Optical Coherence Tomography Evaluation of Dome-shaped Macula in Pediatric High Myopia

Abstract

Background: Dome-shaped macula (DSM) is a morphological feature of myopic maculopathy, defined by an inward macular bulge within a posterior staphyloma. While well studied in adults, its prevalence and significance in pediatric high myopia remains poorly understood. Aim: This study aimed to characterize DSM in children using optical coherence tomography (OCT) and assess associations with biometric and structural ocular factors. Methods:  In this prospective observational cohort study, 150 children (300 eyes) aged 6–18 years with myopia ≤ –3.00 D underwent comprehensive ophthalmic evaluation, axial length measurement, and swept-source OCT imaging. Macular bulge height, subfoveal choroidal thickness and posterior staphyloma type were documented. Statistical analyses included group comparisons, correlations and logistic regression to identify predictors. Results: DSM was detected in 28% of children, with bilateral involvement in 71%. DSM eyes had longer axial length (26.4 ± 1.5 mm vs. 24.7 ± 1.6 mm, P < 0.001) and thinner choroid (185 ± 62 µm vs. 245 ± 58 µm, P < 0.001) compared with non-DSM eyes. Mean bulge height was 112 ± 45 µm, and serous macular detachment occurred in 12%. Independent predictors included axial length > 26 mm (OR 3.2, P < 0.01) and inferior staphyloma (OR 2.5, P < 0.05). Conclusion: DSM is relatively common in pediatric high myopia, associated with axial elongation, choroidal thinning and inferior staphyloma. OCT-based DSM identification may provide an early biomarker of pathologic myopia and guide timely interventions to mitigate long-term vision-threatening complications.