Synopsis
Distinguish strong refractive error from structural myopic disease and recognise retinal complications that require timely specialist assessment.
- High myopia is a refractive category; pathological myopia describes structural posterior eye disease.
- The International Myopia Institute defines high myopia as spherical equivalent at or below minus six dioptres.
- Correction with glasses, contact lenses or corneal laser surgery does not reverse an elongated globe.
Key red flags
A new fixed peripheral shadow or rapidly enlarging curtain requires emergency retinal assessment.
Investigation priorities
Characterise optical error and recover evidence of axial elongation.
Management branches
New flashes, a shower of floaters or a peripheral shadow develops.
- Arrange urgent dilated retinal assessment, using emergency same-day access for suspected tear or detachment.
- Record acuity, symptom onset, field change and relevant prior surgery without delaying referral.
The person has stable vision without a new retinal symptom.
Key medicines
Ranibizumab for active myopic choroidal neovascularisationFor the Lucentis 10 mg/mL product, an ophthalmologist administers 0.5 mg in 0.05 mL intravitreally. Subsequent injections depend on disease activity; doses into the same eye must be at least four weeks apart. Myopic neovascularisation does not require an automatic fixed three-injection course.