Analysis Identifies Factors Associated With Myopia in Dutch Population

Results of a cross-sectional study highlight features linked with high myopia in Dutch individuals.

Among highly myopic Dutch individuals with European ancestry, myopic retinal features are frequent; are associated with age, spherical equivalent of refractive error (SER), and axial length (AL); and occur in all severely visually impaired eyes, according to results of a cross-sectional study.

Findings were published in JAMA Ophthalmology, with the authors stressing “the absence of treatment options for most of these retinal complications emphasizes the need for effective strategies to prevent high myopia.”

Myopia, or nearsightedness, is typically caused by eye elongation and can lead to irreversible vision loss, the researchers explained. Presence of myopia is increasing globally, and it is estimated that by 2050, 10% of the world’s population will be highly myopic. Myopic macular degeneration (MMD) serves as a major cause of visual impairment among those with myopia.

Previous research assessing high myopia features was primarily based on clinical data of Asian patients, while use of the Meta-analysis for Pathologic Myopia (META-PM) Study Group international grading system among patients of European descent is scarce.

To address this knowledge gap, the investigators conducted a cross-sectional study to elucidate the occurrence of myopic macular features in patients with high myopia using data from the population-based Rotterdam Study (RS) and the Dutch Myopia Study (MYST).

All individuals with an SER of −6 diopters (D) or less and an AL of 26 mm or greater included in the RS (n = 117) and MYST (n = 509) were included in the current analyses. “Both studies included extensive ophthalmological examinations at the same research center using the same protocol,” the authors wrote.

In addition to grading retinal images of patients included in these cohorts, the researchers also conducted a systematic review to compare highly myopic persons with European ancestry to those with Asian ancestry.

Of the 626 individuals of European ancestry, the mean (SD) SER was −9.9 (3.2) D and patients had a mean age of 51.4 (15.1) years. The majority of individuals assessed (61.8%) were female.

Analyses revealed:

  • Prevalence of MMD was 25.9% and increased with older age (P for trend <.001), lower SER (odds ratio [OR], 0.70; 95% CI, 0.65-0.76; P < .001), and higher AL (OR, 2.53; 95% CI, 2.13-3.06; P < .001)
  • Choroidal neovascularization or Fuchs spot was present in 2.7% (n  =  17), both lesions in 0.3% (n  =  2), and lacquer cracks in 1.4% (n  =  9)
  • Staphyloma, peripapillary atrophy (PPA) and MMD were highly prevalent in visual impaired and blind eyes (frequency was 73.9% [20 of 27], 90.5% [19 of 21], and 63% [17 of 27] of unilateral blind eyes for MMD, staphyloma, and PPA, respectively)
  • 7 previous studies in Asian populations reported a variable MMD frequency ranging from 8.3% to 64.0%, but frequencies were similar for comparable risk profiles based on age and SER

A lack of data on the prevalence of other retinal complications or features requiring a high-resolution optical coherence tomography marks a limitation to the analysis, while the researchers were also unable to observe more peripherally located lesions or an equatorial staphyloma. The cross-sectional design of the study precludes any causative conclusions from being drawn.

Overall, findings indicate the prevalence of MMD is associated with AL, SER, and age among individuals of European ancestry and is not as dependent on ancestry.

“Because MMD is a major cause of VI and blindness and (high) myopia incidence is increasing globally, we expect the visual burden of MMD to rise accordingly,” the authors concluded. “To save quality of life and productivity, future research needs to focus on development of innovative interventions to prevent these complications, and eye care clinicians should encourage myopia control.”


Haarman AEG, Tedja MS, Brussee C, et al. Prevalence of myopic macular features in Dutch individuals of European ancestry with high myopia. JAMA Ophthalmol. Published online December 16, 2021. doi:10.1001/jamaophthalmol.2021.5346