Myopic Degeneration (Degenerative Myopia)

Myopic degeneration happens when severe nearsightedness damages your retina, causing vision loss. Also known as degenerative myopia or pathologic myopia, this can worsen over time. Not everyone with severe nearsightedness will develop the changes that can cause eye damage and vision loss, but experts estimate that it affects about 1 in 33 people worldwide.

Symptoms of myopic degeneration

The main early symptom of myopic degeneration is being severely nearsighted. As myopic degeneration progresses, it can cause areas of your vision — especially near the center of your vision — to change and worsen. That can cause symptoms like:

• A spot — often near the center of your vision — where things look blurry or a blind spot
• Difficulty seeing some colors
• Needing brighter lights to see well
• Straight lines looking wavy or distorted
• Seeing floaters or flashes in your vision

If your eye care specialist suspects you have the condition, some of the signs of myopic degeneration they’ll look for include:

• Changes in the shape of your macula
• Changes in your retina, like bleeding, thinning, layer separation or bulging
• Macular holes
• Macular pucker(scar tissue)

Myopic degeneration causes

Severe nearsightedness causes myopic degeneration. Your myopia is severe if your vision prescription is -6.00 diopters or higher. Or you might have an eye with a front-to-rear length of 26 millimeters. When you try to focus, your eye muscles work more than they should to help you see better. Your retinas can’t handle that kind of stretching and strain, which leads to retinal damage.

Risk factors for myopic degeneration

There are a few clear risk factors for myopic degeneration:

• Myopia severity. The more severe your myopia (or the higher your myopic prescription), the greater your risk of developing myopic degeneration.
• Eyeball length. The greater the size of your eye, the greater your risk of developing myopic degeneration.
• Age. Your age — or possibly how long you’ve had myopia — seems to increase your risk of developing myopic degeneration.

Experts also suspect that other factors could contribute to the development of myopic degeneration or how severe it is. They include:

• Family history and genetics. There’s evidence that myopia can run in families. But more research is necessary to understand if and how genetics and family history really do factor in.
• Sex. Females may be more likely to develop myopic degeneration.
• Race and ethnicity. People of Asian descent may be at a higher risk, though research isn’t conclusive.
• Environmental factors. These include things in your everyday life that could make you more likely to develop myopia or make existing myopia more severe. Examples include jobs or hobbies that require a lot of up-close focusing, whether you use corrective lenses and more.

Complications of myopic degeneration

The main complications all have to do with your retinal tissue. The complications are:

• Neovascularization. As your retinal tissue thins, older blood vessels break and bleed. Your body makes new blood vessels to restore circulation, but those new vessels further damage your retinal tissue.
• Layer separations. Thinning retinal tissue also increases the risk that the layers of your retina will separate from each other, or that your retina will tear or detach.
• Low vision. The above changes can lead to permanent vision loss, low vision and blindness.

How doctors diagnose myopic degeneration

Eye care specialists can diagnose myopic degeneration using different tests, most of which are part of routine eye exams. Most of the changes from myopic degeneration aren’t things you can feel or vision changes you can see. Instead, they’re changes that a trained medical professional knows to look for and can see using specific methods, tests or devices. They’ll also have you look at the Amsler grid, which helps your provider detect any blind spots or distortions in your visual field.

There are also imaging tests that may help with diagnosing myopic degeneration. They include:

• Fluorescein angiography and indocyanine green angiography
• Optical coherence tomography
• Eye ultrasound

Myopic degeneration treatment

Treatment for myopic degeneration prevents worsening and reverses complications when possible.

Some of the most important treatments include:

• Vision correction. Corrective lenses (like in eyeglasses or contacts) keep your eyes from straining. That can help limit or slow retinal changes.
• Medications. Your body uses a protein called vascular endothelial growth factor (VEGF) to grow new blood vessels. Anti-VEGF drugs block that protein from doing its job.
• Laser therapy and photodynamic therapy. Some laser and light-based eye treatments limit bleeding and damage in the back of your eye. This can slow the progress of myopic degeneration.
• Eye surgery. Some of the complications of myopic degeneration require surgery to repair. Surgery can stop layers from separating, preventing rapid, irreversible vision loss.

Your eye care specialist is the best person to tell you more about the specific options and what you can expect from them.

What questions should I ask my eye care specialist?

Some questions you may want to ask your eye specialist include:

• How severe is my myopic degeneration?
• What can I do to limit or slow the disease?
• What treatment options do I have?
• How often do I need regular eye checkups and care?
• What symptoms can wait for an appointment?
• What symptoms mean I need immediate medical attention?

What can I expect if I have myopic degeneration?

If you have myopic degeneration, what you can expect varies. For some people, it’s progressive (it worsens over time). The more severe your myopia or the greater your eyeball length, the more disruptive this condition tends to be.

Without regular eye care, myopic degeneration is more likely to lead to permanent eye damage and vision loss. While those complications are sometimes unavoidable, regular eye care may make it possible to limit or at least delay them.