{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T18:03:50Z","timestamp":1779732230866,"version":"3.53.1"},"reference-count":22,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To determine whether a progressive reduction in Choroidal Vascularity Index (\u0394CVI) is independently associated with unexplained visual loss (UVL) in highly myopic (HM) eyes without pathologic myopia (PM), and to evaluate the predictive utility of baseline CVI as a structural biomarker.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This longitudinal study included 126 HM eyes (axial length \u226526.0\u2009mm or SE \u2264\u20136.00 D) without PM and with \u22655 years of optical coherence tomography (OCT) follow-up, including 35 eyes with UVL\u2014defined as \u22650.1 logarithm of the minimum angle of resolution best-corrected visual acuity loss in the absence of new anatomical, refractive or media-related changes\u2014 and 91 control eyes with stable vision. A 1:2 propensity score analysis was performed matching 32 eyes from UVL group and 62 control eyes. CVI was computed from subfoveal OCT B-scans acquired with Heidelberg Spectralis at baseline and at 60 months. \u0394CVI was defined as the difference between follow-up and baseline. Multivariate logistic regression and ROC analyses were performed on the whole cohort to identify independent predictors of UVL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\u0394CVI was significantly greater in UVL eyes (mean \u20131.87%) than in controls (\u20130.61%, p\u202f&lt;\u202f10\u207b\u00b9\u00b3). Baseline CVI did not differ significantly after matching (p\u202f=\u202f0.12). In multivariate analysis, \u0394CVI emerged as the strongest predictor of UVL (OR=10.4 per 1% CVI decrease; p\u202f&lt;\u202f0.001), with an area under the curve (AUC) of 0.90 and a Youden index of 0.66. In contrast, baseline CVI had poor predictive power (AUC=0.69) and did not improve model performance when added.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Longitudinal reduction in CVI, but not baseline CVI, is strongly associated with UVL in HM eyes without PM. \u0394CVI may represent an early biomarker of functional decline before visible macular damage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2025-328586","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T17:20:13Z","timestamp":1779729613000},"page":"bjo-2025-328586","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Visual loss in high myopia without pathologic myopia: a 5-year longitudinal study on the role of Choroidal Vascularity Index"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9996-9871","authenticated-orcid":false,"given":"Emanuele","family":"Crincoli","sequence":"first","affiliation":[{"name":"Ophthalmology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"},{"name":"Ophthalmology Department, Rothschild Foundation Hospital, Paris, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2979-1638","authenticated-orcid":false,"given":"Matteo Mario","family":"Carl\u00e0","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Rothschild Foundation Hospital, Paris, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1551-8120","authenticated-orcid":false,"given":"Fiammetta","family":"Catania","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Rothschild Foundation Hospital, Paris, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Giannuzzi","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina","family":"Savastano","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"},{"name":"Catholic University of Sacro Cuore, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Campaniello","sequence":"additional","affiliation":[{"name":"Catholic University of Sacro Cuore, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Mottola","sequence":"additional","affiliation":[{"name":"Catholic University of Sacro Cuore, Rome, Lazio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5156-5314","authenticated-orcid":false,"given":"Clara","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, University of Verona, Verona, Veneto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Bacherini","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Psychology, Drug Research and Child Health, Eye Clinic, University of Florence, Florence, Tuscany, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6302-063X","authenticated-orcid":false,"given":"Stanislao","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"},{"name":"Catholic University of Sacro Cuore, Rome, Lazio, Italy"},{"name":"Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Pisa, Tuscany, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"2026052510200582000_bjo-2025-328586v1.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2016.01.006"},{"key":"2026052510200582000_bjo-2025-328586v1.2","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/j.oret.2025.02.015","article-title":"Longitudinal Progression of Myopic Maculopathy in a Long-Term Follow-Up of a European Cohort","volume":"9","author":"Carl\u00e0","year":"2025","journal-title":"Ophthalmol Retina"},{"key":"2026052510200582000_bjo-2025-328586v1.3","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1097\/APO.0000000000000230","article-title":"Pathologic Myopia","volume":"5","author":"Ohno-Matsui","year":"2016","journal-title":"Asia Pac J Ophthalmol (Phila)"},{"key":"2026052510200582000_bjo-2025-328586v1.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2010.01.020"},{"key":"2026052510200582000_bjo-2025-328586v1.5","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1111\/opo.13059","article-title":"Factors associated with reduced visual acuity in myopes with and without ocular pathologies after optical correction","volume":"43","author":"Manoharan","year":"2023","journal-title":"Ophthalmic Physiol Opt"},{"key":"2026052510200582000_bjo-2025-328586v1.6","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1111\/cxo.12563","article-title":"Reduced vision in highly myopic eyes without ocular pathology: the ZOC-BHVI high myopia study","volume":"101","author":"Jong","year":"2018","journal-title":"Clin Exp Optom"},{"key":"2026052510200582000_bjo-2025-328586v1.7","doi-asserted-by":"crossref","DOI":"10.1167\/tvst.13.11.9","article-title":"Choroidal Thickness and Visual Acuity in High Myopia Without Myopic Maculopathy: Insights From a Chinese Population Study","volume":"13","author":"Wang","year":"2024","journal-title":"Transl Vis Sci Technol"},{"key":"2026052510200582000_bjo-2025-328586v1.8","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1167\/iovs.63.12.20","article-title":"Vascular Changes of the Choroid and Their Correlations With Visual Acuity in Pathological Myopia","volume":"63","author":"Wang","year":"2022","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2026052510200582000_bjo-2025-328586v1.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12886-021-02139-3","article-title":"Choroidal remodeling distribution pattern in the macular region in Chinese young patients with myopia","volume":"21","author":"Wang","year":"2021","journal-title":"BMC Ophthalmol"},{"key":"2026052510200582000_bjo-2025-328586v1.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.preteyeres.2018.10.005"},{"key":"2026052510200582000_bjo-2025-328586v1.11","doi-asserted-by":"crossref","first-page":"100007","DOI":"10.1016\/j.xops.2021.100007","article-title":"Validation of a Standardized Home Visual Acuity Test for Teleophthalmology","volume":"1","author":"Siktberg","year":"2021","journal-title":"Ophthalmol Sci"},{"key":"2026052510200582000_bjo-2025-328586v1.12","doi-asserted-by":"crossref","DOI":"10.1038\/srep21090","article-title":"Choroidal vascularity index as a measure of vascular status of the choroid: Measurements in healthy eyes from a population-based study","volume":"6","author":"Agrawal","year":"2016","journal-title":"Sci Rep"},{"key":"2026052510200582000_bjo-2025-328586v1.13","doi-asserted-by":"crossref","first-page":"16626","DOI":"10.1038\/s41598-022-20590-0","article-title":"Influence of scan direction on subfoveal choroidal vascularity index using optical coherence tomography","volume":"12","author":"Kim","year":"2022","journal-title":"Sci Rep"},{"key":"2026052510200582000_bjo-2025-328586v1.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2015.03.005"},{"key":"2026052510200582000_bjo-2025-328586v1.15","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1038\/s41433-025-03738-w","article-title":"Diameter of cystoid spaces and choroidal hypertransmission as novel prognostic biomarkers in myopic foveoschisis","volume":"39","author":"Crincoli","year":"2025","journal-title":"Eye (Lond)"},{"key":"2026052510200582000_bjo-2025-328586v1.16","doi-asserted-by":"publisher","DOI":"10.1097\/IAE.0000000000000035"},{"key":"2026052510200582000_bjo-2025-328586v1.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.preteyeres.2009.12.002"},{"key":"2026052510200582000_bjo-2025-328586v1.18","doi-asserted-by":"crossref","DOI":"10.1186\/s12886-015-0059-2","article-title":"Choroidal thickness and high myopia: a cross-sectional study and meta-analysis","volume":"15","author":"Wang","year":"2015","journal-title":"BMC Ophthalmol"},{"key":"2026052510200582000_bjo-2025-328586v1.19","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1038\/s41433-021-01889-0","article-title":"Choroidal vascularity index in leptochoroid: A comparative analysis between reticular pseudodrusen and high myopia","volume":"37","author":"Sacconi","year":"2023","journal-title":"Eye (Lond)"},{"key":"2026052510200582000_bjo-2025-328586v1.20","doi-asserted-by":"crossref","DOI":"10.1007\/s10792-025-03408-6","article-title":"What is the relationship between the choroidal vascularity \u0131ndex (CVI) and myopia?","volume":"45","author":"Cevher","year":"2025","journal-title":"Int Ophthalmol"},{"key":"2026052510200582000_bjo-2025-328586v1.21","doi-asserted-by":"crossref","DOI":"10.1167\/iovs.65.10.7","article-title":"Choroidal Vascularity and Axial Length Elongation in Highly Myopic Children: A 2-Year Longitudinal Investigation","volume":"65","author":"Xuan","year":"2024","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2026052510200582000_bjo-2025-328586v1.22","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2005.081992"}],"container-title":["British Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjo-2025-328586","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T17:20:15Z","timestamp":1779729615000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjo.bmj.com\/lookup\/doi\/10.1136\/bjo-2025-328586"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":22,"alternative-id":["10.1136\/bjo-2025-328586"],"URL":"https:\/\/doi.org\/10.1136\/bjo-2025-328586","relation":{},"ISSN":["0007-1161","1468-2079"],"issn-type":[{"value":"0007-1161","type":"print"},{"value":"1468-2079","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]}}}