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Wong, Chee Wai, MMed(Ophth)*,†; Teo, Yi Chong Kelvin, MMed(Ophth)*,†; Tsai, Shih Tsiang Andrew, FRCOphth*,†; Ting, Shu Wei Daniel, PhD*,†; Yeo, Yew San Ian, FRCOphth*,†; Wong, Wen Kuan Doric, FRCOphth*,†; Lee, Shu Yen, FRCOphth*,†; Wong, Tien Yin, PhD*,†; Cheung, Chui Ming Gemmy, FRCOphth*,†

doi: 10.1097/IAE.0000000000002233
Original Study: PDF Only

Purpose: To characterize the choriocapillaris (CC) in highly myopic eyes with myopic maculopathy, using optical coherence tomographic angiography.

Methods: Prospective, clinic-based study of 42 eyes of 38 patients with high myopia (≤−6 diopters and axial length ≥26.5 mm). Myopic maculopathy was graded from fundus photographs according to the Meta-Analysis for Pathologic Myopia classification. Macular 3 × 3 mm en face optical coherence tomographic angiographic images were obtained with swept-source optical coherence tomographic angiography and graded for CC flow impairment as follows: 1) intact CC, 2) focal (<1 mm2), and 3) extensive (>1 mm2).

Results: Of the 42 eyes, 17 (39.5%) had tessellated fundus, 20 (46.5%) had diffuse, and 6 (14.0%) had patchy atrophy. Choriocapillaris flow impairment was observed in all eyes with diffuse and patchy atrophy. Even in eyes with tessellated fundus only, CC signal voids were seen in 3 eyes (17.6%). With increasingly severe myopic maculopathy, the pattern of CC flow impairment changed from predominantly focal to predominantly extensive.

Conclusion: Choriocapillaris flow impairment was observed in many highly myopic eyes, even in those with mild fundus changes, and worsened with increasing severity of myopic maculopathy. Longitudinal studies are needed to assess whether CC flow impairment predicts the risk of myopic maculopathy progression.

Optical coherence tomographic angiography can detect choriocapillaris signal voids in highly myopic eyes without clinically apparent myopic maculopathy. The pattern of choriocapillaris signal voids changed from predominantly localized to predominantly extensive with increasing severity of myopic maculopathy.

*Singapore Eye Research Institute, Singapore National Eye Centre, Vitreoretinal Service, Singapore; and

Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore.

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

Supported by the Singhealth Foundation Grant (grant number: SHF/FG649S/2015).

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

© 2019 by Ophthalmic Communications Society, Inc.