Long-term Visual Prognosis of Choroi Neovascularization in High Myopia A Comparison between Age Groups Takeshi Yoshida, MD, Kyoko Ohno-Matsui, MD, Yoshiteru Ohtake, MD, Takayuki Takashima, MD, Soh Futagami, MD, Takayuki Baba, MD, Kenjiro Yasuzumi, MD, Takashi Tokoro, MD, Manabu Mochizuki, MD Objective: To analyze visualoutcome in highly myopic patients of differentage groups with choroidal neovascularization (CNV). Design: Retrospective observational case series. Participants: We reviewed the medical records of 63 consecutive patients (73 eyes) with myopic CNV. The patient population was divided into two groups according to age at onset of CNV (ⱕ40 and ⬎40 years old). Intervention: Demographic and clinical data were obtained from the patients’ medical records. Main Outcome Measures: Visualacuity at least 3 years after CNV diagnosis. Results: Group 1 (ⱕ40 years old) consisted of 22 patients (26 eyes), and group 2 (⬎40 years old) consiste of 41 patients (47 eyes). Throughout the follow-up period, group 1 retained better visual acuity than group 2. Almost half the patients in group 1 retained a final visual acuity better than 20/40. No significant change occ in the logarithm of the minimum angle of resolution (logMAR) in group 1 during follow-up. Group 2 had worse visualacuity at the initial evaluation than did group 1, and a statistically significant worsening of logMAR was found during the follow-up period. More than half of the patients in group 2 had a final visualacuity less than 20/200. In addition, group 2 had a larger area of CNV, and chorioretinal atrophy was more frequently seen after the regression of CNV than in group 1. Conclusions: The visualprognosis of myopic CNV is influenced by age at onset. The results of this study indicate thatpatientage at the time ofonset of myopic CNV should be considered when determining the therapeutic course. Ophthalmology 2002;109:712–719 © 2002 by the American Academy of Ophthalmology. High myopia is a major cause of legal blindness in many developed countries. 1–3 It affects 27% to 33% of all myopic eyes,corresponding to a prevalence of 1.7% to 2% in the general population of the United States. 4 High myopia is especially common in Asia and the Middle East. 4 In Japan, the estimated number of all cases of myopia is unknown, but pathologic or high myopia reportedly affects 6% to 18% of the myopic population and 1% to 2% of the general popu- lation. 5 High myopia is associated with progressive and exces- sive elongation of the eyeball, which may be accompanied by degenerative changes in the sclera, choroid, Bruch’s membrane, retinalpigmentepithelium, and neuralreti- na. 6 –10 As a result of excessive eyeball elongation, various funduscopic changes within the posterior staphyloma de- velop in highly myopic eyes. 11–14 These changes include geographic areas of atrophy of the retinal pigment epithe- lium and choroid, lacquercracks in Bruch’s membrane, subretinal hemorrhage, and choroidal neovascularization (CNV; so-called Fuchs’ spot). 15–18 Among these various myopic fundus lesions, macular CNV is the most common vision-threatening complication of high myopia. 19 –21 Clin- ical and histopathologic studies have documented CNV i 4% to 11% of highly myopic eyes. 6,7,18 Recently, active treatments such as photodynamic ther- apy have been applied to myopic CNV. 22 So it is important to know the natural history of myopic CNV in defining th indications for photodynamic therapy. However, previous studies describing the natural progression of myopic CN are somewhat conflicting. 17,19 –21,23–26 Although myopic CNV has a relatively self-limited course, 19,23,24 unlike other disorders accompanied by CNV (e.g., age-related macular degeneration), others have reported poor visual outcome myopic CNV. 17,21 Therefore, we sought to clarify the nat- ural history of the visual outcome of myopic CNV in a lar study group. Originally received: May 10, 2001. Accepted: September 13, 2001. Manuscript no. 210311. From the Department of Ophthalmology and Visual Science, Graduate School, Tokyo Medical and Dental University, Tokyo,Japan. Presented in part as a poster at the Association for Research in Vision and Ophthalmology (ARVO) meeting, Fort Lauderdale, Florida, April 2000. Supported in part by research grant 12671698 from the Japanese Ministry of Education. The authors have no financial interest in any products/drugs discussed in this article. Reprint requests to Kyoko Ohno-Matsui, MD, Department of Ophthalmol- ogy and Visual Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. 712 © 2002 by the American Academy of Ophthalmology ISSN 0161-6420/02/$–see front matter Published by Elsevier Science Inc. PII S0161-6420(01)01007-7