Myopic Maculopathy in Children and Adolescents With High Myopia-Reply

We appreciate the comments by Asensio-Sánchez on our study1 exploring the 4-year progression of myopic maculopathy in children and adolescents with high myopia.We agree that myopic maculopathy is a complex disease. The challenges of classifying numerous myopic maculopathy findings are reflected, for example, by the frequently cited International Photographic Classification and Grading System for Myopic Maculopathy.2 This system uses fundus photographs to grade myopic macular degeneration, demonstrating relatively high sensitivity when applied in clinical studies, including those involving younger age groups.3We acknowledge that some patients develop highly asymmetric myopic maculopathy with substantially different severity in each eye. However, in our experience, the vast majority of patients with bilateral high myopia exhibit relatively symmetric fundus lesions. The analysis of the severity of myopic maculopathy between right and left eyes in our study found no meaningful differences. Additionally, when we performed a logistic regression analysis using only 1 eye per participant, while the smaller dataset led to wider confidence intervals, the findings appeared consistent with the results of our original findings, including myopic maculopathy progression associated with worse best-corrected visual acuity (odds ratio [OR], 11.33; 95% CI, 0.60-213.80), longer axial length (OR, 1.74; 95% CI, 1.19-2.54), faster axial length elongation (OR, 607.86; 95% CI, 20.41-18 100.37), and more severe myopic maculopathy (diffuse atrophy: OR, 5.23; 95% CI, 1.49-18.40; patchy atrophy: OR, 5.57; 95% CI, 1.63-19.09).Furthermore, when reviewing the article referenced by Asensio-Sánchez regarding asymmetric myopic maculopathy between eyes of the same participant,4 that study appeared to focus on the morphology of posterior vitreous detachments (PVDs) in highly myopic eyes, without specifically addressing changes related to myopic maculopathy. Current classifications do not generally include PVDs as part of myopic maculopathy.2,5 Nevertheless, the characteristics of PVDs may provide insights into the pathogenesis of myopic traction maculopathy, which may be associated with various risk factors. These include the presence of an epiretinal membrane, vitreomacular traction syndrome, remnants of cortical vitreous, and the inherently less elasticity of the retina and the inner limiting membrane compared with the surrounding tissues, which are unable to accommodate the scleral outpouching of the posterior pole.5 Also, that study4 found that PVDs commonly were more asymmetric relative to the fovea in highly myopic eyes than in eyes that were not highly myopic, without exploring differences of PVDs between the left and right eyes of the same patient.Of course, further research with more participants evaluated and potentially more precise categorization would be of value to validate our findings and to more definitively elucidate their clinical relevance.