TY - JOUR
T1 - Myopic Choroidal Neovascularization
T2 - Review, Guidance, and Consensus Statement on Management
AU - Cheung, Chui Ming Gemmy
AU - Arnold, Jennifer J
AU - Holz, Frank G
AU - Park, Kyu Hyung
AU - Lai, Timothy Y Y
AU - Larsen, Michael
AU - Mitchell, Paul
AU - Ohno-Matsui, Kyoko
AU - Chen, Shih-Jen
AU - Wolf, Sebastian
AU - Wong, Tien Yin
N1 - Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
PY - 2017/11
Y1 - 2017/11
N2 - TOPIC: The aim of this article is to review and compile available information on the classification, pathophysiology, and clinical features of myopic choroidal neovascularization (CNV); to describe the latest data on the management of this disease; and to present guidance.CLINICAL RELEVANCE: In the United States, myopia affects approximately 34 million people (2010), and similar figures have been reported in Europe. Pathologic myopia (PM), a possible consequence of myopia, is estimated to affect up to 3% of the global population. One of the most serious complications of PM is myopic CNV, which often leads to a sudden onset but progressive decline in central vision and is associated with a poor prognosis unless treated. Furthermore, 35% of patients with myopic CNV develop bilateral disease in the fellow eye within 8 years. Although intravitreal anti-vascular endothelial growth factor (VEGF) therapies have had a major impact on the management of patients with myopic CNV, there remain significant gaps in our understanding of this condition and how to best administer treatment. Additionally, the long-term safety and efficacy of these treatments are largely unknown.METHODS: We carried out a literature review (September 2015) of all English-language articles in PubMed resulting from searches of the following terms: "choroidal neovascularization" AND "myopia" OR "myopic macular degeneration" OR "degenerative myopia" OR "myopic maculopathy" OR "myopic retinopathy" OR "pathological myopia" OR "pathologic myopia."RESULTS: We screened a total of 566 abstracts, and 250 articles were deemed relevant for full publication review. We excluded a further 71, but an additional 44 articles were identified. This resulted in 223 articles being used to develop this review.CONCLUSIONS: Highly myopic patients experiencing a sudden loss of central vision should be referred for further examination. Once a diagnosis of myopic CNV has been confirmed, after fluorescein angiography, treatment initiation should be prompt and anti-VEGF agents considered as first-line therapy, unless contraindicated. Continued monitoring of patients is required to assess any progression or recurrence of the condition.
AB - TOPIC: The aim of this article is to review and compile available information on the classification, pathophysiology, and clinical features of myopic choroidal neovascularization (CNV); to describe the latest data on the management of this disease; and to present guidance.CLINICAL RELEVANCE: In the United States, myopia affects approximately 34 million people (2010), and similar figures have been reported in Europe. Pathologic myopia (PM), a possible consequence of myopia, is estimated to affect up to 3% of the global population. One of the most serious complications of PM is myopic CNV, which often leads to a sudden onset but progressive decline in central vision and is associated with a poor prognosis unless treated. Furthermore, 35% of patients with myopic CNV develop bilateral disease in the fellow eye within 8 years. Although intravitreal anti-vascular endothelial growth factor (VEGF) therapies have had a major impact on the management of patients with myopic CNV, there remain significant gaps in our understanding of this condition and how to best administer treatment. Additionally, the long-term safety and efficacy of these treatments are largely unknown.METHODS: We carried out a literature review (September 2015) of all English-language articles in PubMed resulting from searches of the following terms: "choroidal neovascularization" AND "myopia" OR "myopic macular degeneration" OR "degenerative myopia" OR "myopic maculopathy" OR "myopic retinopathy" OR "pathological myopia" OR "pathologic myopia."RESULTS: We screened a total of 566 abstracts, and 250 articles were deemed relevant for full publication review. We excluded a further 71, but an additional 44 articles were identified. This resulted in 223 articles being used to develop this review.CONCLUSIONS: Highly myopic patients experiencing a sudden loss of central vision should be referred for further examination. Once a diagnosis of myopic CNV has been confirmed, after fluorescein angiography, treatment initiation should be prompt and anti-VEGF agents considered as first-line therapy, unless contraindicated. Continued monitoring of patients is required to assess any progression or recurrence of the condition.
KW - Angiogenesis Inhibitors/therapeutic use
KW - Choroidal Neovascularization/classification
KW - Consensus
KW - Databases, Factual
KW - Disease Progression
KW - Fluorescein Angiography
KW - Humans
KW - Myopia, Degenerative/classification
KW - Practice Guidelines as Topic
KW - Visual Acuity
U2 - 10.1016/j.ophtha.2017.04.028
DO - 10.1016/j.ophtha.2017.04.028
M3 - Review
C2 - 28655539
SN - 0161-6420
VL - 124
SP - 1690
EP - 1711
JO - Ophthalmology
JF - Ophthalmology
IS - 11
ER -