Myopia-related retinal detachments in younger patients: A retina view

Retinal holes, tears, and detachments linked to myopia are appearing in younger patients, according to Nimesh A. Patel, MD, director of pediatric retina at Mass Eye and Ear and Mass General Hospital and director of pediatric retina surgery at Boston Children's Hospital. In an interview with the Eye Care Network, Patel discussed why these complications are occurring earlier, what optometrists should watch for, and when retinal damage becomes irreversible. In a companion interview, Patel discussed compounded low-dose atropine and the regulatory path for an approved treatment option.

Why are retinal detachments occurring in younger patients?

Patel noted that, as a pediatric retina specialist, he sees most of the complications of myopia, so his perspective is, "probably a little bit biased." Clinicians traditionally considered retinal detachment mainly an adult disease associated with vitreous detachment, with occasional cases in young adults and pediatric patients. As myopia has increased nationally and internationally, however, Patel said clinicians are starting to see a rise in retinal holes, tears, and detachments. "What happens is as the axial length increases, or the eye grows and the myopia progresses, that can cause extra strain between the vitreous and the retina and lead to these tears," he said.

At what point should optometrists consider structural risk?

Patel said no exact correlation exists between the degree of myopia and the risk of retinal detachment, although patients with myopia beyond −6 or −8 D may be at higher risk and warrant retinal examinations. More broadly, he emphasized general awareness that myopia can lead to retinal detachment, noting that detachment has become more of a risk in young adulthood as the number of younger patients with myopia grows.

Patel said intervention is often possible, especially when a detachment is caught early. Some detachments are asymptomatic in children because one eye takes over for the other, so patients may lose vision, including central vision, without noticing. Routine optometry examinations often identify these cases. "It's really important for optometrists to be dilating patients or taking fundus photos," Patel said, adding that he would rather see over-referral than under-referral.

When does retinal damage become irreversible?

According to Patel, even chronic tears and detachments that likely developed years earlier can sometimes be repaired with vision fully preserved. When a detachment involves the center of the retina, surgeons can repair the retina, but patients may be left with some degree of vision loss. Late detachments with scar tissue can be irreversible or inoperable, but Patel said these cases are quite rare. Patel called for greater awareness of myopia and myopia progression, dilated examinations or fundus photography for pediatric patients and young adults, and consistent examinations for patients with myopia.