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Ma et al. J Transl Genet Genom 2022;6:179-203 https://dx.doi.org/10.20517/jtgg.2021.48 Page 181

Table 1. META-PM classification for myopic maculopathy [17]
Category Plus lesion
Category 0: No myopic atrophy Lacquer cracks
Category 1: Tessellated fundus Myopic CNV
Category 2: Diffuse chorioretinal atrophy Fuchs’ spot
Category 3: Patchy chorioretinal atrophy
Category 4: Macular atrophy

The bold fonts mark stages defined as pathologic myopia. META-PM: Meta-analysis for pathologic myopia; CNV: choroidal neovascularization.

Figure 1. The fundus photography of each category of META-PM classification. (A) Category 0: no myopic retinal degenerative lesion.
(B) Category 1: tessellated fundus. Thinning of the retina results in increasing visibility of the deep choroidal vessels. (C) Category 2:
diffuse chorioretinal atrophy. An ill-defined yellowish-white lesion can be seen in the posterior pole. (D) Category 3: patchy
chorioretinal atrophy. Multiple grayish-white, well-defined atrophy can be seen. The fovea is spared. (E) Category 4: macular atrophy.
Atrophy involves the fovea. (F) Lacquer cracks (indicated by white arrow) in the background of patchy chorioretinal atrophy. (G) Active
myopic CNV with bleeding (indicated by white arrow) in the background of patchy chorioretinal atrophy. (H) Fuchs’ spot (indicated by
white arrow) in the background of macular chorioretinal atrophy. META-PM: meta-analysis for pathologic myopia; CNV: choroidal
neovascularization.

category in a matter of time. Progression was seen in 19% of tessellated fundus in one ten-year
observation , and up to 40% high myopic patients with only tessellated fundus or no myopic retinal lesions
[14]
progressed to myopic maculopathy in follow-ups of more than ten years [15,19] .

Category 2: diffuse chorioretinal atrophy
[17]
Diffuse choroidal atrophy is the ill-defined yellowish-white lesion in the posterior pole . Diffuse atrophy
starts around the optic disc, extends to the macular, and eventually covers the entire posterior pole .
[20]
Compared with tessellated fundus, patients have thinner choroid and worse visual acuity . A pronounced
[21]
loss of choriocapillaris, medium, and large-size choroidal vessels can be seen at this stage . The thickness of
[2]
choroid and sclera decreased due to the elongation of AL, while the thickness of Bruch’s membrane stayed
the same . Because the outer retina and RPE remain even though the choroid is absent, the visual acuity of
[22]
[2]
patients is relatively preserved .
Category 3: patchy chorioretinal atrophy
Patchy chorioretinal atrophy is defined as grayish-white, well-defined atrophy. In this stage, the outer retina
layers, RPE, choriocapillaris, and medium- and large-sized choroidal vessels are lost, and the inner retina