Myopic Degeneration: Understanding and Protecting Your Vision

Nearsightedness is increasingly common, and high myopia affects a notable portion of the population. Myopic degeneration develops in a subset of those with high myopia and is considered a leading cause of visual impairment. The condition is reported to be among the top causes of legal blindness in the United States and Europe, and the leading cause of blindness in Japan. These figures highlight why ongoing monitoring matters so much.

Several factors raise the risk of developing myopic degeneration. Being aware of these can help you and your eye care provider make informed decisions about how often your eyes should be examined.

• Greater axial length of the eye, meaning it measures longer than normal from front to back
• A stronger myopic prescription, especially beyond negative 6.00 diopters
• Older age, though degenerative changes have been identified in patients as young as their twenties
• A family history of high myopia or myopic degeneration
• East and Southeast Asian descent, populations with the highest documented rates of myopia

Myopic degeneration can affect both eyes, though each eye may progress at a different rate. Research shows that a significant percentage of patients who develop CNV in one eye will go on to develop it in the other eye within several years. This is why both eyes require close monitoring, even when only one eye currently shows signs of the condition.

The primary treatment for myopic CNV is anti-VEGF therapy. VEGF stands for vascular endothelial growth factor, a protein that stimulates the growth of abnormal blood vessels. Anti-VEGF medications block this protein, helping to stop leaking and prevent new vessel growth. These medications are delivered through intravitreal injections, meaning they are injected directly into the eye in a clinical setting.

Several anti-VEGF medications are used for this condition, including ranibizumab and aflibercept, both of which hold FDA approval for myopic CNV. Bevacizumab is sometimes used as an off-label option. Clinical evidence consistently supports anti-VEGF therapy as the most effective treatment for myopic CNV. Most patients respond well, and recurrence tends to be less frequent compared to other retinal conditions that cause abnormal vessel growth.

Biosimilars are medications that are highly similar to already-approved biologic drugs and meet the same strict regulatory standards. The FDA has approved biosimilar versions of both ranibizumab and aflibercept for the treatment of myopic CNV. These biosimilars offer additional options for patients and their specialists, and they undergo rigorous review to confirm their safety and effectiveness.

A common approach for treating myopic CNV is called a one-plus-PRN regimen. The patient receives one initial injection and is then monitored monthly. Additional injections are given only when signs of active disease return, such as new fluid beneath the retina or worsening vision. Because myopic CNV tends to respond well to initial treatment, many patients need fewer injections over time compared to other retinal conditions.

Monthly monitoring remains important even during quiet periods. A specialist will evaluate your vision and review imaging at each visit to determine whether additional treatment is needed.

Not all complications of myopic degeneration involve CNV. Retinal tears or detachments may require surgical repair. Options include vitrectomy (a surgery to remove the vitreous gel inside the eye), laser photocoagulation (a thermal laser used to seal retinal tears), or cryopexy (a freezing treatment that seals retinal tears). Macular holes, another complication associated with high myopia, may also require vitrectomy. A specialist will recommend the most appropriate approach based on each patient's specific situation.

There is currently no proven way to prevent myopic degeneration once high myopia has developed. The structural elongation of the eye is not reversible. That said, research into slowing the progression of myopia in children is ongoing, and some interventions such as low-dose atropine drops and specialized contact lenses may help reduce the rate of eye growth in younger patients. For adults, the focus shifts from prevention to early detection, since catching complications like CNV at the earliest possible stage gives treatment the best chance to protect remaining vision.

Both conditions involve abnormal blood vessel growth beneath the retina and are treated with anti-VEGF injections, but they differ in meaningful ways. Myopic CNV typically affects younger patients and is caused by the mechanical stretching and thinning of the eye's layers. Wet age-related macular degeneration (AMD) is associated with aging and the accumulation of deposits under the retina. Myopic CNV also tends to require fewer injections over time and often responds more quickly to initial treatment than wet AMD does. If you have been told you have one of these conditions, it is worth asking your specialist how the treatment plan reflects those differences.

Many patients with myopic CNV need only a limited number of injections, unlike some other retinal conditions that require long-term, frequent treatment. After the initial injection, ongoing monitoring determines whether further treatment is necessary. Some patients remain stable for months or even years without needing retreatment. If CNV does return, additional injections can be given at that time. The goal is always to treat only when active disease is present rather than on a fixed schedule, which helps minimize the total number of injections a patient receives.

No. LASIK and similar refractive surgeries reshape the cornea, the clear dome at the front of the eye, to correct blurred distance vision. These procedures do not change the length of the eye itself, which is what drives myopic degeneration. A person who has had LASIK still has the same elongated eye and remains at the same risk for retinal complications as before surgery. If you have had refractive surgery for nearsightedness, it is still important to continue regular retinal monitoring with a specialist.

Yes, and we encourage it. An Amsler grid is a simple, printable chart that looks like a grid of straight lines with a dot in the center. You use it by covering one eye at a time and looking at the center dot. If any of the surrounding lines appear wavy, bent, missing, or blurry, that is worth reporting to your specialist right away rather than waiting for your next scheduled visit. Home monitoring does not replace regular clinical exams, but it can give you an early warning that something has changed and prompt you to seek care sooner.

Regular comprehensive eye exams are recommended for all children, and they are especially important when a parent or sibling has high myopia. A child does not need to currently be nearsighted to benefit from monitoring. Early detection of high myopia as it develops opens the door to interventions that may slow eye growth and reduce the eventual risk of degenerative complications. If your child is diagnosed with myopia that is progressing quickly, ask your eye care provider whether a referral to a specialist is appropriate.