Foveoschisis: OCT Findings, Causes, Symptoms, and Treatment in Degenerative Myopia

Foveoschisis:

• What is Foveoschisis?
• OCT Findings
• Causes
• Symptoms
• Treatment in Degenerative Myopia

What is Foveoschisis?

Foveoschisis refers to the splitting or separation of the retinal layers within the macular region of the eye, specifically at the fovea, which is responsible for sharp central vision. This condition results in the formation of small cavities or cystic spaces within the retina that can disrupt normal vision. It is most commonly associated with degenerative (pathologic) myopia, a condition characterized by excessive elongation of the eyeball and thinning of the retina.

Foveoschisis can be asymptomatic in early stages, but as it progresses, patients may experience visual distortion, blurred vision, or reduced central visual acuity. It is often discovered incidentally during retinal imaging, particularly with Optical Coherence Tomography (OCT)

OCT Findings

Optical Coherence Tomography (OCT) is the primary imaging tool for diagnosing and monitoring foveoschisis. On OCT, characteristic findings include splitting of the retinal layers—typically between the outer plexiform and inner nuclear layers—with the presence of hyporeflective cystic spaces. These separations may appear as vertical or oblique columns of fluid, giving the retina a “stretched” or “laminated” appearance.

Additional OCT findings may include posterior staphyloma, internal limiting membrane (ILM) detachment, vitreomacular traction, or small areas of retinal thinning. In more advanced cases, the fovea may show disruption of the photoreceptor layer or development of a full-thickness macular hole. OCT imaging is crucial for distinguishing foveoschisis from other causes of cystoid macular edema or tractional maculopathies.

Causes

The most common cause of foveoschisis is degenerative myopia, where excessive elongation of the eye leads to structural stress on the retina. The stretching of the posterior pole can cause micro-breaks and splitting between retinal layers. Other contributing factors include tractional forces from an attached vitreous, epiretinal membranes, or abnormalities in the internal limiting membrane.

Less commonly, foveoschisis can occur due to congenital or hereditary vitreoretinal disorders such as X-linked retinoschisis. However, in adults, it is most frequently associated with high myopia. The biomechanical changes in the sclera and choroid in these eyes can lead to localized retinal instability and separation, which are hallmarks of myopic traction maculopathy.

Symptoms

In many cases, foveoschisis develops gradually, and early stages may be asymptomatic. As the condition progresses, patients often notice blurred or distorted central vision (metamorphopsia). Reading or performing close-up tasks may become difficult, and straight lines may appear bent or wavy. In advanced cases, central vision can decline significantly if a macular hole or foveal detachment develops.

Peripheral vision is usually preserved since the condition primarily affects the central macula. Routine ophthalmologic exams, especially with OCT imaging, can detect foveoschisis even before symptoms become noticeable. Early detection is key to preventing irreversible damage and preserving visual function.

Treatment in Degenerative Myopia

Treatment for foveoschisis associated with degenerative myopia depends on the severity of symptoms and the risk of progression. In mild or asymptomatic cases, observation with regular OCT monitoring is often recommended. The goal is to track retinal stability and intervene if significant visual decline or structural progression occurs.

For symptomatic or progressive cases, pars plana vitrectomy (PPV) is the most common surgical treatment. The procedure involves removing the vitreous to relieve traction, often combined with internal limiting membrane (ILM) peeling to reduce tangential forces on the retina. In some cases, gas tamponade is used to help flatten the retina. Surgery has shown good anatomical success rates, though visual improvement can vary depending on preoperative damage.

In patients with severe posterior staphyloma, additional surgical techniques such as macular buckling may be considered to support the posterior pole. Postoperative follow-up with OCT is essential to ensure the retina remains reattached and the foveoschisis does not recur. There is currently no proven medication for reversing foveoschisis, so management primarily focuses on surgical correction and careful monitoring.