Optical coherence tomography findings in high myopia

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Myopic Traction Maculopathy

The above complications of high myopia are well known and are relatively easy to detect with conventional techniques such as direct/indirect ophthalmoscopy, ultrasonography or fluorescein angiography.

However, the posterior retina can also be damaged by the less obvious presence of tractional forces, which may act tangentially to the retina (resulting from overlying epiretinal membranes (ERM), often with multifocal attachments), or in an anteroposterior direction (where there are residual focal vitreoretinal adhesions, following incomplete posterior vitreous detachment).

The combination of traction derived from the presence of ERM and vitreomacular adhesions can be further complicated by the progressive scleral stretching and posterior staphyloma, leading to characteristic macular damage in such forms as retinoschisis, lamellar holes and shallow foveal detachments. Furthermore, such traction may be a contributory factor in the formation of macular holes.4 These pathological findings have been termed 'myopic traction maculopathy' (MTM) by Panozzo et al.5 It is very unusual to see such macular damage caused by similar epiretinal traction in a non-myopic eye.

The early stages of MTM can be difficult to detect with standard investigative techniques, due to the presence of other myopic changes complicating the appearance of the posterior pole, such as tigroid fundus, choroidal atrophy, RPE changes, thinned retina, staphyloma and so on. However, optical coherence tomography (OCT, Zeiss-Humphrey) is one technique that is of great value in the detection of such subtle macular changes.