Myopic traction maculopathy biomarkers on optical coherence tomography angiography—An overlooked mechanism of visual acuity correction in myopic eyes

Background/objectives: Myopic traction maculopathy of the retinoschisis type is a unique entity that has been frequently overlooked in refraction correction in daily practice in myopic eyes. The objective of this study was to describe the imaging characteristics of myopic traction maculopathy (MTM) seen on optical coherence tomography angiography (OCTA) and to detect biomarkers of the associated functional changes. Subjects/methods: We performed OCTA on eyes with MTM and retinoschisis (RS group; n = 27) and highly myopic eyes without MTM (control group; n = 27). The RS group was further divided into a dome-shaped macula (DSM) group and a non-DSM group. The groups were compared for morphologic and perfusion characteristics. Results: The RS and control groups had comparable spherical equivalence (p = 0.65), but the RS group had worse best-corrected visual acuity (p < 0.01), larger retinal volumes (p < 0.01), and greater subfoveal choroid capillary vessel density values (p = 0.04). Compared to the non-DSM group, the DSM group had significantly smaller inner retinal volumes (p = 0.05) and significantly larger choroid capillary vessel density values in both the whole macula (p = 0.005) and the fovea (p = 0.03). Conclusions: Our high-resolution OCTA morphologic and vascular perfusion data correlated well with functional abnormalities encountered in myopic eyes. Changes in vessel density may elucidate the pathogenesis of MTM and characterize the mechanical stretch forces acting in eyes with MTM.