AOA 2026: High myopia's consequences on the retina

In an exclusive interview with Optometry Times, Mohammad Rafieetary, OD, FAAO, FORS, DipABO, ABCMO, summarized the key themes of his panel contribution on myopia, with a particular emphasis on high/pathologic myopia and associated ocular complications. He stressed that high myopia—typically defined as greater than 6 diopters of myopia—should not be viewed merely as a refractive error requiring stronger glasses. Instead, it represents a spectrum of conditions that confer a significant risk of structural retinal and optic nerve pathology.

Rafieetary highlighted 3 major areas of concern in highly myopic patients:

1. Myopic macular degeneration, in which the elongation and thinning of the globe lead to degenerative changes in the macula that can threaten central vision.
2. Peripheral retinal disease, including lattice degeneration, peripheral retinal thinning, and related lesions that may predispose to retinal tears or detachment.
3. Optic nerve assessment challenges, especially in the presence of tilted optic discs, which are common in myopic eyes.

He underscored that myopic patients are at higher risk for glaucoma, but that conventional clinical assessment can be misleading. In particular, the standard evaluation of cup-to-disc (C/D) ratio is complicated by the anatomic distortion associated with tilted optic nerves. In these cases, relying solely on ophthalmoscopic impressions of the disc can result in diagnostic uncertainty or misclassification.

To address this, Rafieetary advocates the use of optical coherence tomography (OCT) as a critical adjunct. He explained that OCT can help clinicians better understand the optic nerve head anatomy, refine their evaluation of the cup-to-disc ratio, and more accurately assess the retinal nerve fiber layer (RNFL) and ganglion cell layer, structures that are central to glaucoma diagnosis and monitoring. By integrating OCT findings with clinical examination, practitioners can more reliably distinguish between myopic structural variants and true glaucomatous damage.

Overall, his talk emphasized a comprehensive, pathology-focused approach to high myopia: recognizing associated macular and peripheral retinal disease, understanding the complexities of optic nerve evaluation in tilted discs, and leveraging advanced imaging to protect visual function in this vulnerable patient population.