Sir,

In their recent article, Gohil et al thoroughly review a condition referred to as ‘myopic foveoschisis’ that is diagnosed in highly myopic eyes.1 Our letter aims to support the argument that the use of the term ‘schisis’ for this particular condition, originally coined by Tacano and Kishi in 1999,2 is inaccurate and misleading and should be abandoned in favor of a more representative term.

According to Merriam Websters the term ‘schisis’ refers to ‘breaking up of attachments or adhesions’.3 The root of the term is the Greek verb ‘σχíζω’, which means to cleave, to part, to separate, or to divide.4

As stated by the authors, imaging of this condition with spectral domain OCT clearly and consistently demonstrates that the retinal tissues are not cleaved but rather stretched with ‘bridges’ of neural structural elements spanning between the retinal layers. When the stretching forces are relieved after removal of epiretinal membranes and the internal limiting membrane, the retinal tissue can return to its normal anatomy and function (Figure 1). This is in contrast to other entities defined as schisis, such as juvenile X-linked retinoschisis and long-standing age-related degenerative retinoschisis, in which anatomical restoration is usually not possible.

Figure 1
figure 1

Case of a patient with ‘myopic ectatic retinopathy’. The favorable functional outcome of such cases after vitrectomy supports our argument that the term foveoschisis is not appropriate for the description of this clinical entity. Left: At presentation BCVA was 20/40 and OCT revealed the typical appearance of outer retinal layers stretching. Right: After vitrectomy, OCT revealed normalization of the retinal anatomy with attenuation of stretching. BCVA improved to 20/25.

Full size image

For reasons probably related to habit, convention, mutual understanding and convenient literature citing, the term ‘schisis’ continues to be used. However, the use of this term for this specific clinical entity is inaccurate and misleading since it groups this situation together with juvenile and degenerative retinal schisis, diseases with different morphological characteristics and prognosis. Other authors have used the term ‘myopic traction maculopathy’, but in our opinion this name is equally confusing.5

We thus propose the term ‘myopic ectatic retinopathy’ as an appropriate term in order to describe the clinical situation that occurs in some myopic patients leading to stretching of retinal layers at the posterior pole of the eye. We think the proposed term is literally and functionally more accurate, denoting the mechanical background of the situation, while at the same time it is distinct and non-confusing. It can also be included under the broader category of ‘traction retinopathies’ together with vitreoretinal traction syndrome and tractional retinal detachment.