Author: José M. Ruiz-Moreno


  1. Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain.
  2. Department of Ophthalmology, Castilla La Mancha University. Albacete. Spain.
  3. Vissum Corporation. Spain.


High myopia (HM) is defined as the presence of a high negative refractive error (> -6 to -8 diopters) in the context of eye elongation beyond 26-26.5 mm. Myopic maculopathy is a very complex disease, defined by the macular alterations induced by high myopia, in which an excessive axial length and/or posterior staphyloma are the main factors. These macular alterations include not only atrophic changes, which are the basis of the majority of current classifications, but also neovascular alterations, traction-induced changes to the macula, and specific modifications of the posterior pole profile that may cause myopia-related conditions, such as Dome-Shape Maculopathy. Multimodal imaging is necessary in order to stablish a correct grading of HM patients. Current classification systems do not fully account for the numerous changes that occur in the macula of these patients. A more comprehensive classification system is thus needed, for several important reasons. We propose a new system based on three different factors: atrophy (A), traction (T), and neovascularization (N), which we call the ATN classification system.

Keywords: Pathologic myopia; staphyloma; myopic maculopathy; myopic traction maculopathy; myopic choroidal neovascularization; high myopia; myopic maculopathy classification; dome-shape maculopathy.