Dome-Shaped Macula
SALIENT FEATURES
Dome-shaped macula (DSM) is a forward macular bulging present in select patients with high myopia, with a prevalence of 20% of highly myopic eyes in Japan and 11% in Europe.1
Though the pathophysiology behind DSM remains to be fully established, focal scleral thickening in the foveal area is thought to be the major factor.1
DSM can lead to loss of vision secondary to subretinal fluid accumulation and increase risk for serous retinal detachments.2 A rare cause of serous retinal detachment in DSM eyes is choroidal neovascularization (CNV), usually pachychoroid-associated (type 1) or typical myopic (type 2) CNV.3
Currently, DSM is categorized by morphology: horizontal oval-shaped dome, vertical oval-shaped dome, and round dome.
OCT IMAGING
Optical coherence tomography (OCT) is the gold standard test for identification and monitoring DSM and its sequelae.
To characterize DSM morphology, both vertical and horizontal OCT raster scans are needed to ensure full visualization. The horizontal-oriented oval-shaped dome can be seen on vertical spectral-domain (SD)-OCT (Figures 27.1 and 27.2).1
FIGURE 27.1 Spectral-domain optical coherence tomography (SD-OCT) vertical raster scan demonstrating a moderate macular bulge identifying the dome-shaped macula. Thickened subfoveal sclera is noticeable. Minimal retinal pigment epithelium (RPE) disruption is present, and overall retinal layer integrity is intact.
DSM is typically defined by the inward bulging of the retinal pigment line of >50um above baseline connecting the RPE lines on both sides outside of the DSM (Figures 27.3 and 27.4).4
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