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

Cheng, Clarissa MMED; Teo, Kelvin MMED; Tan, Colin S. FRCS(Ed); Lee, Shu Yen FRCOphth; Loh, Boon Kwang FRCS(Ed); Wong, Edmund FRCS(Ed); Wong, Doric FRCS(Ed); Wong, Tien Yin FRCS(Ed); Cheung, Chui Ming Gemmy FRCOphth

doi: 10.1097/IAE.0000000000000757
Original Study

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.

Using spectral domain optical coherence tomography, the authors have found eyes with more extensive myopic retinoschisis, photoreceptor detachment, ellipsoid zone disruption, macular hole, and central retinal thickness >300 μm to be associated with poorer visual acuity with extensive myopic retinoschisis being more likely to deteriorate and require surgery.

*Singapore National Eye Center, Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore;

Singapore National Eye Centre, Singapore, Singapore;

Singapore Eye Research Institute, Singapore, Singapore;

§Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore; and

Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Reprint requests: Chui Ming Gemmy Cheung, FRCOphth, Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Singapore; e-mail:

None of the authors have any financial/conflicting interests to disclose.

© 2016 by Ophthalmic Communications Society, Inc.