Is myopic degeneration the same as macular degeneration?

Myopic macular degeneration is a vision-threatening condition that primarily affects younger individuals with high myopia. Interventions to slow down myopia progression can also help reduce the likelihood of MMD. Prompt treatment with anti-VEGF therapy has been shown to improve vision for those with myopic CNV.

Our vision is more than just a way to see the world around us. It defines who we are, shapes our experiences, and allows us to connect with the people and things we love. So when macular degeneration threatens to take that away, it can be a terrifying experience.

There are two prevalent types of macular degeneration: age-related macular degeneration (AMD) and myopic macular degeneration (MMD). Medical conditions often have both a full name and an abbreviated name that people are more familiar with. Age-related macular degeneration is commonly referred to as just "macular degeneration," while myopic macular degeneration is shortened to  "myopic degeneration."

In this article, we'll focus on MMD and highlight some of the differences between the two types of macular degeneration. We'll also explore the ways we can prevent and treat MMD.

What are the differences between myopic degeneration and AMD?

Myopic and age-related macular degeneration are two conditions that can cause sudden and rapid changes in vision, including distorted straight lines, difficulty recognizing faces, blurry words, and black spots. Both conditions can cause vision loss due to the deterioration or death of retinal cells.

One distinguishing factor between MMD and AMD is the age of onset. MMD typically occurs in individuals younger than 50 years of age, while AMD occurs in older individuals. 

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In myopic macular degeneration, the retina and other layers at the back of the eye become progressively thin due to an abnormal elongation of the eye, which can cause the cells in the retina to die slowly. This results in atrophy and a gradual decline in central vision. Additionally, thinning in the back of the eye can lead to cracks in the deeper layers under the retina, which can cause further atrophy or even bleeding.

Similar to wet AMD, abnormal new blood vessels can form under the macula in MMD, which is referred to as myopic choroidal neovascularization (myopic CNV). However, myopic CNV also typically occurs in a younger age group than wet AMD, and there is usually less prominent fluid or blood leakage.

Myopic CNV is sometimes referred to as the wet form of MMD

Can you prevent myopic macular degeneration?

Myopic macular degeneration is a serious eye condition that can lead to vision loss, and its prevention can start with controlling the progression of myopia at a young age. One of the challenges with myopia control is that it requires the involvement of parents since children are too young to understand or pay for it.

The good news is that our understanding of myopia has advanced significantly in recent years, and researchers have developed various interventions that can slow down or stop the progression of myopia. These interventions include atropine eye drops, myopia-control glasses or contacts, and more outdoor time.

However, it's important to note that many myopia control treatment options in the US are not yet approved by the FDA and are used off-label, including atropine or myopia control glasses. Therefore, parents should work even more closely with eye doctors to discuss the effectiveness and potential side effects of each intervention to make an informed decision that is appropriate for their child.

How to treat myopic CNV?

Myopic CNV is the most common cause of conditions related to new blood vessel growth in the eye in people <50 years old; a study estimated that 5-10% of eyes with myopic macular degeneration were at risk of developing myopic CNV.

Until recent years, the primary treatments for myopic CNV were limited to thermal laser photocoagulation or verteporfin photodynamic therapy. However, these treatments were not effective in improving vision and have been replaced by anti-vascular endothelial growth factor treatments (anti-VEGFs).

Studies showed an imbalance in factors controlling blood vessel growth, specifically an increase in the expression of VEGF. The VEGF protein promotes the growth of abnormal new blood vessels in the retina. Anti-VEGF treatment works by binding to VEGF and stopping abnormal blood vessel growth and fluid leakage.

Once active myopic CNV is diagnosed, prompt treatment with intravitreal anti-VEGF therapy should be administered as soon as possible. Anti-VEGF therapies –  Lucentis, Eylea, bevacizumab, or conbercept – all have shown good efficacy in treating myopic CNV. However, conbercept and bevacizumab have not received FDA-approval for treating the condition.

In studies, Lucentis and Eylea demonstrated significant visual gain efficacy and require about four injections per year. Furthermore, a study showed that 4 in 5 patients with myopic CNV required no further anti-VEGF treatments after two years. Lastly, another study also reported a low recurrence rate of approximately less than 23% after two years.

As a last note, there are benefits and risks to any treatment. It is important to discuss treatment options with your healthcare provider to find the most effective and appropriate treatment for your specific situation if you have myopic CNV.

Key Takeaways

Myopic macular degeneration is a serious eye condition that can lead to vision loss, primarily affecting younger individuals with high myopia. While it shares some similarities with age-related macular degeneration (AMD), MMD has distinct differences in its cause, onset, and prevention.

Fortunately, there are interventions available to prevent or slow down the progression of myopia, which can help the likelihood of MMD. And for those already diagnosed with myopic CNV, prompt treatment with anti-VEGF therapy can help improve vision.

As research and technology continue to advance, we can remain hopeful for even more effective treatments and preventative measures in the future.

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