Complications of High Myopia: New Vascular Issues Explained - Ophthalmology

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High myopia, often defined as a refractive error greater than -6.00 diopters or an axial length exceeding 26.5 mm, is associated with various ocular complications, particularly affecting the retina and choroid. One of the most significant concerns in patients with high myopia is the development of pathological myopia, which can lead to severe visual impairment due to complications such as myopic macular degeneration, retinal detachment, and choroidal neovascularization (CNV).

In your case, the symptoms of a blind spot and distortion of straight lines, particularly in the context of high myopia, raise concerns about potential complications involving the macula. The fact that you have undergone several diagnostic tests, including fluorescein angiography, optical coherence tomography (OCT), and MRI, which returned normal results, is reassuring but does not entirely rule out the possibility of subtle changes that may not have been detected at the time of examination.

As your symptoms have progressed with the enlargement of the blind spot and the emergence of distortion in the Amsler grid, further evaluation is warranted. Here are some additional tests that may be considered:
1. Enhanced Depth Imaging OCT (EDI-OCT): This technique allows for better visualization of the choroid and can help identify any changes that may not be apparent on standard OCT.

2. Indocyanine Green Angiography (ICGA): This imaging technique is particularly useful for assessing choroidal circulation and can help detect choroidal neovascularization, which is a common complication in pathological myopia.

3. Fundus Autofluorescence (FAF): This test can help visualize the metabolic activity of the retinal pigment epithelium and may reveal areas of atrophy or dysfunction that are not visible on standard examination.

4. Visual Field Testing: This can help assess the extent of any visual field loss and monitor changes over time.

Regarding your question about the difference in treatment protocols between pathological myopia and age-related macular degeneration (AMD), it is important to understand that the underlying pathophysiology of these conditions differs significantly.
In age-related macular degeneration, particularly the neovascular (wet) form, there is a well-established treatment protocol involving anti-VEGF (vascular endothelial growth factor) injections, which have been shown to be effective in preserving vision. The treatment regimen typically allows for more frequent injections due to the nature of the disease and its progression.

In contrast, the treatment for myopic macular degeneration and associated complications, such as CNV, is less standardized. The response to anti-VEGF therapy in myopic CNV can be variable, and while some patients may benefit significantly, others may not respond as well. This variability may be due to the different mechanisms of disease progression in myopic degeneration compared to AMD. Consequently, healthcare providers may limit the number of injections covered by insurance for myopic conditions, reflecting the uncertainty regarding the long-term efficacy and the potential for recurrence.

In summary, if you are experiencing worsening symptoms, it is crucial to follow up with your ophthalmologist for further evaluation and to discuss the possibility of additional diagnostic tests. Understanding the nature of your condition and the rationale behind treatment protocols can help you make informed decisions about your ocular health.