Vitreoretinal complications in high myopia

09/01/2026

Patients should be instructed to recognise warning symptoms at an early stage so that they can seek immediate consultation with an ophthalmologist.

High myopia, defined as a refractive error greater than –6 dioptres, constitutes a major risk factor for the development of multiple vitreoretinal diseases.

Excessive elongation of the eyeball leads to progressive thinning of the sclera, choroid and retina, in addition to altering the vitreoretinal interface.

These structural changes predispose patients to complications that can severely and irreversibly compromise visual function.

Main complications

Posterior vitreous detachment (PVD) occurs earlier and more frequently in pathological high myopia due to accelerated vitreous liquefaction. Although PVD is a common ageing-related phenomenon, in these patients it may cause excessive traction and retinal tears, particularly in weakened areas.

Peripheral retinal degenerations, especially lattice degeneration, are more common in highly myopic patients and predispose to retinal breaks that may lead to retinal detachment. Ophthalmological detection is essential in order to assess the need for prophylactic laser treatment.

Retinal tears and rhegmatogenous retinal detachment are serious complications: the thinned and tractioned retina tears, vitreous fluid enters beneath it and separates it, requiring urgent surgery.

Myopic maculopathy is the leading cause of irreversible loss of central vision, with manifestations such as chorioretinal atrophy, choroidal neovascular membranes, tractional pathology and macular hole.

Finally, staphyloma is a localised protrusion of the ocular wall in the posterior segment, resulting from scleral thinning and weakening. Its presence increases the likelihood of developing myopic maculopathy and promotes progression of chorioretinal atrophy, worsening long-term visual prognosis.

Warning symptoms

The most notable include:

• Sudden onset of  myodesopsias (floaters).
• Perception of photopsia or flashes of light.
• The presence of scotomas or shadows in the visual field.
• Metamorphopsia, corresponding to distorted central vision.

Prevention and monitoring

Follow-up of high myopia requires regular ophthalmological examinations, with detailed assessment of the peripheral retina under mydriasis (pupil dilation).

Optical coherence tomography (OCT) is an indispensable tool for monitoring the macula and for early detection of structural abnormalities.

Dr Sònia Viver, ophthalmologist at the Barraquer Opthalmology Centre