title: Myopia-related fundus changes in Singapore adults with high myopia.
abstract: OBJECTIVE
  To examine the pattern of myopia-related macular and optic disc changes in Singapore adults with high myopia (spherical equivalent ≤-6.00 diopters).
  
  
  METHODS
  Asian adults with high myopia from 3 population-based surveys.
  
  
  METHODS
  Adults 40 years and older (n = 359) with high myopia were pooled from 3 population-based surveys in Singapore Asians: (1) the Singapore Prospective Study Program (SP2, n = 184); (2) the Singapore Malay Eye Study (SiMES, n = 98); and (3) the Singapore Indian Eye Study (SINDI, n = 77). All study participants underwent standardized refraction and fundus photography, and SiMES and SINDI subjects also completed ocular biometry measurements. Myopia-related macular (posterior staphyloma, lacquer cracks, Fuchs spot, myopic chorioretinal atrophy, and myopic choroidal neovascularization) and optic disc (optic nerve head tilt, optic disc dimensions, and peripapillary atrophy) changes were evaluated.
  
  
  RESULTS
  The most common myopia-related macular finding in adults with high myopia was staphyloma (23%), followed by chorioretinal atrophy (19.3%). There were few cases of lacquer crack (n = 6, 1.8%), T-sign (n = 6, 1.8%), retinal hemorrhage (n = 3, 0.9%), active myopic choroidal neovascularization (n = 3, 0.9%), and no case of Fuchs spot. The most common disc finding associated with high myopia was peripapillary atrophy (81.2%), followed by disc tilt (57.4%). Staphyloma and chorioretinal atrophy increased in prevalence with increasing age, increasing myopic refractive error, and increasing axial length (all P < .001). Ethnicity comparisons demonstrated the highest proportion of staphyloma (P = .04) among Malays, the highest proportion of peripapillary atrophy (P = .01) and disc tilt (P < .001) among Chinese, and the largest cup-to-disc ratio (P < .001) among Indians.
  
  
  CONCLUSIONS
  Staphyloma and chorioretinal atrophy lesions were the most common fundus findings among Asian adults with high myopia. In this population, tilted discs and peripapillary atrophy were also common, while choroidal neovascularization and Fuchs spot were rare. In contrast with Singapore teenagers, in whom tilted disc and peripapillary atrophy were common while staphyloma and chorioretinal atrophy were rare, pathologic myopia appears to be dependent on the duration of disease and, thus, age of the individual.
authors.affiliation: Duke Eye Center, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Lan
authors.initials: L
authors.lastname: Chang
authors.forename: Chen-Wei
authors.initials: CW
authors.lastname: Pan
authors.forename: Kyoko
authors.initials: K
authors.lastname: Ohno-Matsui
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Lin
authors.forename: Gemmy C M
authors.initials: GC
authors.lastname: Cheung
authors.forename: Gus
authors.initials: G
authors.lastname: Gazzard
authors.forename: Victor
authors.initials: V
authors.lastname: Koh
authors.forename: Haslina
authors.initials: H
authors.lastname: Hamzah
authors.forename: E Shyong
authors.initials: ES
authors.lastname: Tai
authors.forename: Su Chi
authors.initials: SC
authors.lastname: Lim
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.forename: Terri L
authors.initials: TL
authors.lastname: Young
authors.forename: Tin
authors.initials: T
authors.lastname: Aung
authors.forename: Tien-Yin
authors.initials: TY
authors.lastname: Wong
authors.forename: Seang-Mei
authors.initials: SM
authors.lastname: Saw
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology; D003317:Corneal Dystrophies, Hereditary / Q000175:diagnosis / Q000208:ethnology; D004108:Dilatation, Pathologic / Q000175:diagnosis / Q000208:ethnology; D005128:Eye Diseases / Q000175:diagnosis / Q000208:ethnology; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D047728:Myopia, Degenerative / Q000175:diagnosis* / Q000208:ethnology; D009896:Optic Atrophy / Q000175:diagnosis / Q000208:ethnology; D009898:Optic Disk / Q000473:pathology*; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D012164:Retinal Diseases / Q000175:diagnosis* / Q000208:ethnology; D012846:Singapore / Q000453:epidemiology; D014792:Visual Acuity / Q000502:physiology