High Myopia and Visual Disability: New Evidence from a Spanish Clinical Cohort

A new retrospective study from the Institute of Applied Ophthalmobiology in Valladolid, which was published in the Journal of Optometry in 2025, offers new insight into the impact of high myopia (HM) on visual disability (VD) in Spanish adults.

Analyzing clinical data from 300 adult patients between 2023 and 2024, the researchers identified key drivers of visual impairment and highlighted the disconnect between global and local disability classifications, raising important questions about how we recognize and support vision loss.

Visual Disability: A Prevalent and Underrecognized Burden

According to the Wecker scale—a tool used in Spain to determine work-related disability—nearly 47 percent of patients met criteria for VD. But international scales such as ICD-11 painted a less severe picture: 27 percent of patients were classified with any degree of VD on the ICD-11 scale, and just 2.7 percent met the criteria for blindness.

Moderate agreement (Cramer’s V = 0.535) between the Wecker and ICD-11 scales suggests that significant numbers of patients may fall through the cracks depending on the metric applied. Notably, unlike the ICD-11, which evaluates the better-seeing eye, the Wecker scale accounts for both eyes, offering a more functionally relevant view of impairment.

Among the HM-related complications, myopic macular atrophy (MMA) stood out as the strongest predictor of visual disability. Patients with MMA were nearly eight times more likely to have VD (OR=7.816 for ICD-11). Other significant contributors included:

• Retinal detachment (OR=3.956)
• Amblyopia (OR=3.455)
• Myopic choroidal neovascularization (OR=2.668)

Importantly, age and spherical equivalent (SE)—a surrogate for axial length—were also independent risk factors. Each additional year of age increased VD risk by about 4 percent, and each diopter of increased myopia raised the odds of VD by about 11 percent. Patients aged 70 or older had significantly higher odds of developing MMA (OR=29.2), retinal detachment (OR=3.7), and glaucoma (OR=23.6) compared to younger counterparts.

Contrary to prior studies suggesting sex-linked pathology distributions, this study found no statistically significant sex differences in either VD prevalence or pathology frequency. This may reflect population-specific factors such as behavioral habits, genetic predisposition, or sampling differences, underscoring the need for regionally contextualized data.

Methodological Strengths and Gaps

By leveraging both international and national disability scales, the study offers a more holistic picture of how vision loss manifests and is measured.

However, several limitations are worth noting. Lack of axial length measurements, exclusion of visual field data, and single-center design limit generalizability. And psychosocial and quality-of-life data were not captured, omitting a key dimension of the VD experience.

The reliance on SE as a surrogate for axial length—due to the retrospective design—may under- or overestimate risk in borderline cases (SE just below -6 D). Also notable is the absence of staphyloma assessment, a known driver of HM complications that was not consistently recorded.

Clinical Implications: A Call for Proactive Monitoring and Rehabilitation

This study reinforces the need for targeted screening and rehabilitation in aging populations with high myopia. Early identification of MMA, RD, and CNV could guide referral for low-vision rehabilitation, including optical aids and eccentric viewing training.

It also highlights a systemic need: unifying disability classification systems to better reflect the reality of patients’ visual function and facilitate access to social support.

Preventative strategies—especially those aiming to slow axial elongation and myopia progression in younger cohorts—may offer the most promising route to reduce future VD burden.

Reference

Arlanzon-Lope P, Fernandez-Pedruelo D, Alvarez-Arauzo B, et al. Impact of high myopia on visual disability and its causes in a Spanish cohort. J Optom. 2025;18:100571. doi:10.1016/j.optom.2025.100571