Don’t skip appointments, even if your vision seems stable.
- Watch for warning signs. Use an Amsler grid at home and contact your eye care professional straight away if you notice any new distortion or blank spots.
- Protect your eyes. People with high myopia have thinner retinas, which makes them more vulnerable to injury. Wearing protective eyewear during sports or activities that could cause impact is an important precaution to take.
- Support your eye health with nutrition. While no diet will reverse myopic macular degeneration, nutrients like lutein, zeaxanthin, zinc and omega-3 fatty acids are linked to better overall macular health. Leafy greens, oily fish and colourful fruits and vegetables are all good sources.
Related read: 9 Nutrients That Are Good For Your Eyes
When to see a specialist
If you’ve been told you have high myopia, or if your prescription has been steadily getting stronger over the years, it’s worth asking your optician about your risk of myopic macular degeneration specifically. Many people with high myopia don’t realise they’re at increased risk of retinal complications, and gradual vision loss can be easy to overlook when you’re already used to wearing strong glasses.
And if you ever notice sudden changes in your vision, such as flashing lights, a sudden increase in floaters or a new dark area in your central vision, seek urgent attention. These could be signs of retinal detachment or CNV, both of which need prompt treatment.
