Thirty-nine percent of highly myopic eyes without peripheral drusen-like deposits had MNV in this study, while 62.1% of eyes with this finding showed neovascularization, suggesting that peripheral DLDs may be associated with complications of pathologic myopia. Photo: Dias MR, et al. Rev Bras Oftalmol. 2018;77(3):146-8. Click image to enlarge.

Despite significant attention given to macular and optic nerve lesions in high myopia, the peripheral retinal changes have been largely overlooked; however, modern ultra-widefield (UWF) imaging has improved our ability to evaluate and study these retinal changes. One recent study out of Tokyo observed drusen-like deposits (DLDs) on UWF imaging of highly myopic eyes. Aiming to investigate further, a new study published in the journal Eye used UWF imaging to evaluate the morphological characteristics and incidence of peripheral DLDs in a cohort of high myopes. While they found the finding to be uncommon, the researchers argue “[it] may provide a basis for the evaluation of the natural progression of peripheral retinal changes in eyes with pathological myopia.”

The study was a retrospective, observational case series study involving 676 patients (1,352 eyes) diagnosed with high myopia (95% with pathological myopia) at a single university clinic in Tokyo between 2017 and 2021. UWF pseudo color and fundus autofluorescence (FAF) images were evaluated for the presence of peripheral DLDs, which appeared as isolated or scattered yellowish-white deposits.

The cohort had a mean age of 70 and a mean axial length of 29.8mm. The researchers reported the incidence of peripheral DLDs as 4.9% or 66 of 1,352 eyes examined. Interestingly, five of these eyes had DLDs at the staphyloma edge. The incidence of staphylomas was slightly higher in Zone 2 at 66.7% compared to 62.2% in Zone 3, and patients with drusen in Zone 2 were older on average (80 vs. 64 years old).

Another noteworthy finding is that significantly more eyes with DLDs exhibited myopic macular neovascularization (MNV; 62.1%) than eyes without DLD (39.1%), which the study authors suggest may indicate that peripheral DLDs are associated with complications of pathologic myopia.

“In conclusion,” they wrote in their paper, “the results indicate that high myopia, especially pathological myopia, is a retinochoroidal disorder that affects the entire fundus. Mechanical tension due to an elongation of peripheral fundus and staphyloma formation may be causative factors for the peripheral DLDs.”