Characterization of myopic maculopathy and related factors of its subtypes and visual outcomes in a Colombian population

Abstract

Purpose

To evaluate the diagnostic and prognostic utility of the atrophy-traction-neovascularization (ATN) classification in characterizing myopic maculopathy (MM) and identifying factors influencing its subtypes and visual outcomes.

Methods

228 eyes (136 patients) with high myopia [spherical equivalent (SE) ≤ −6.00 diopters (D) or axial length (AL) ≥ 26.5 mm] were assessed. Ocular evaluations included optical coherence tomography and ocular biometry. MM was classified into three subtypes: myopic atrophy-maculopathy (MAM), myopic tractional-maculopathy (MTM), and myopic neovascular-maculopathy (MNM). Final corrected-distance-visual-acuity (CDVA), AL, and SE were compared between eyes with and without MM and its subtypes. Univariate and multivariate models were used to identify related factors in each subtype: moderate-severe vision impairment (final CDVA between 20/70–20/400) and blindness (final CDVA < 20/400).

Results

MM was present in 58.8% of cases, 52.2% had MAM, 27.2% MNM and 14% MNM. Notably, fifteen eyes (11.2%) exhibited traction or neovascularization without atrophy. Eyes with MM exhibited worse BCVA, more negative SE, and longer AL than those without MM (p < 0.001). AL ≥ 30 mm was related to MAM (OR = 1.51; 95% CI 1.30–3.00; p = 0.004) and MNM (OR = 9.36; 95% CI 1.56–13.08; p = 0.021). Blindness was related to aged ≥ 50 years (OR = 2.80; 95% CI 1.30–6.05; p = 0.010), MTM (OR = 1.90; 95% CI 1.80–4.80; p = 0.029), and MNM (OR = 5.60; 95% CI 2.78–15.55; p = 0.005).

Conclusion

The ATN classification is valuable for diagnosing and prognosing MM, as it identifies subtypes and key factors influencing visual outcomes. Notably, tractional and neovascular changes, detected in ATN but often undetectable on fundus photography, were linked to worse visual prognosis, reinforcing its clinical relevance.