Eye Shape Deformity Predicts Myopic Maculopathy Progression among Highly Myopic Individuals：A 4-Year Longitudinal Study

Purpose: To determine the impact of eye shape using three-dimensional magnetic resonance imaging on myopic maculopathy (MM) progression. Methods: At baseline, 67 participants with high myopia were selected. Eye shape was classified into spheroidal, ellipsoidal, temporally distorted, nasally distorted, conical, and barrel-shape identified from three-dimensional magnetic resonance imaging. Spheroidal and ellipsoidal shapes were defined as nondeformity; others were defined as eye deformity. Myopic maculopathy progression was determined through color fundus photography. Results: Within a 4-year follow-up, 17.1% (7/41) of patients with nondeformed eye shape had MM progression, whereas 69.2% (18/26) of patients with eye shape deformity had MM progression. In multivariable analysis, eye shape deformity (odds ratio, 4.35; 95% confidence interval, 1.10–17.29; P = 0.036) and axial length of ≥28 mm (odds ratio, 12.75; 95% confidence interval, 2.27–71.48; P = 0.004) significantly correlated with MM progression. The predictive discrimination of eye shape alone for MM progression did not differ from axial length (area under the curve: 0.765 vs. 0.750, P = 0.486). By incorporating age, sex, axial length, and eye shape, the prediction model achieved an area under the curve of 0.862 for discriminating MM progression. Conclusion: Eye shape deformity assessed by three-dimensional magnetic resonance imaging is a novel predictor for MM progression in high myopia.