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A novel classification of high myopia into anterior and posterior pathologic subtypes

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

High myopia and pathologic myopia are common causes of visual morbidity. Myopic pathology can affect all regions of the retina, though there is currently no classification system to distinguish anterior (peripheral) and posterior (macular) pathology. We hypothesize that these classifications are characterized by distinct demographic and refractive features, highlighting the disparity in types of pathologic myopia.

Methods

Institutional retrospective cohort study. The Stanford University Medical Center Clinical Data Warehouse was used to identify patients with high myopia by ICD-9 and ICD-10 codes. Predetermined ICD diagnoses were then used to classify patients with high myopia into isolated high myopia (IHM), anterior pathologic myopia (APM), posterior pathologic myopia (PPM), and combined pathologic myopia (CPM). A cohort of this population was then manually reviewed to gather refractive data and confirm accuracy of ICD coding.

Results

Patients (3274) were identified with high myopia. Overall, 22.1% individuals met criteria for APM, 10.7% for PPM, 17.0% for CPM, and 50.2% for IHM. We identified a significantly higher frequency of females with PPM compared to APM (62.3 vs. 48.3%; OR, 1.73; 95% CI, 1.34 to 2.25), Asian patients with PPM as compared to APM (42.9 vs. 33.3%; OR, 1.50; 95% CI, 1.16 to 1.95), and younger patients with APM compared to PPM (median 45.3 vs. 63.4 years). The refractive error was significantly more myopic in the CPM (median − 9.8D; interquartile range, IQR 6.7) and PPM (median − 10.5D; IQR 9.8) subgroups as compared to the APM (median − 8.1D; IQR 3.5), and IHM (median − 8.2D; IQR 4.1) subgroups (p = 0.003).

Conclusions

High myopia may be divided into four distinct subgroups based on presence and location of pathology, which is associated with differences in age, gender, race, and refractive error.

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Acknowledgements

The Research Electronic Data Capture (REDCap) database tool hosted by Stanford University is maintained by the Stanford Center for Clinical Informatics grant support (Stanford CTSA award number UL1 RR025744 from NIH/NCRR).

Funding

This work was supported by an unrestricted departmental grant from Research to Prevent Blindness, Inc. The TL1 component of the Stanford Clinical and Translational Science Award to Spectrum (NIH TL1 TR 001084) provided additional support for Cassie A. Ludwig.

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Authors and Affiliations

  1. Byers Eye Institute, Stanford University, 2452 Watson Court, Palo Alto, CA, 94303, USA

    Cassie A. Ludwig, Ryan A. Shields, Tiffany A. Chen, Matthew A. Powers & Darius M. Moshfeghi

  2. California Pacific Medical Center, 2333 Buchanan Street, San Francisco, CA, 94115, USA

    Cassie A. Ludwig

  3. VitreoRetinal Surgery, PA, 710 East 24th St, Ste. 103, Minneapolis, MN, 55404, USA

    D. Wilkin Parke III

  4. Department of Ophthalmology, USC Eye Institute, Keck School of Medicine of USC, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA

    Andrew A. Moshfeghi

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Correspondence to Darius M. Moshfeghi.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Ludwig, C.A., Shields, R.A., Chen, T.A. et al. A novel classification of high myopia into anterior and posterior pathologic subtypes. Graefes Arch Clin Exp Ophthalmol 256, 1847–1856 (2018). https://doi.org/10.1007/s00417-018-4071-0

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