Retinal Holes in High Myopia and Peripheral Scotoma
Yes, a hole in the retina due to high myopia can result in a scotoma in the peripheral visual field, and early intervention is recommended to prevent progression to retinal detachment and permanent visual field loss. 1
Pathophysiology and Risk Factors
High myopia significantly increases the risk of retinal pathology, including:
- Progressive retinal and choroidal thinning
- Peripheral retinal degeneration
- Retinal holes and tears
- Retinal detachment 2
Patients with high myopia (typically defined as refractive error >-6.00 diopters) have elongated axial length, which stretches the retina and makes it more susceptible to breaks and holes 2, 1. When a retinal hole forms, it creates a discontinuity in the neurosensory retina that can manifest as a scotoma (blind spot) in the corresponding visual field.
Diagnostic Evaluation
When a patient with high myopia reports symptoms of a peripheral scotoma, the following diagnostic approach is essential:
- Comprehensive dilated fundus examination with scleral depression to identify retinal holes, tears, or detachment 2, 1
- Visual field testing to map the scotoma and correlate with the anatomical defect 1
- Optical Coherence Tomography (OCT) to confirm the presence and extent of retinal holes 1
- B-scan ultrasonography if media opacity prevents clear visualization 2, 1
Clinical Significance and Risks
The presence of a retinal hole with scotoma in a highly myopic eye represents a significant risk:
- Untreated retinal holes can progress to retinal detachment, which occurs in 2-8% of highly myopic eyes and increases cumulatively over time 2
- Fellow eyes in patients with retinal detachment associated with macular holes have an 8.1% risk of developing macular hole-related retinal detachment 3
- Patients with bilateral high myopia who develop a macular hole with retinal detachment in one eye are at increased risk for similar pathology in the fellow eye 3
Management Recommendations
For Peripheral Retinal Holes:
- Laser photocoagulation is the treatment of choice for symptomatic peripheral retinal holes to create chorioretinal adhesion and prevent progression to retinal detachment 1
- The success rate of preventing progression to retinal detachment is >95% with appropriate treatment 1
- Treatment should be performed promptly after diagnosis to prevent progression 2, 1
For Macular Holes:
- Vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade is recommended for macular holes 2, 1
- Success rates for macular hole closure are approximately 90% for holes less than 400 μm 1
- Anatomic success is less likely in eyes with axial length >30 mm 4
Follow-Up and Monitoring
After diagnosis or treatment:
- Follow-up examinations at 1-2 weeks, 2-6 weeks, and every 3-6 months thereafter 1
- Regular monitoring of both eyes due to the 10-15% risk of developing holes in the fellow eye 2
- Patient education about symptoms of retinal detachment (new flashes, floaters, visual field loss, decreased acuity) that require immediate attention 1
Prognosis and Complications
- Even with successful anatomical closure, the scotoma may persist due to permanent photoreceptor damage 1
- Visual prognosis is worse in eyes with macular hypoautofluorescence with foveal involvement and axial length >30 mm 4
- Cataract formation is a frequent complication of vitrectomy surgery for macular holes 2
Prevention
- Regular comprehensive eye examinations for patients with high myopia
- Early detection and treatment of retinal breaks before they cause symptoms
- Patient education about symptoms that require prompt evaluation
High myopia requires vigilant monitoring due to the increased lifetime risk of vision-threatening complications, including retinal holes that can cause scotomas and potentially progress to retinal detachment.