Study: Prevalence of myopic macular degeneration in those 85 years and older

(Image Credit: AdobeStock/kohanova1991)

The takeaway message from a population-based study of very old, highly myopic individuals found a high risk of developing myopic maculopathy and marked visual impairment,¹ according to first author Mukharram M. Bikbov, MD, from the Ufa Eye Research Institute, Ufa, Russia.

The investigators explained that with older age a risk factor for the development of myopic macular degeneration (MMD), the aging of a young myopic generation may result in even more visual impairment and blindness as the result of myopic macular degeneration.²

They conducted a study to assess the prevalence of and associations of MMD in very old individuals recruited in a population-based manner. They then compared the results with the findings from another population-based study previously conducted with a similar study design and in the same geographic region on younger individuals.

The Ural Very Old Study included 1,526 of 1,882 eligible individuals who were 85 years and older; 60.9% of these (930 individuals; mean age, 88.6 years) had fundus images available for assessment.

The authors explained that MMD was defined by the presence of macular patchy atrophies (stages 3 and 4 as defined by the Pathologic Myopia Study Group³).

MMD prevalence

MMD was found in 21 of 930, for a prevalence rate of 2.3% (95% confidence interval [CI], 1.3–3.3). Ten individuals had stage 3 MMD and 11 participants had stage 4 MMD.

In those 2 stages, the authors reported that “the prevalence of binocular moderate-to-severe vision impairment was 4 of 10 (40%; 95% CI, 31–77) and 7 of 11 (64%; 95% CI, 30–98), respectively, and the prevalence of binocular blindness was 2 of 10 (20%; 95% CI, 0–50) and 3 of 11 (27%; 95% CI, 0–59), respectively.”

An analysis of the axial lengths showed that in low myopia (axial length, 24.0 to <24.5 mm), moderate myopia (axial length, 24.5 to <26.5 mm), and high myopia (axial length, ≥26.5 mm), the respective MMD prevalence rates in the right eyes were 0 of 46 eyes (0%), 3 of 40 eyes (8%; 95% CI, 0–16), and 7 of 9 (78%; 95% CI, 44–100) and the respective MMD prevalence rates in the left eyes were 1 in 48 eyes (2%; 95% CI, 0–6), 4 of 36 eyes (11%; 95% CI, 0–22), and 3 of 4 eyes (75%; 95% CI, 0–100).

Multivariable analysis showed that a higher MMD prevalence rate (odds ratio, 8.89; 95% CI, 3.43–23.0) and a higher MMD stage (beta, 0.45; B, 19; 95% CI, 0.16–0.22) (p < 0.001 for both comparisons) were correlated with longer axial length but not any other ocular or systemic parameter.

Bikbov and colleagues concluded, “The MMD prevalence (stages 3 and 4) in very old individuals increased 8.89-fold for each millimeter increase in the axial length, with a prevalence of 75% or higher in highly myopic eyes. In old age, highly myopic individuals have a high risk of eventually developing MMD with marked vision impairment.”

References:

1. Bikbov MM, Gilmanshin TR, Kazakbaeva GM, Panda-Jonas S, Jonas JB. Prevalence of myopic maculopathy among the very old: The Ural Very Old Study. Invest Ophthalmol Vis Sci. 2024;65:29. doi: https://doi.org/10.1167/iovs.65.3.29

2. Morgan IG, Ohno-Matsui K, Saw SM. Myopia. Lancet. 2012;379:1739–1748.

3. Ohno-Matsui K, Kawasaki R, Jonas JB, et al. International classification and grading system for myopic maculopathy. Am J Ophthalmol. 2015;159:877–883.