Vitreous Structure and Visual Function in Myopic Vitreopathy Causing Vision-Degrading Myodesopsia

PURPOSE: Myopic vitreopathy features precocious fibrous vitreous liquefaction and early posterior vitreous detachment (PVD). It is unclear whether visual function is affected by myopic vitreopathy and PVD. This study assessed the relationships among axial length, structural vitreous density, PVD, and visual function. center dot DESIGN: Retrospective case-control study. METHODS: Ultrasonography measurements were made of axial length, logMAR VA, contrast sensitivity function (CSF [Freiburg acuity contrast test]), and quantitative B scan ultrasonography. RESULTS: Seventy-nine subjects (45 men and 34 women; mean age: 49 +/- 14 years) were analyzed. Axial lengths ranged from 22 to 29.2 mm (mean: 24.9 +/- 1.8 mm; myopic eyes: 26.35 +/- 1.35 mm; and nonmyopic eyes: 23.45 +/- 0.75 mm; P <.001). With increasing axial length there was greater vitreous echodensity (R: 0.573; P <.01) and degradation in CSF (R: 0.611; P <.01). Subgroup analyses found that myopic eyes (>L 3 diopters) had 37% more vitreous echodensity than nonmyopic eyes (762 +/- 198 arbitrary units [AU] vs. 557 +/- 171 AU, respectively; P <.001) and that CSF was 53% worse in myopic eyes (3.30 +/- 1.24 Weber index [%W]) than in nonmyopic eyes (2.16 +/-.59 %W; P <.001). Myopic eyes with PVD had 33% greater vitreous echodensity (815 +/- 217 AU; P <.001) and 62% degradation in CSF (3.63 +/- 2.99 %W) compared to nonmyopic eyes with PVD (613 +/- 159 AU; 2.24 +/- 0.69 %W; P <.001, each). Limited vitrectomy was performed in 11 of 40 cases (27.5%), normalizing vitreous echodensity and CSF in each case. CONCLUSIONS: Axial myopia is associated with increased fibrous vitreous liquefaction and echodensity, as well as profound degradation of CSF. PVD in myopic eyes is associated with even more structural and functional abnormalities, normalized by limited vitrectomy. These findings may explain some common complaints of myopic patients with respect to vision and quality of life. (Am J Ophthalmol 2021;224:246-253. (c) 2020 Elsevier Inc. All rights reserved.)