Pathologic myopia is a major cause of blindness in developed countries in East Asia. However, no clear conclusions have presently been reached as to whether high axial myopia in childhood leads to future pathologic myopia in such patients. We retrospectively analyzed ocular findings during childhood in patients with pathologic myopia who developed ocular complications because of pathologic myopia when they were adults. The subjects initially visited our clinic at the age of 15 years or younger and were then followed up for 20 years or longer. We investigated whether characteristics suggestive of the future development of pathologic myopia could be identified in childhood. Results showed that diffuse chorioretinal atrophy was already apparent during childhood in 29 of the 35 eyes (83%) in which ocular complications associated with pathologic myopia occurred in adulthood. In the remaining six eyes (17%), only tessellated fundus was apparent in childhood. The diffuse chorioretinal atrophy in childhood was localized in the parapapillary region. Next, for determining the pathogenesis of parapapillary diffuse choroidal atrophy (PDCA), we used swept-source optical coherence tomography (swept-source OCT) to analyze the fundus tomographic images of PDCA in children. Results revealed that all 21 children with PDCA suddenly developed severe thinning of the temporal parapapillary choroid. We found that when the cutoff value for choroidal thickness at 2500 μm nasal to the fovea was below 60 μm, children with PDCA could be detected with a sensitivity of 76% and specificity of 100%. Thus, PDCA could be an important sign for predicting the future development of pathologic myopia. In addition, measuring temporal parapapillary choroidal thickness appears to be useful for identifying PDCA in children.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 122: 859-867, 2018.