One of my patients has come for an eye examination today. She is 60 years old with a prescription of -12.00 DS in each eye. She started wearing glasses when she was 9 years old and her prescription has increased regularly from -0.50 DS. She complains of blurred and distorted print when she reads a book which she has noticed for around one week. Amsler grid testing reveals broken and wavy lines when viewed with the left eye. She has gone from 6/9 to 6/24 in that eye. What is going on?

• People with high myopia (more than -6.00 DS) are at risk of a range of eye diseases. These are the main ones:
• Retinal atrophy – these are areas where the retina has become thin and is no longer functioning.
• Lattice degeneration – a type of retinal thinning at the periphery of the retina.
• Lacquer cracks – breaks that occur in the membrane (Bruch’s membrane) between the retina and its underlying blood supply (the choroid layer).
• New blood vessels (myopic choroidal neovascularisation) – new leaky blood vessels from the blood supply underneath the retina (the choroid layer), through lacquer cracks or areas of atrophy onto the retina.
• Myopic macular degeneration – these degenerative changes can develop at the macula.
• Myopic macular degeneration is also known as myopic maculopathy, affecting your central detailed vision.
• Foster Fuchs spot – myopic choroidal neovascularisation can lead to scarring at the macula, known as a Foster Fuchs spot causing a blank or missing patch in your central vision.

It sounds as if this patient has a macular problem associated with her myopia; myopic choroidal neovascularisation and/or myopic macular degeneration. It also sounds like she has only had this for a few days, which means this condition can be treated using anti-VEGF injections. She deserves to be referred on an urgent basis to an eye specialist with experience in treating macular disorders.