Myopic fundus changes in adult-onset moderate myopia

Abstract

Purpose: To show a case of adult-onset moderate myopia that developed myopic maculopathy in both eyes. This report shows that an individual with moderate myopia can still develop myopic maculopathy because of a combination of a long axial length and a low lens power that produces a lower-than-expected myopic refraction.

Case report: A 67-year-old man came for first time visit seeking vision exam in 2021 with moderate myopia. He reported having good distance and near vision in his youth but then by age 30 he began to experience impaired distance vision. He was initially given a prescription for low astigmatism for his right eye, but his distance vision slowly degraded to the point where he needed higher powered spectacles as years passed. His refractive error in 2021 was -3.25D, -2.00 D 90° (OD) and -3.25D (OS) with a best corrected visual acuity of 20/30 (OD) and 20/20 (OS). His ocular biometry showed an eye that was longer than usual with an almost normal cornea and a low-powered crystalline lens. In both eyes, the fundus showed typical myopic degenerations mainly peripapillary atrophy. The examination after pupil dilation showed mild nuclear opacity grade 1 (LOCS III) bilaterally, with no cortical or subcapsular opacities.

Conclusions: This adult-onset moderate myopic subject probably developed myopic maculopathy because his eye was longer than usual during emmetropization due to a low powered crystalline lens.