1. Grand Rounds Eddie Apenbrinck M.D. University of Louisville School of Medicine Department of Ophthalmology & Visual Sciences 11/07/2014

2. Subjective CC: chronic floaters OU and a slight decrease in vision OU HPI: 54 year old African American female seen in Retina clinic for chronic floaters OU and recent decrease in vision OU. Glasses recently changed but still having difficulty with small print.

3. POH: high myopia, ocular hypertension PMHx: hypertension Family Hx: glaucoma (mother) Allergies: codeine Meds: lisinopril

4. Exam OD OS BCVA: 20/25 -2 20/20 -2 -6.25 +0.75 x 175 -7.50+2.00 x 175 Pupils: 4 2No RAPD 4 2 IOP: 24 25 Pachymetery 617609 EOM: Full OU

5. Anterior Segment Exam OD OS L/L: WNLOU C/S:WNL OU Cornea:WNLOU AC: No cell or flare OU I/L: WNL OU

6. Fundus Photos OD OS Tilted disc OU and petalloid appearance of the macula OU

7. OCT OD Vitreomacular adhesion(VMA) and splitting of multiple layers of the retina

8. OCT OS Vitreomacular adhesion(VMA) and splitting of multiple layers of the retina

9. High Resolution OCT OD

10. High Resolution OCT OS

11. Assessment and Plan 54 year old female with pathologic myopia, macular foveoschisis and ocular hypertension OU. 54 year old female with pathologic myopia, macular foveoschisis and ocular hypertension OU. Plan Plan Myopic foveoschisis with VMA Myopic foveoschisis with VMA Observation Observation Ocular Hypertenion Ocular Hypertenion Observation off medications Observation off medications

12. Myopic Macular Degeneration The prevalence of myopia ranges from 17%-43% among Asians, and from 13%-27% among white populations of the USA, Europe and Australia The prevalence of myopia ranges from 17%-43% among Asians, and from 13%-27% among white populations of the USA, Europe and Australia The prevalence of high myopia (spherical equivalent (SE) <-5.0 or <-6.0 D sphere) is greater in Asian populations (1.7% to 9.1%), than in Hispanic (2.4%), White (2.0%), and Black (1.0%) populations. The prevalence of high myopia (spherical equivalent (SE) <-5.0 or <-6.0 D sphere) is greater in Asian populations (1.7% to 9.1%), than in Hispanic (2.4%), White (2.0%), and Black (1.0%) populations. Pathologic myopia, defined as myopia which develops retinal pathology due to axial length Pathologic myopia, defined as myopia which develops retinal pathology due to axial length The prevalence is increasing presumably due to an increase of near activities The prevalence is increasing presumably due to an increase of near activities

14. Clinical Features Myopic Conus Myopic Conus Posterior Staphyloma Posterior Staphyloma Myopic Chorioretinal Atrophy Myopic Chorioretinal Atrophy

15. Clinical Features Lacquer Cracks Lacquer Cracks Myopic Choroidal Neovascularization Myopic Choroidal Neovascularization Myopic Macular Retinoschisis/Myopic Foveoschisis Myopic Macular Retinoschisis/Myopic Foveoschisis

16. Treatment Observation Observation Anti-VEGF and PDT with verteporfin for myopic choroidal neovascularizations Anti-VEGF and PDT with verteporfin for myopic choroidal neovascularizations Vitrectomy with ILM peel for myopic foveoschisis if significant vitreomacular traction is present Vitrectomy with ILM peel for myopic foveoschisis if significant vitreomacular traction is present

17. Retrospective chart review of 40 eyes of 36 patients that had undergone 25-gauge vitrectomy with internal limiting membrane peeling for macular foveoschisis were studied. Retrospective chart review of 40 eyes of 36 patients that had undergone 25-gauge vitrectomy with internal limiting membrane peeling for macular foveoschisis were studied. The eyes were divided into 2 groups: 1)those with foveal detachment and 2)those without foveal detachement The eyes were divided into 2 groups: 1)those with foveal detachment and 2)those without foveal detachement The main outcome measures were the best-corrected visual acuity (BCVA) and the optical coherence tomography (OCT) findings. The main outcome measures were the best-corrected visual acuity (BCVA) and the optical coherence tomography (OCT) findings.

18. Postoperative OCT showed resolution of macular foveoschisis with a significant reduction in central foveal thickness in both groups Postoperative OCT showed resolution of macular foveoschisis with a significant reduction in central foveal thickness in both groups The final mean BCVA significantly improved in both groups The final mean BCVA significantly improved in both groups Foveal detachment group final BCVA: Foveal detachment group final BCVA: improved (63%), unchanged (31%), worse (13%) improved (63%), unchanged (31%), worse (13%) No Foveal detachment group final BCVA: No Foveal detachment group final BCVA: improved (21%), unchanged (71%), worse (8%) improved (21%), unchanged (71%), worse (8%) A better final BCVA was significantly correlated with a better preoperative BCVA in both groups A better final BCVA was significantly correlated with a better preoperative BCVA in both groups

20. References 1. BCSC: Retina and Vitreous. Pathologic Myopia. Pgs 85-87. 2. 2. Myopic Macular Degeneration. Retina.. Ohno-Matsui, Kyoko; Ikuno, Yasushi; Yasuda, et al. Published January 1, 2013. Pages 1256-1266. © 2013. 3. 3. Blinder KJ, Blumenkranz MS, Bessler NM, et al. Verteporfin therapy for subfoveal choroidal neovascularization in pathologic myopia: 2-year results of a randomized clinical trial. VIP report no, 3. Ophthalmology. 2003; 110(4):667-673 4. 4. Chan WM, Lai TY, Liu SDT, Lam DS. Intravitreal bevacizumab (Avastin) for myopic choroidal neovascularization: six-month results of a prospective pilot study. Ophthalmology. 2007;114(12):2190-2196. 5. 5. Hampton GR, Kohen D, Bird AC. Visual prognosis of disciform degeneration in myopia. Ophthalmology. 1983;90(8):923-926 6. Krumpaszky HG, Ludtke R, Mickler A, et al. Blindness incidence in Germany. A population- based study from Wurttemberg-Hohenzollern. Ophthalmologica 1999;213:176–82. 7. Munier A, Gunning T, Kenny D, et al. Causes of blindness in the adult population of the Republic of Ireland. Br J Ophthalmol 1998;82:630–3. 8. 8. Parodi MB, Iacono P, Papayannis A, Sheth S. Bandello F. Laser Photocoagulation, photodynamix therapy, and intravitreal bevacizumab for the treatment of juxtafoveal choroidal neovascularization. Ophthalmology. 1999; 106(11):2063-2067