Myopic Choroidal Neovascularization Review, Guidance, and Consensus Statement on Management

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 antievascular endothelial growth factor (VEGF) therapies have had a major impact on the management of patientswithmyopic CNV, there remain significant gaps in our understanding of this condition and howto 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. (C) 2017 by the American Academy of Ophthalmology