Clinical characteristics and microperimetry of patients with myopic maculopathy referred to vision rehabilitation compared to age related macular degeneration

Myopic maculopathy (MM) is a progressive degenerative change of the retina and choroid associated with high myopia leading to central vision loss. The burden of MM is anticipated to increase due to the rising prevalence of myopia globally. Patients with MM are often referred for vision rehabilitation (VR) to help adapt to visual impairment. VR aims to allow patients to continue performing tasks and remain safe despite vision loss, typically through training with optical devices, assistive technology, or new strategies. This study compares the presenting clinical characteristics and VR process of patients with MM to patients with age-related macular degeneration (AMD), the latter being the most common diagnosis of patients referred for VR. This retrospective chart review included 32 consecutive patients with MM and 32 randomly selected patients with AMD referred for VR. Only patients with visual acuity in either eye better than 20/200 were included to represent the early stage of both disease processes. Available microperimetry data were collected for all eyes with a visual acuity better than 20/200 and graded for the presence of scotomas by two independent reviewers. Patients with MM were significantly younger (p < 0.0001) than those with AMD (mean age 68.0 vs 81.6 years respectively). Reported priority goals for vision rehabilitation showed a significant trend: patients with MM and moderate acuity prioritized daily living tasks more frequently (67%, p = 0.0045) than patients with AMD. At good acuity (>20/50), dense paracentral scotomas trended towards being more prevalent amongst patients with MM compared to moderate acuity (between 20/50 and 20/200) where central scotomas were more prevalent amongst patients with AMD. Patients with early MM have unique characteristics at presentation for VR compared to patients with AMD. It is important for providers to be aware of the visual challenges faced by younger patients with paracentral scotomas, which may warrant VR referral even when visual acuity is good.