Myopic Maculopathy Risk Increases With Age

Senior eyesight test
Doctor measuring eyesight with his equipment on a senior man.
The researchers suggest timely macula screening for patients in middle age with high myopia.

The percentages of myopic maculopathy (MM) and related visual impairment (VI) increased nonlinearly with ageing, according to a study published in Acta Ophthalmologica. The study also identified that different age groups are associated with different risk factors for VI. 

Researchers in China conducted an investigation of 2099 eyes (1220 participants) with high myopia. All participants underwent comprehensive ocular examinations. Based on the atrophic-tractional-neovascular (ATN) classification system, MM was evaluated as myopic atrophy maculopathy (MAM), myopic traction maculopathy (MTM), or myopic neovascular maculopathy (MNM). 

The mean age of the participants was 47.74+20.08 years (age range, 18-93 years). The researchers found that most participants younger than 50 years had normal vision. Conversely, the percentage of mild VI, VI and blindness gradually increased after 50 years to 59 years. The percentage of MAM, MTM, and MNM increased nonlinearly with older age (all P <.001), with a notable increase after 45 years for MAM, and after 50 years for MTM and MNM. 

In participants between ages 18 years and 39 years, axial length (AL) 30 mm or longer was the only risk factor for mild VI or worse (P <.001). In participants between ages 40 years and 49 years, MAM, older age, and AL 30 mm or longer were risk factors for mild VI or worse (all P <.05). In participants 50 years or older, women, longer AL, and more severe MM were risk factors for VI and blindness (all P <.05). 

The researchers acknowledge several limitations to their work, such as the possibility of referral bias, the cross-sectional nature of the study, the relatively small sample size of middle-aged participants (40-49 years), and those with severe cataract were not included in the analysis.

“MM and related VI were uncommon in young high myopes and had an accelerated worsening period at about 45 years for MAM, 50 years for MTM, MNM and VI,” the researchers report. “Although the clinical relevance of this study cannot be determined and warrant future longitudinal study, these results might help in suggesting the onset features and progression trends of MM, and guiding screening strategies and clinical decision-making for high myopia.” 


Ye L, Chen Q, Guangyi H, et al. Distribution and association of visual impairment with myopic maculopathy across age groups among highly myopic eyes – based on the new classification system (ATN). Acta Ophthalmol. Published online October 4, 2021. doi:10.1111/aos.1520