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42 R E T I N A L P H Y S I C I A N . C O M | N O V E M B E R / D E C E M B E R 2 0 1 6 In addition, Jonas 13 have found that the status of Bruch's membrane may alter the scleral curvature. us, in the future, therapies targeting Bruch's membrane may also become a promising approach to prevent staphyloma development. CONCLUSION As Curtin suggested some 40 years ago, posterior staphyloma is the most important feature of pathologic myopia. Because staphylomas occur even in eyes without long axial length and the since staphyloma development significantly affects the outcome of myopic patients, pathologic myopia should be considered, by definition, by the presence of staphylomas and not by refractive error or axial length. But some confusion exists between the terms "high myopia" and "pathologic myopia." e former means "high myopic refractive error" and should be defined by refractive degree. However, the latter has staphylomas and characteris- tic fundus complications even without long axial length. us, Curtin's words have been proven to be true: "Posterior staphyloma may give us an unimpeachable basis for the genetic studies of myopia. ... e morphology of pos- terior staphyloma [c]ould be a much more reliable basis for genetic studies." Imaging modalities, like widefield OCT, used to visu- alize the wide extent of staphylomas are improving. Such improvements could exactly determine the staphylomas in a large population of patients. Quantitative and objective analyses of staphylomas could also become possible, which are important to establish treatment strategies. "Pathologic myopia" is the only myopia responsible for decreasing BCVA due to its specific complications. Retina specialists have the privilege of seeing patients with patho- logic myopia; thus it is expected that we should take a lead in the management of this vision-threatening disease. RP REFERENCES 1. Curtin BJ. The posterior staphyloma of pathologic myopia. Trans Am Ophthalmol Soc. 1977;75:67-86. 2. Spaide RF. Staphyloma: Part 1. In: Spaide RF, Ohno-Matsui K, Yannuzzi LA, eds. Pathologic Myopia. New York, NY: Springer; 2014:167-176. 3. Ohno-Matsui K, Moriyama M. Staphyloma II: analyses of morphological features of posterior staphyloma in pathologic myopia analyzed by a combination of wide-view fundus observation and 3D MRI analyses. In: Spaide RF, Ohno-Matsui K, Yannuzzi LA, eds. Pathologic Myopia. New York, NY: Springer; 2014: 177-185. 4. Ohno-Matsui K. Proposed classification of posterior staphylomas based on analyses of eye shape by three-dimensional magnetic resonance imaging and wide-field fundus imaging. Ophthalmology. 2014;121:1798-1809. 5. Ohno-Matsui K. What is the fundamental nature of pathologic myopia? Retina. 2016 Oct 10. [Epub ahead of print] 6. Wang NK, Yu YM, Wang JP, et al. Clinical characteristics of posterior staphylo- mas in myopic eyes with axial length shorter than 26.5 mm. Am J Ophthalmol. 2016;162: 180-190. 7. Moriyama M, Ohno-Matsui K, Hayashi K, et al. Topographic analyses of shape of eyes with pathologic myopia by high-resolution three-dimensional magnetic resonance imaging. Ophthalmology. 2011;118:1626-1637. 8. Moriyama M, Ohno-Matsui K, Modegi T, et al. Quantitative analyses of high- resolution 3D MR images of highly myopic eyes to determine their shapes. Invest Ophthalmol Vis Sci. 2012;53:4510-4518. 9. Ohno-Matsui K, Alkabes M, Salinas C, et al. Features of posterior staphylomas analzyed in wide-field fundus images in patients with unilateral and bilateral pathologic myopia. Retina. 2016 Aug 23. [Epub ahead of print] 10. Curtin BJ. Ocular findings and complications. In: Curtin BJ, ed. The Myopias. New York, NY: Harper and Row; 1985:277-347. 11. Liu S, Li S, Wang B, et al. Scleral cross-linking using riboflavin UVA irradiation for the prevention of myopia progression in a guinea pig model: blocked axial extension and altered scleral microstructure. PLoS One. 2016;11:e0165792. 12. Shinohara K, et al. Establishment of novel therapy to reduce progression of myopia in rats with experimental myopia by fibroblast transplantation on sclera. J Tissue Eng Regen Med. In press. 13. Jonas JB, Panda-Jonas S, Ohno-Matsui K. Bruch´s membrane and the mecha- nism of myopization: a new theory. Retina. In press. R E T I N A L P H Y S I C I A N | J A N U A R Y / F E B R U A R Y 2 0 1 7 42 Figure 8. Wide, macular staphyloma (modified from reference #4). A. In widefield fundus image, the upper edge of wide staphyloma is observed as pigmentary abnormalities (arrowheads). B through D. 3D MRI images show posterior outpouching of wide area of posterior segment of the eye in the image viewed from inferior (B), nasal (C), and back (D) views. Figure 9. Narrow, macular staphyloma (modified from reference #4). A. In widefield fundus image, the upper edge of narrow staphyloma is observed as pigmentary abnormalities (arrowheads). B through D. 3D MRI images show posterior outpouch- ing of narrow area of posterior segment of the eye in the image viewed from the inferior (B), nasal (C), and back views (D). e eye looks like a strawberry.