Yesterday a high myope came to me. She had come for a visit 1 months ago and other doctor prescribed spectacles of -17D to her. So I asked why she came again. She answered: ‘I can’t see clearly’. Reliablely, her visial acuity was both 0.08. I thought her low vision due to amblyopia. But I could not jump a conclusion arbitrarily. I told her to stare at Amsler grid with her eye alternately covered to see if the grid transformed. She said both of her eyes were seeing transformed grid. I don’t want to dilate the pupils because it was time consumption and I had a lot of patients to take care. So I asked her to take a Zeis OCT for fundus examination. The pictorial reports surprised me: Both of her eyes had macular retinoschisis(Photoed by my cell phone). But there were no obvious traction factors, the surgery could not solve this situation and increase visial acuity. At last, I didn’t do fundus examination.

This disease is caused by high myopia of macular degeneration. High myopia also called pathologic myopia which is one of the leading causes of blindness and in characterized by progressive elongation of the eye with subsequent thinning and atrophy of the choroid and pigment epithelium in the macula.


Macular retinoschisis is not uncommon in highly myopic eyes with staphyloma and is better characterized by OCT than by biomicroscopy. Intraretinal splitting occurs in both the outer and inner layers of the retina, leading to the formation of cystoid spaces. In most cases, the condition is fairly stable in terms of visual acuity and retinal thickness and change occurs slowly over time. However, a macular hole may occur when the retinoschisis is associated with tangential traction of the posterior hyaloid.

The patient asked me several times:’If I will be blind’. I told her and her family she would not be blind for a long time and to review regularly. Now I am thinking why I didn’t do fundus examination? If I did, perhaps I would have found some new pathological changes such as macular hole or local retinal detachment that need surgery to improve the situation.

Retinoschisis, you should exclude other causing factors, such as X-linked juvenile retinoschisis. This is a congenital disease of males characterized by a macular lesion called foveal schisis. Visual acuity is usually between 20/40 and 20/200, peripheral visual field abnormalities are present in the 50% of patients with associated peripheral retinoschisis. The posterior pole appears normal on fluorescein angiography. This is the clinical differentiation from CME(cystoid macular edema).

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