Myopic Degeneration: Protecting Your Vision
Understanding Myopic Degeneration
Most people with myopia (nearsightedness) simply need glasses or contact lenses to see clearly at a distance. Myopic degeneration is different. It occurs in people with high myopia, generally defined as a prescription stronger than negative 6.00 diopters or an eye length greater than 26 millimeters (AAO). In these eyes, the eyeball has grown significantly longer than normal.
As the eye elongates, it does not produce new tissue to cover the increased surface area. Instead, the existing layers of the eye stretch and thin. Over time, this stretching can cause the retinal pigment epithelium (RPE), the supportive layer beneath the retina, to break down. Choroidal blood vessels and even the white sclera (outer wall of the eye) may become visible during an eye exam. These degenerative changes can progress and lead to vision loss.
The hallmark of myopic degeneration is progressive stretching of the back of the eye, an area called the posterior pole. As the tissue thins, several complications can develop. Cracks in the supportive membrane beneath the retina, known as lacquer cracks, may form. Areas of RPE loss called atrophy can appear and expand. The retina itself can develop holes or tears. The vitreous gel inside the eye may also pull away from the retina.
One of the most serious complications is choroidal neovascularization (CNV). CNV is the growth of abnormal new blood vessels beneath the retina. These fragile vessels can leak fluid or blood, causing rapid damage to central vision. CNV occurs in approximately 5 to 10 percent of patients with pathologic myopia (AAO).
Not everyone with high myopia develops myopic degeneration. High myopia refers to the degree of nearsightedness. Myopic degeneration refers to the structural damage that can result from it. Many people with high myopia maintain stable vision for years. However, the risk of degenerative changes increases with greater eye length and advancing age. Regular monitoring by a retina specialist is important for anyone with high myopia.
Who Is Affected and Risk Factors
Nearsightedness is widespread. The number of Americans who are nearsighted has nearly doubled over the past 50 years, reaching about 41.6 percent of the population (AAO). High myopia affects a smaller group, roughly 1 to 2 percent of the United States population (VRM New York). Myopic degeneration develops in a subset of those with high myopia. In a Dutch study of 626 participants with high myopia, the overall prevalence of myopic macular degeneration was 25.9 percent (AAO, 2023).
The condition is reported to be the seventh leading cause of blindness in the United States and Europe. It is also the leading cause of blindness in Japan (AAO). These numbers underscore the importance of early detection and ongoing care.
Several factors increase the likelihood of developing myopic degeneration:
- Greater axial length of the eye, meaning it is longer from front to back
- A stronger myopic prescription, especially beyond negative 6.00 diopters
- Older age, although degenerative changes have been seen in patients as young as their twenties
- Family history of high myopia or myopic degeneration
- East and Southeast Asian descent, populations with the highest documented prevalence of myopia
Myopic degeneration can affect both eyes, though it may progress at different rates in each eye. Research shows that 35 percent of patients who develop CNV in one eye will develop it in the fellow eye within eight years (AAO). This is why a retina specialist will monitor both eyes closely. Close monitoring is important even if only one eye currently shows signs of the condition.
Signs and Symptoms
In its early stages, myopic degeneration may not cause noticeable symptoms. The stretching and thinning of retinal tissues can be detected during a dilated eye exam before any vision changes occur. This is one reason why people with high myopia should have regular retinal examinations, even when their vision seems stable.
As the condition progresses, some people notice a gradual decline in their best-corrected vision. Colors may seem slightly faded. Fine details may become harder to see, even with the correct glasses or contact lens prescription.
When CNV develops, symptoms tend to appear suddenly. A person with myopic CNV may experience a rapid decline in central vision over days or weeks. Straight lines may appear wavy or distorted, a symptom called metamorphopsia. Dark or gray patches may appear in the central field of vision. These patches are called scotomas.
Color perception may also change. Any of these symptoms in a person with high myopia should prompt an urgent visit to a retina specialist. Early treatment of CNV can help preserve remaining vision.
Certain symptoms require immediate attention. If you have high myopia and experience sudden vision loss, new distortion of straight lines, a dark spot in your central vision, or a sudden increase in floaters and flashes of light, see a retina specialist or go to the emergency room right away. Delaying care when CNV or a retinal tear is present can lead to irreversible vision loss.
Diagnosis and Testing
Diagnosing myopic degeneration begins with a thorough eye examination. A retina specialist will measure your refractive error (glasses prescription). The specialist may also measure the axial length of your eye using ultrasound or optical techniques. A dilated fundus examination allows the specialist to view the retina directly and look for signs of stretching, thinning, atrophy, lacquer cracks, and abnormal blood vessels.
Optical coherence tomography (OCT) is a noninvasive imaging test that creates detailed cross-sectional pictures of the retina. OCT can reveal fluid beneath the retina, thickening or thinning of retinal layers, and early signs of CNV. Some of these findings may not be visible during a standard exam. Retina specialists rely on OCT to monitor disease progression and guide treatment decisions.
If CNV is suspected, a retina specialist may perform fluorescein angiography. During this test, a yellow dye is injected into a vein in the arm. As the dye circulates through the blood vessels in the eye, a special camera captures images. Leaking or abnormal vessels appear clearly in these images. Indocyanine green angiography (ICG) and OCT angiography are additional tools that can help identify abnormal blood vessels. In some cases, these tools do not require dye injection.
Treatment Options
The primary treatment for myopic CNV is anti-VEGF therapy. VEGF stands for vascular endothelial growth factor, a protein that promotes abnormal blood vessel growth. Anti-VEGF medications block this protein and help stop leaking and new vessel growth. These medications are delivered through intravitreal injections (injections directly into the eye).
Lucentis (ranibizumab) is FDA-approved specifically for the treatment of myopic CNV. Eylea (aflibercept) is also approved for this indication. Avastin (bevacizumab), which is FDA-approved for cancer treatment, is sometimes used off-label for myopic CNV. Network meta-analysis research confirms that anti-VEGF therapy is the most effective treatment for myopic CNV (AAO). Patients with myopic CNV usually respond rapidly to treatment. Recurrence is much less frequent compared to other conditions that cause abnormal vessel growth in the retina.
The typical approach to treating myopic CNV is called a one-plus-PRN (pro re nata) regimen. This means the patient receives one initial injection and is then monitored monthly. Monitoring includes vision testing and OCT imaging. Additional injections are given only when signs of active disease return, such as new fluid or worsening vision. Because myopic CNV tends to respond well, many patients need fewer injections over time.
Monthly monitoring remains important even during quiet periods. A retina specialist will evaluate your visual acuity and review imaging results at each visit to determine whether retreatment is needed.
Biosimilars are medications that are highly similar to existing approved biologic drugs. The FDA has approved ranibizumab-nuna, a biosimilar to Lucentis, for the treatment of myopic CNV. This was the first ophthalmology biosimilar approved in the United States. An aflibercept biosimilar (FYB203) has also received FDA approval for myopic CNV as of 2024. These biosimilars offer additional treatment options for patients and retina specialists.
Not all complications of myopic degeneration involve CNV. Retinal tears or detachments may require surgical repair. Options include vitrectomy (a surgery to remove the gel inside the eye), laser photocoagulation (thermal laser to seal retinal tears), or cryopexy (a freezing treatment to seal retinal tears). Macular holes, another complication of high myopia, may also require vitrectomy. A retina specialist will recommend the appropriate approach based on the specific problem.
What to Expect
An intravitreal injection is performed in a clinical setting and takes only a few minutes. The eye is numbed with anesthetic drops before the injection. Most patients describe a sensation of pressure during the procedure. Some discomfort, mild redness, and a gritty feeling are common afterward but typically resolve within a day or two. Vision may be temporarily blurry right after the injection.
Serious complications from intravitreal injections are uncommon but can include infection inside the eye (endophthalmitis), bleeding, and retinal detachment. A retina specialist will discuss these risks and provide instructions for post-injection care.
Many patients with myopic CNV experience stabilization or improvement in their vision after anti-VEGF treatment. The response to the first injection is often noticeable within weeks. However, the degree of vision recovery depends on how long the CNV was present before treatment. The extent of underlying retinal damage from myopic degeneration also plays a role.
It is important to understand that anti-VEGF therapy effectively treats CNV but does not reverse the underlying stretching and thinning. Ongoing monitoring is essential to catch any recurrence of CNV or new complications early.
Myopic degeneration is a lifelong condition. The structural changes in the eye do not reverse, and some degree of progressive change is expected over time. With regular monitoring and timely treatment of complications like CNV, many patients maintain useful vision for decades. Advances in anti-VEGF therapy and the availability of biosimilars continue to improve treatment options and outcomes.
Living with Myopic Degeneration
People living with myopic degeneration can take several practical steps to support their eye health. Attending all scheduled appointments with a retina specialist is essential. Monitoring your own vision at home using an Amsler grid, a simple chart with a grid of straight lines, can help you detect new distortion or blind spots between visits. If you notice any changes, contact your retina specialist promptly.
Wearing appropriate corrective lenses and protecting your eyes from injury with safety glasses during sports or activities is also advisable. Ultraviolet-blocking sunglasses may help protect the retina from additional light damage.
If myopic degeneration has affected your central vision, low vision rehabilitation services can help you make the most of your remaining sight. These services may include magnifying devices, specialized lighting, large-print materials, and training on adaptive techniques for daily tasks. Many people with moderate vision loss from myopic degeneration continue to live independently and remain active.
Because high myopia and myopic degeneration have a genetic component, family members of affected individuals should have regular comprehensive eye exams. Parents with high myopia should be aware that their children may be at increased risk. Early detection of high myopia in children allows for closer monitoring. Timely referral to a retina specialist is important if degenerative changes begin to appear.
When to See a Retina Specialist
Anyone with high myopia should have periodic examinations with a retina specialist (AAO). Even in the absence of symptoms, these visits allow for early detection of stretching, thinning, and other degenerative changes. Your general eye care provider or optometrist can identify high myopia and refer you for specialized retinal evaluation.
Contact a retina specialist or go to the emergency room immediately if you experience any of the following:
- Sudden loss of vision in one eye
- New distortion where straight lines appear wavy or bent
- A dark or gray spot in the center of your vision
- A sudden increase in floaters or new flashes of light
- A curtain or shadow over part of your vision
These symptoms may indicate CNV, a retinal tear, or retinal detachment. Prompt treatment can make a significant difference in preserving your vision.
Questions and Answers
There is currently no proven way to prevent myopic degeneration once high myopia has developed. The structural elongation of the eye is not reversible. However, early detection through regular retinal examinations allows a retina specialist to identify complications like CNV at their earliest stage, when treatment is most effective. Research into slowing the progression of myopia in children is ongoing. Some interventions such as atropine drops and specialized contact lenses may help reduce the rate of eye growth in younger patients.
Both myopic CNV and wet age-related macular degeneration (AMD) involve abnormal blood vessel growth beneath the retina. Both are treated with anti-VEGF injections. However, they differ in important ways. Myopic CNV typically affects younger patients and is caused by stretching and thinning of the eye's tissues. Wet AMD is associated with aging and the buildup of deposits called drusen. Myopic CNV also tends to respond more quickly to treatment and usually requires fewer injections over time.
Many patients with myopic CNV require only a limited number of injections. Unlike some other retinal conditions, myopic CNV often responds well to initial treatment. Recurrences tend to be less frequent. Some patients may need additional injections months or years later if CNV returns. A retina specialist will monitor your eyes regularly and recommend treatment only when active disease is present. The goal is to treat as needed while minimizing the total number of injections.
No. LASIK and similar refractive surgeries reshape the cornea, the clear front surface of the eye, to correct the focusing error of nearsightedness. These procedures do not change the length of the eye. They do not address the stretching and thinning of retinal tissues that cause myopic degeneration. A person who has had LASIK for myopia still has the same elongated eye and remains at risk for all complications of high myopia. Continued monitoring by a retina specialist is important regardless of refractive surgery history.
While lifestyle changes cannot reverse myopic degeneration, certain habits may support overall eye health. Monitoring your vision at home with an Amsler grid can help you detect new symptoms early. Wearing UV-protective sunglasses outdoors, maintaining a healthy diet rich in leafy greens and omega-3 fatty acids, and avoiding smoking are generally recommended for retinal health. Most importantly, keeping all scheduled appointments with your retina specialist ensures that any new complications are caught and treated promptly.