Ophthalmology & Optometry/Pathological myopia


QUESTION: Dear Dr Dovie,

Please will you help me, I have five questions about pathological myopia and I would be so grateful if you would help me.

1. If you had pathological myopia, and had a prescription of -20 or so by age 25, what is the likelihood that you will end up with myopic macular degeneration, and at what age is this degeneration likely to occur?

2. Is pathological myopia always present at birth, or can it come on at any age? If it's not always present at birth, could someone have completely normal vision at birth and then go on to develop pathological myopia? What age is most common for pathological myopia to come on?  

3. In someone with pathological myopia, how much and how often does the prescription generally worsen? Does it get worse every year, or can it worsen even quicker than that? And by how much does it usually worsen at a time?

4. Do people who have very high myopia (for instance -20) always have pathological myopia, or is it possible for people to have that level of myopia all their lives without it being pathological?

5. If it is possible to have very high myopia without it being pathological, if someone had very high myopia (-20), and this prescription was mostly stable, but sometimes worsened, is that normal, or would that be pathological myopia?

I hope that my questions aren't too vague or too stupid. This is very important to me but I am very new to learning about pathological myopia. I hope I'm not wasting your time. Thank you very much.

ANSWER: I apologize for the delay in my response, here are some answers.

1.  It's difficult to predict progression, but it's very uncommon for pathologic myopia to continue to change into the 30s and 40s.  We wouldn't expect large changes that late, but -0.50 wouldn't be uncommon over a year or so.

2.  It is not always present at birth, although there are typically signs of it in the first few years.  In the early years, it would just be 'high' or 'progressive' myopia.  It typically doesn't get the term 'pathologic' myopia until the axial length of the eye is over 26mm.

3.  Too complex to answer - everyone is different.  A typical change is less than 1.00 diopter.

4. High myopia is a risk factor for pathologic myopia.  Pathologic myopia means that the shape of the eye is long enough, that the tissues are at risk for degenerative change.

Good luck!

---------- FOLLOW-UP ----------

QUESTION: Thank you so much, Dr Dovie, that's so helpful.

Could you tell me, please, if your prescription is -20, what is the likelihood that degenerative change in the tissues will occur? Is it basically a fait accompli when the prescription is that bad?

Thank you so much again for your help.

I would suspect a prescription of that number already has some thinning of the retina and sclera, just based on shape.  So in a way, yes, it already has some 'degenerative' changes.  It doesn't mean it will cause retinal detachment, etc, but it should certainly be monitored yearly.
Good Luck.

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John M. Dovie, OD, FAAO


As a residency-trained Fellow of the American Academy of Optometry I am able to answer most questions regarding eye and vision health. Anything is welcome, ranging from dry or allergy eyes, bifocal contact lenses, or thoughts on LASIK surgery. As I am not a surgeon, detail-oriented surgical-related questions may be better answered by an ophthalmologist.


Selected to participate in the PCO residency program in Philadelphia at The Eye Institute, where I worked OD and MD specialists gaining invaluable experience in various clinics including glaucoma, cornea and cataract, oculo-plastics, retinal disease, neuro-ophthalmic disease, primary care, emergency medicine, and special populations. Have practiced and trained in numerous settings including hospital, academic, retail and private practice. I earned my Fellowship in the American Academy of Optometry (FAAO). There are currently only about 3000 active fellows worldwide, and there are only about 70 Fellows in the state of Virginia. I currently own and operate my own optometric practice/clinic.

American Academy of Optometry, American Optometric Association (Contact Lens/Cornea Section member since 2001), Southwest Virginia Optometric Association, Virginia Tech Alumni Association

“Nyctalopia as the Presenting Sign of Vitamin A Deficiency: A Late Complication of Gastric Bypass Surgery.” Clinical Case Study Poster presented at The American Academy of Optometry Denver, Colorado, December 2006, co-authored with Bradley Lane, OD.
“The Importance of Considering Paranasal Sinus Mucocele as a Differential Diagnosis in Diplopia.” Clinical Case Study Poster presented at The American Academy of Optometry San Diego, California, December 2005, co-authored with Kelly Malloy, OD, FAAO and Cherie Farkash, OD.
“Acute Onset of Halos and Glare: Bilateral Keratitis—An Atypical Presentation of Amiodarone Keratopathy.” Clinical Case Study Poster presented at The American Academy of Optometry Tampa, Florida December 2004. Also Presented to New Jersey Academy of Optometry, Neptune, New Jersey March 2005.
“The Opportunity for an Optometrist to Save a Life.” Clinical Case Study and Grand Rounds Presentation presented at The Pennsylvania College of Optometry, Philadelphia, Pennsylvania, September 2004.
“Corneal whorls cause wonder.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 10/15/2006.
“Acute onset of halos and glare: bilateral corneal epithelial edema with cystic eruptions--atypical presentation of amiodarone keratopathy.” Co-authored with Andrew Gurwood, OD, FAAO. Published February, 2006, Optometry.
“Pondering the posterior polka-dots.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 5/15/2005.
Professional Involvement:
“AION: Amiodarone-Induced or Anterior Ischemic Optic Neuropathy?” Participated as a peer-review referee for Expert Review of Ophthalmology (London, UK); refereed 10/2006.

Bachelor of Science, Cum Laude, Virginia Tech. Bachelor of Science, Pennsylvania College of Optometry. Doctorate (OD), Pennsylvania College of Optometry Residency, Pennsylvania College of Optometry Fellow of the American Academy of Optometry

Awards and Honors
Winner, First Place, "Best Beside Manner" by Our Health Magazine: 2012, 2013, 2014 Winner, First Place, "Best Eye Doctor" by The Roanoke Times: 2013, 2014 Recognized as a Fellow of the American Academy of Optometry, December, 2006 Recipient of the Onofrey G. Rybachok Memorial Scholarship, 2000-2001 Member: The Golden Key International Honor Society Member: The National Biological Honor Society Member: The National Honor Society Eagle Scout awarded 1994

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