A Dome-Shaped Macula (DSM) is a special shape change in the central part of the retina (the macula) where, instead of being flat or slightly concave, it bulges gently forward like a small dome toward the inside of the eye. This bump is seen inside a larger “dent” or outpouching at the back of the eye called a posterior staphyloma, which is common in very nearsighted (high myopic) eyes. DSM was first described in 2008 and is now recognized as a distinct anatomical feature that can affect vision, often by causing fluid buildup under the retina or other secondary problems. The dome is thought to come from changes in the shape and thickness of the sclera (the white, tough outer coating of the eye) and related changes beneath it, including how the choroid and retinal pigment epithelium behave. PubMed EyeWiki ScienceDirect
Dome-Shaped Macula (DSM), also called dome-shaped maculopathy when symptomatic, is an anatomical configuration seen most often in highly myopic eyes where the central macula (the part of the retina responsible for sharp central vision) shows a localized anterior convex protrusion—like a small dome—toward the vitreous cavity, visible on optical coherence tomography (OCT). This bulging is thought to result from localized variations in scleral thickness or biomechanics, producing an inward “push” that gives the macula a dome-like elevation inside a surrounding posterior staphyloma (an outpouching of the back of the eye). DSM was first described in 2008 in eyes with high myopia, though later work has shown it can occur in mildly myopic or even non-myopic eyes. The condition may remain stable for many patients, but it can be associated with complications such as chronic serous retinal detachment, choroidal neovascularization, and vision distortion. PMC EyeWiki PMC
Dome-Shaped Macula is like a small hill in the middle of the back of the eye, where the macula should normally be flat or slightly curved. Instead of sinking outward as in typical staphyloma, the center bulges forward due to uneven strength or thickness in the white part of the eye (sclera). This subtle shape change can disturb how fluid behaves under the retina, causing a slow leak or collection that doesn’t always go away on its own. Sometimes nothing needs to be done because vision stays good; other times the fluid or new blood vessels grow and start interfering with sharp focus. People with DSM may notice that straight lines look slightly wavy, colors or small details are harder to see, or that the center of their vision feels a bit dull. Because DSM often hides under other myopia-related changes, doctors use advanced imaging, especially OCT, to see it clearly. PMCPubMedPMC
Types and Morphological Variants of Dome-Shaped Macula
Dome-shaped macula is not always the same shape or orientation. Doctors classify and describe variants based on how the dome appears on imaging and the underlying shape of the inner sclera:
Orientation-based types: The dome can be longer in one direction or round. On optical coherence tomography (OCT) scans, it may appear as a horizontal oval, vertical oval, or nearly circular dome. Different orientations may have different risks for complications, and imaging both vertical and horizontal scans is important to fully capture the dome. OCT Club OCT Club
Inner scleral surface pattern types: In recent studies, the shape of the inner scleral surface was grouped into patterns. One of the patterns is the classic dome-shaped macula, while others include sloped surfaces toward the optic nerve, symmetric or asymmetric shapes around the fovea, and irregular surfaces. This helps clinicians understand how DSM fits into broader variations of posterior pole anatomy in high myopia. PMC
Prominent or protective domes: Some studies found that a well-defined, pronounced dome might paradoxically protect against certain myopic complications like foveoschisis, even though DSM is associated with high degrees of myopia. BioMed Central
DSM with associated serous detachment: In some patients, there is a build-up of clear fluid under the fovea (serous retinal detachment) that sits on top of or near the dome. This is often called dome-shaped maculopathy when the dome is directly linked to fluid-related damage. PMCWiley Online Library
DSM inside different myopic staphyloma types: Posterior staphylomas themselves have sub-types, and the presence or shape of DSM can vary depending on the specific staphyloma configuration, which affects progression and visual outcomes. Lippincott JournalsTVST
Causes and Associated Risk Factors
Dome-shaped macula is primarily an anatomical change, but several underlying and associated factors are linked to its development. Some are direct structural causes, while others are risk or associated conditions. The following are 20 causes or contributing / associated factors, with explanations:
High Myopia (Severe Nearsightedness): The most common setting for DSM is very high myopia. The eyeball stretches and deforms, leading to posterior staphyloma and inward bulging at the macula. EyeWikiPMC
Posterior Staphyloma: This outpouching or thinning of the posterior scleral wall creates the background “concavity” in which the dome forms; DSM is viewed as a convex elevation within that larger concave staphyloma. ScienceDirectPMC
Scleral Thickening or Remodeling: Localized changes in scleral thickness underneath the macula—particularly abnormal thickening—are believed to push the retina forward, forming the dome shape. This mechanical alteration is central to how DSM arises. ScienceDirectAjo
Choroidal Vascular Changes: The layer beneath the retina (choroid) can undergo changes in blood flow or structure in and around a DSM. These changes are implicated in secondary fluid accumulation (serous detachments). ScienceDirectLippincott Journals
Reduced Choroidal Thickness: A thinner choroid, especially at the apex of a dome, is linked to higher risk of serous retinal detachment forming on top of the dome. PMCResearchGate
Increased Macular Bulge Height: The more pronounced (higher) the dome is, the more stress it may place on the overlying retinal layers, and it correlates with a greater risk of fluid collection. ResearchGate
Mechanical Compression of Choroidal Outflow: The bulge may obstruct normal fluid movement from the choroid, leading to accumulation under the retina (serous detachment). PMC
Myopic Maculopathy Spectrum: DSM frequently occurs as part of degenerative myopic changes; the overall diseased environment of the macula in pathologic myopia—including thinning and atrophy—creates susceptibility. ScienceDirect
Eye Growth and Developmental Variation: Some evidence suggests developmental or early-life anatomical differences may predispose certain individuals to form DSM even in childhood, especially when associated with staphyloma formation. PMC
Asymmetric Posterior Pole Remodeling: Uneven stretching or remodeling of the back of the eye can lead to localized dome formation rather than uniform deformation. PMC
Myopic Foveoschisis (Tractional Forces): Although foveoschisis (splitting of retinal layers) is a separate condition, its mechanical interplay with the dome can contribute to altered fluid dynamics and further anatomical stress. BioMed Central
Epiretinal Membrane and Vitreomacular Traction (Indirect Contributors): These tractional forces on the macula can modify how the dome interacts with overlying tissue and may exacerbate secondary complications. BioMed Central
Retinal Pigment Epithelium (RPE) Atrophy: Damage or thinning of the RPE overlying the dome may reflect chronic stress and contribute to visual symptoms and fluid leakage. PubMedScienceDirect
Local Ischemia or Microvascular Dysfunction: Subtle problems with the tiny blood vessels in the choroid or retina around the dome may weaken normal fluid homeostasis and promote detachment. ScienceDirect
Age-related Changes in Ocular Rigidity: The stiffness of the sclera and surrounding tissues changes with age, potentially affecting DSM prominence or its sequelae. (Inference based on structural remodeling literature in pathologic myopia, e.g., posterior pole shape studies). PMC
Genetic Predisposition to Myopic Structural Changes: While specific genes for DSM are not established, inherited tendencies to develop high myopia and abnormal scleral remodeling underlie the risk. ScienceDirect (inference)
Local Inflammation or Subclinical Uveitic Changes: Rarely, inflammatory changes may alter tissue compliance or fluid homeostasis, aggravating DSM-related detachments; this is usually considered when atypical fluid accumulations are present. PMC
Systemic Connective Tissue Differences: Conditions that affect collagen or connective tissue strength could theoretically change scleral behavior and contribute to the shape changes, especially in the setting of pathologic myopia. (This is more speculative but consistent with understanding of scleral biomechanics.) Nature (inference)
External Optical Factors (e.g., corrective lens-induced stress): Chronic optical defocus and visual habits may influence progression of axial elongation, indirectly affecting the substrates where DSM appears. ScienceDirect (inference)
Coexisting Structural Ocular Anomalies (e.g., tilted disc syndrome): Other shape-related anomalies of the back of the eye may coexist and interact with DSM to produce combined changes in fluid and stress distribution. Ophthalmology Retina
Symptoms of Dome-Shaped Macula
Patients with dome-shaped macula may not always notice problems, especially early on. When symptoms appear, they are usually due to additional complications like fluid under the retina or distortion of the retinal layers. The following are common symptoms, explained simply:
Blurred Vision: The most frequent complaint, often due to fluid under the central retina or distortion from the dome, making it hard to see fine details. PubMedPMC
Metamorphopsia (Distorted Vision): Straight lines appear wavy or bent because the macula’s shape and overlying retinal architecture are altered. OCT Club
Central Scotoma (Blind Spot): A dark or missing spot in the center of vision can arise when the photoreceptors in the fovea are not working well due to chronic stress or fluid. PMC
Decreased Contrast Sensitivity: Difficulty distinguishing subtle differences in shades or textures, often because of early retinal or RPE changes. BioMed Central (inference from associated myopic maculopathy)
Fluctuating Vision: Vision may change over time, worse when fluid increases and better if it settles, especially in serous detachments. PMC
Difficulty Reading Small Print: Fine tasks become harder as central vision clarity drops. PubMed
Colors Look Faded: Subtle color vision changes can occur because the central photoreceptor layers are distorted or damaged. BioMed Central (inference)
Sensitivity to Glare: Light may seem harsh or scatter due to irregular retinal surfaces or RPE disturbances. BioMed Central (inference)
Vision Loss in One Eye (Unilateral Symptoms): DSM can be asymmetric, so one eye may be affected more, causing a difference in vision between eyes. EyeWiki
Visual Disturbance Worsened in Low Light: Because the central macula handles detail and low-light adaptation is sensitive to structural integrity. (General knowledge of macular function affected in DSM.) ScienceDirect (inference)
Perceived Central Shadow or Gray Area: Patients might describe a fog or patch over their central vision due to persistent subretinal fluid or chronic detachment. PMC
Slow Visual Recovery After Blink or Focus Shift: The distorted anatomy can cause delayed adaptation when shifting focus. (Logical implication from macular distortion.) BioMed Central (inference)
Micropsia or Macropsia (Size Distortion): Objects may appear smaller or larger in the center if the retinal mapping is altered. OCT Club (inference)
Sudden Onset of Disturbance with Fluid Accumulation: When serous detachment develops on or near the dome, vision can drop quickly, alerting the patient. Wiley Online Library
No Symptoms (Asymptomatic Cases): Some people with DSM have no complaints, and the dome is found during routine eye exams, especially if there is no fluid or advanced retinal damage. BioMed Central
Diagnostic Tests
To diagnose dome-shaped macula and understand its complications, ophthalmologists use a mix of clinical evaluation, functional testing, and imaging. Here are 20 distinct tests, grouped into categories, with explanations of why each matters:
A. Physical Examination (Basic Clinical Checks)
Best-Corrected Visual Acuity (BCVA): Tests how clearly the patient can see with glasses or contacts. A drop in central vision is often the first detectable sign of DSM-related trouble. PubMed
Amsler Grid Test: A simple square grid used by patients to self-monitor for distortion (metamorphopsia) or blind spots in central vision; helpful for catching early functional effects of dome or fluid. OCT Club
Intraocular Pressure Measurement: Although DSM is not primarily a pressure disease, checking eye pressure ensures there is no coexisting glaucoma or other pressure-related pathology that could confuse the clinical picture. ScienceDirect (general ocular exam context)
Pupil Reflex Testing: Tests for neurological problems or large central retinal dysfunction that might alter the afferent pupillary response, helping rule out other causes of vision loss. ScienceDirect (standard exam practice)
Slit-lamp Examination: Examines the front structures of the eye to rule out other contributing pathologies and confirm the eye is healthy enough to proceed with posterior evaluation. ScienceDirect
B. Manual / Clinical Functional Tests
Dilated Fundus Examination with Indirect Ophthalmoscopy: The doctor uses drops to widen the pupil and looks inside the eye with special lenses to see the shape of the macula, any dome bulge, and associated atrophy or fluid. EyeWikiScienceDirect
Fundus Photography: High-resolution color photos of the retina document the dome’s appearance over time and help compare changes, including RPE atrophy and secondary neovascular events. OCT Club
Microperimetry: Measures light sensitivity point by point across the macula while directly correlating it with the dome structure, showing which areas have functional loss. BioMed Central (inference from functional correlation)
Contrast Sensitivity Testing: Detects subtle loss in visual quality not captured by standard acuity, which may occur with early DSM-related changes. BioMed Central (inference)
Color Vision Testing: Screens for central macular dysfunction; damaged or stressed photoreceptors over the dome can slightly affect color discrimination. BioMed Central (inference)
C. Lab and Pathological Tests (Mostly to Rule Out Mimics or Contributing Systemic Causes)
Inflammatory Markers (CRP, ESR): If the presentation is unusual (e.g., sudden fluid with signs suggesting inflammation), these help rule out inflammatory or autoimmune causes that might mimic or complicate DSM symptoms. PMC
Systemic Malignancy Workup (e.g., Tumor Markers, Imaging Referral): Used when a dome-like elevation could be a hidden metastasis or tumor mimicking DSM; helps ensure the bulge is not a choroidal metastasis. American Academy of OphthalmologyModern Optometry
Infectious Disease Panels (Syphilis, Tuberculosis, etc.): In rare cases where posterior inflammation or masquerade syndromes are possible, these help rule out infectious causes of serous detachments that might confound the DSM picture. PMC
Genetic/Connective Tissue Evaluation (Selective Use): When high myopia is part of a syndrome or unusual anatomical changes appear, referral for broader connective tissue or genetic evaluation can contextualize risk (more indirect). ScienceDirect (inference)
General Blood Count and Systemic Health Check: A basic panel to make sure other systemic diseases (e.g., anemia influencing vision) are not superimposed, especially in atypical visual decline. ScienceDirect (standard differential approach)
D. Electrodiagnostic Tests
Multifocal Electroretinography (mfERG): Measures electrical responses from many small areas of the central retina to determine localized dysfunction over the dome or adjacent tissue. Nature (related to functional mapping; inference)
Pattern Electroretinography (Pattern ERG): Evaluates ganglion cell and macular function, useful in detecting subtle central retinal changes even when acuity is relatively preserved. Nature (inference from central function testing)
Visual Evoked Potentials (VEP): Assesses the signal transmission from the retina to the brain; can show delays or reduced strength if central macular input is compromised. Nature (inference)
Electro-oculography (EOG): Tests RPE function; since the RPE is often involved in DSM-related detachments or atrophy, abnormalities can support dysfunction. PMC (inference based on RPE role)
E. Imaging Tests
Spectral-Domain OCT (SD-OCT) with Enhanced Depth Imaging: The key imaging method. It shows the dome’s shape, the height of bulge, any serous fluid, retinal splitting (foveoschisis), and the health of outer retinal layers. Enhanced depth imaging helps visualize deeper structures like sclera and choroid. ScienceDirectAjo
Swept-Source OCT (SS-OCT): Provides deeper tissue penetration and more detail of the sclera and choroid, helping to better characterize the dome and underlying staphyloma anatomy. Retina Today
OCT Angiography (OCTA): Noninvasively shows blood flow in retinal and choroidal layers, useful to rule out neovascular complications and assess microvascular health around the dome. ScienceDirect (inference from vascular assessment in myopic maculopathy)
Fluorescein Angiography (FA): Highlights leaks or fluid accumulation patterns; helps distinguish serous retinal detachment related to DSM from other causes like choroidal neovascular membranes. Wiley Online Library
Indocyanine Green Angiography (ICGA): Complements FA by showing deeper choroidal circulation, which can help detect occult choroidal changes or rule out inflammatory or neovascular mimics. Ophthalmology Retina
Fundus Autofluorescence (FAF): Shows stress or damage to the RPE by detecting lipofuscin patterns; areas over the dome may develop changes indicating chronicity or risk. BioMed Central (inference)
B-Scan Ultrasonography: Useful when media are opaque or to confirm staphyloma configuration; can show posterior wall shape and rule out solid masses. ScienceDirect
Axial Length Measurement (A-scan or Optical Biometry): Measures how long the eye is; very elongated eyes are associated with high myopia and higher likelihood of posterior staphyloma and DSM. ScienceDirect
Wide-field Retinal Imaging: Captures peripheral retina to rule out additional myopic complications or other pathologies that might alter overall management. ScienceDirect (general retinal assessment)
Serial Imaging (Follow-up OCT/Photography Over Time): Repeating key imaging over months or years helps track dome stability, fluid appearance/resolution, and evolution of any secondary damage. Ophthalmology Retina
Cross-sectional (Horizontal and Vertical) OCT Scans: Because the dome can look different depending on scan direction, both axes are needed to fully characterize its shape and identify asymmetric bulging. OCT Club
Non-Pharmacological Treatments
Regular Monitoring with OCT: Frequent imaging with optical coherence tomography helps detect changes early (e.g., increasing subretinal fluid, development of CNV) so that interventions can be timed appropriately. The purpose is to watch without overtreatment; mechanism is structural imaging. EyeWikiPMC
Observation (Watchful Waiting): Many cases of DSM, especially with stable vision and minimal fluid, do not require immediate treatment. The purpose is to avoid unnecessary risks. The mechanism relies on the natural stability of the dome configuration in many patients. PubMed
Myopia Progression Control (Low-Dose Atropine): Using very low concentrations (e.g., 0.01–0.05%) of atropine eye drops in children or progressing myopes can slow axial elongation, reducing worsening high myopia that predisposes to posterior staphyloma and potentially DSM-related instability. The purpose is prevention of progression; mechanism involves muscarinic receptor modulation in the sclera/choroid thereby reducing elongation. PMCScienceDirectPMC
Orthokeratology (Ortho-K) for Myopia Control: Overnight rigid contact lenses temporarily reshape the cornea to reduce daytime myopia and slow axial eye growth. Purpose is to reduce further elongation that worsens myopic structural changes. Mechanism is redistribution of peripheral defocus reducing stimulus for eye growth. PMCBioMed Centralkosinmedj.org
Combined Low-Dose Atropine + Orthokeratology: Using both together produces synergistic myopia control, which can indirectly reduce risk factors that exacerbate DSM complications. Purpose is enhanced myopia stabilization; mechanism combines muscarinic inhibition with altered optical defocus. PMCScienceDirect
Increased Outdoor Time: Spending more time outdoors in childhood is linked with lower myopia onset and progression. The purpose is primary prevention of developing or worsening high myopia; mechanism is thought to involve light-stimulated dopamine release in the retina, which inhibits axial elongation. (General myopia control evidence, extrapolated to reduce DSM risk factors.) PMC
Visual Rehabilitation / Low Vision Aids: For patients with persistent visual compromise from DSM complications, tools like magnifiers, contrast-enhancing glasses, and training improve functional vision. Purpose is quality-of-life improvement; mechanism is optimizing use of remaining macular function. ResearchGate
Proper Optical Correction: Ensuring up-to-date glasses/contact lens prescriptions reduces visual strain and prevents compensatory behaviors that might stress the retina. Purpose is to maintain best-corrected vision; mechanism is minimizing defocus and the visual effort that can mask early warning signs. ResearchGate
Posture and Ergonomics for Near Work: Reducing prolonged near work and ensuring proper viewing distances helps limit accommodative stress and may indirectly lower risk of myopia progression. Purpose is supportive lifestyle modification; mechanism is decreased stimulus for axial elongation. PMC
Screen Time Management: Reducing continuous screen exposure (with breaks) helps reduce eye fatigue and optimizes overall eye health. Purpose is symptom reduction; mechanism is limiting accommodative strain and maintaining tear film stability. (General eye health principle.) PMC
UV Protection: Wearing sunglasses that block UVA/UVB protects ocular surface and may reduce cumulative photochemical stress, supporting long-term retinal health. Purpose is prevention; mechanism is blocking harmful ultraviolet light. Prevention
Smoking Cessation: Smoking increases oxidative stress and is associated with worse outcomes in many retinal diseases; therefore quitting supports structural eye health. Purpose is risk reduction; mechanism is lowering free-radical–mediated damage. PMC
Healthy Diet (General Retinal Support): Consuming foods rich in antioxidants, carotenoids, and omega-3 fatty acids builds a nutritional environment that may help retinal resilience. Purpose is long-term maintenance; mechanism is reducing oxidative damage and supporting photoreceptor function. PMCJAMA NetworkVerywell Health
Stress Reduction: Chronic stress may influence choroidal circulation. Reducing stress through lifestyle (sleep, mindfulness) supports stable ocular perfusion. Purpose is stabilizing subretinal fluid dynamics; mechanism is modulation of systemic vascular tone. (Inference from general vascular health knowledge.) Review of Optometry
Blood Pressure Control: Keeping systemic blood pressure within normal range avoids fluctuations in choroidal perfusion that could exacerbate retinal fluid dynamics. Purpose is prevention of secondary fluid shifts; mechanism is regulated ocular blood flow. Review of Optometry
Avoid Unnecessary Systemic Steroids: In some fluid-related retinal conditions (like central serous chorioretinopathy), systemic corticosteroids can worsen subretinal fluid; cautious use is prudent in overlapping circumstances. Purpose is risk avoidance; mechanism is decreasing steroid-induced permeability changes. Review of Optometry
Controlled Physical Activity (Avoid Valsalva Spikes): Avoiding extreme Valsalva maneuvers (heavy lifting causing sudden pressure spikes) may reduce the chance of transient fluid shifts in sensitive retinal configurations. Purpose is protective; mechanism is avoiding abrupt intraocular pressure changes. (General ophthalmic precaution.)
Patient Education and Self-Monitoring (Amsler Grid): Teaching patients to self-check central vision for wavy lines or new scotomas helps early detection of complications like CNV. Purpose is early recognition; mechanism is home monitoring of macular function. Karger
Avoidance of Eye Trauma: Protecting eyes from blows or injuries reduces superimposed structural insults that could destabilize an already altered macular architecture. Purpose is prevention; mechanism is avoiding mechanical deformation.
Adequate Sleep and Hydration: Good systemic health supports normal ocular tissue metabolism and fluid regulation. Purpose is supportive maintenance; mechanism is optimal physiological clearance and repair.
Drug Treatments
Ranibizumab (Anti-VEGF agent): Ranibizumab is used when choroidal neovascularization (CNV) develops in myopic eyes, including those with DSM-related mCNV. It is an intravitreal injection typically given monthly initially, then extended based on response. Purpose is to stop abnormal vessel growth and leakage; mechanism is blocking vascular endothelial growth factor (VEGF). Side effects include intraocular inflammation, endophthalmitis (rare infection), elevated intraocular pressure, and floaters. BMJ Best Practice
Aflibercept (Anti-VEGF): Aflibercept binds VEGF and placental growth factor, often allowing longer intervals between injections after initial loading. It improves visual acuity and reduces fluid in mCNV. Purpose is similar to ranibizumab; mechanism is VEGF/trap binding to reduce neovascular leakage. Side effects parallel other intravitreal anti-VEGF agents. ScienceDirectPLOS
Bevacizumab (Off-label Anti-VEGF): Commonly used off-label for myopic CNV due to lower cost, given intravitreally in similar regimens. Purpose is VEGF inhibition; mechanism is neutralizing VEGF-A. Side effects include same injection-related risks. PMC
Brolucizumab: A newer anti-VEGF with potential for longer dosing intervals in neovascular conditions; its role in myopic CNV is emerging but holds promise for reducing injection frequency. Purpose is sustained VEGF suppression; mechanism is small single-chain antibody fragment targeting VEGF. Caution: rare retinal vasculitis has been reported. Verywell Health (inference from evolving anti-VEGF landscape; extrapolated)
Verteporfin Photodynamic Therapy (PDT): Verteporfin is a light-activated drug infused intravenously, followed by laser activation at the lesion, used historically for CNV and sometimes for chronic subretinal fluid associated with DSM refractory to other treatments. Purpose is occlusion of leaking choroidal vessels or altering choroidal permeability; mechanism is generating free radicals on activation that selectively damage neovascular tissue. Side effects include temporary vision dimming, photosensitivity, and rare retinal damage. ResearchGate
Spironolactone (Mineralocorticoid Receptor Antagonist): Used off-label in SRD associated with DSM, particularly chronic serous retinal detachment; oral spironolactone over months has been shown to reduce subretinal fluid thickness though visual acuity improvement may be limited. Purpose is to reduce fluid accumulation; mechanism is blocking mineralocorticoid receptors implicated in choroidal vascular permeability. Side effects include hyperkalemia, breast tenderness, and hormonal effects. PMC
Topical Carbonic Anhydrase Inhibitor (e.g., Dorzolamide): Applied as eye drops, this has been reported to help resolve nonresolving subretinal fluid in DSM in some cases. Purpose is fluid modulation; mechanism is believed to affect retinal pigment epithelium pump function and choroidal fluid dynamics. Side effects include local irritation and, rarely, systemic effects if absorbed. PubMed
Eplerenone (Mineralocorticoid Antagonist): Although more extensively studied in central serous chorioretinopathy, its mechanism (mineralocorticoid blockade reducing choroidal hyperpermeability) is sometimes extrapolated for fluid in related pachychoroid or DSM-like detachments with caution; evidence is less direct. Purpose is to reduce chronic subretinal fluid; mechanism is selective mineralocorticoid receptor inhibition. Side effects are milder than spironolactone but include hyperkalemia. BioMed Central
Acetazolamide (Systemic Carbonic Anhydrase Inhibitor): Occasionally used in difficult fluid cases to alter trans-retinal fluid movement (extrapolated from other fluid-related retinal conditions). Purpose is to reduce subretinal fluid; mechanism is systemic reduction of bicarbonate increasing fluid resorption via RPE. Side effects include paresthesias, kidney stones, metabolic acidosis. (Note: evidence in DSM is limited and mostly extrapolated—use cautiously.) Review of Optometry (inference)
Adjunctive Anti-inflammatory Agents (Careful Use): Though steroids are generally avoided if they may worsen serous detachments, low-grade inflammation management in associated co-pathologies (e.g., post-surgical inflammation) may be needed under specialist guidance. Purpose is inflammation control; mechanism depends on agent; risk of fluid worsening requires careful balance. (Inference from general retinal treatment principles.)
Dietary Molecular Supplements
Lutein (10–20 mg/day): A carotenoid concentrated in the macula that filters blue light and acts as an antioxidant. Its supplementation (as in AREDS2 formulations) has been shown to slow progression of macular degeneration and support retinal health by reducing oxidative stress. Mechanism: quenching reactive oxygen species and absorbing harmful light. JAMA NetworkMDPIScienceDirect
Zeaxanthin (2–4 mg/day): Often paired with lutein, zeaxanthin also builds macular pigment density, protecting photoreceptors and improving visual performance. Mechanism is similar—blue light filtering and antioxidant protection. JAMA NetworkScienceDirect
Omega-3 Fatty Acids (DHA/EPA, ~500–1000 mg combined/day): Long-chain omega-3s support retinal cell membrane integrity and have anti-inflammatory effects. In combination with lutein/zeaxanthin, they contribute to improved macular environment and are part of extended AREDS2-related research. Mechanism includes modulation of inflammatory mediators and structural phospholipid support. PubMedScienceDirect
Bilberry Extract (Anthocyanins, typical standardized doses vary, e.g., 80–160 mg/day equivalent): Contains antioxidants that reduce inflammation, lipid peroxidation, and protect retinal cells under stress. Mechanism: enhancing endogenous antioxidant defense and stabilizing capillary permeability. PMCLaboratory Investigation
Vitamin C (500–1000 mg/day from diet/supplement): General antioxidant that supports ocular collagen and vascular health. Its role in cataract prevention is clearer than in DSM, but it aids in reducing oxidative stress broadly. Mechanism: scavenges free radicals. Verywell Health
Vitamin E (15 mg/day): Lipid-soluble antioxidant that protects cell membranes in the retina. Mechanism: prevents lipid peroxidation in photoreceptor outer segments. Verywell Health
Zinc (25–80 mg/day with accompanying copper): Essential trace mineral for retinal metabolism and visual pigment regeneration. In the AREDS formulation, zinc has protective effects against progression of degenerative macular disease. Mechanism: cofactor in antioxidant enzymes and stabilizing retinal cells. ScienceDirect
Copper (2 mg/day, included to avoid zinc-induced deficiency): Balances high zinc and supports antioxidant defense systems (e.g., superoxide dismutase). Mechanism: necessary for proper function of copper-dependent enzymes. ScienceDirect
Resveratrol (150–500 mg/day, investigational): Polyphenol with anti-inflammatory and anti-oxidative properties; thought to support mitochondrial health in retinal cells. Mechanism: activation of SIRT1 pathways, reducing oxidative stress. (Evidence more general for retinal protective potential; early and indirect.) PMC (inference from antioxidant literature)
Astaxanthin (4–12 mg/day): A potent carotenoid antioxidant that may support retinal microcirculation and reduce oxidative stress. Mechanism: scavenging reactive oxygen species more effectively than some other carotenoids; supports mitochondrial function in photoreceptors. (Emerging evidence from ocular oxidative stress literature.) PMC (inference)
Note: Many of these supplements were originally studied in the context of age-related macular degeneration; their use in DSM is supportive (not curative) and intended to optimize general retinal resilience. Always check for interactions (e.g., high-dose vitamin E with anticoagulants) and consult an ophthalmologist before starting any supplementation. PMC
Regenerative / Stem Cell / “Hard Immunity”
Human Embryonic Stem Cell–Derived Retinal Pigment Epithelium (hESC-RPE) Transplants: In early clinical trials (e.g., London Project to Cure Blindness), sheets or patches of RPE derived from embryonic stem cells are placed subretinally to replace damaged support cells. Purpose is tissue restoration; mechanism is replacing dysfunctional RPE, improving photoreceptor survival. These are experimental and not approved for DSM specifically. Risks include immune rejection, unintended growth, and surgical complications. Macular SocietyPMC
Induced Pluripotent Stem Cell–Derived RPE (iPSC-RPE): Similar to hESC-RPE but derived from reprogrammed adult cells, potentially reducing rejection. Purpose is personalized regenerative repair; mechanism is providing healthy RPE to support the macula. Still in early-phase trials, with safety and efficacy under evaluation. PMC
Mesenchymal Stem Cell (MSC) Intravitreal or Subretinal Therapy: MSCs from bone marrow, adipose tissue, or umbilical cord are investigated for their paracrine neuroprotective effects, secreting growth factors and modulating inflammation to preserve retinal neurons. Purpose is neuroprotection and microenvironment support; mechanism is trophic factor release and immunomodulation. Evidence remains preliminary. PMCFighting Blindness Canada (FBC)
Umbilical Cord–Derived Stem Cells / Wharton’s Jelly MSCs: These are being evaluated for their immune-privileged, anti-inflammatory, and regenerative signaling properties in retinal diseases. Purpose is to support healing and modulate pathological processes; mechanism includes secretion of cytokines and extracellular vesicles. Research is early-stage and not standard-of-care. PMC
Autologous Adipose-Derived Stem Cells (Cautionary, Experimental): These are harvested from the patient’s fat and sometimes injected intravitreally; while some clinics promote them, serious safety concerns (including vision loss) have been reported when unregulated. Purpose (intended) is retinal repair; mechanism is paracrine support. Strong caution is advised—only within approved trials. PMC
Gene-Modified Neurotrophic Factor Delivery (e.g., CNTF Implants or Similar): Though not strictly “stem cell,” delivery of neurotrophic factors through implants or gene therapy aims to boost retinal cell survival. Purpose is support of neural tissue under stress; mechanism is sustained release of protective proteins. This complements regenerative approaches and is in early testing for macular disorders. PMC (inference from neuroprotective research)
Note: All regenerative therapies listed are experimental, with limited direct data for Dome-Shaped Macula. They are avenues of future hope more than current standard treatments. Patients should only access these through regulated clinical trials. OAE PublishingPMC
Surgical / Procedural Interventions (What They Are and Why Done)
Macular Buckling: This surgical procedure places a specially shaped exoplant (e.g., silicone sponge-titanium) at the back of the eye to indent the sclera under the macula, altering the posterior contour and relieving traction or associated detachments. It is used for complicated myopic macular holes or detachment in highly myopic eyes, sometimes with DSM features. Purpose is mechanical support and realignment; mechanism is reshaping the scleral profile to reduce stress and promote reattachment. Long-term follow-ups have shown efficacy in select refractory cases. PMCResearchGate
Posterior Scleral Reinforcement: A procedure that strengthens the back of the eye (sclera) with graft material to stabilize progression of posterior staphyloma and associated maculopathy. It can be combined with vitrectomy to improve outcomes in cases with vision-threatening complications. Purpose is structural reinforcement; mechanism is slowing scleral deformation and improving postoperative visual acuity when done adjunctively. PMCBMJ Best Practice
Pars Plana Vitrectomy with Internal Limiting Membrane (ILM) Peeling: Used when DSM is complicated by macular holes, foveoschisis, or tractional changes. Removing vitreous traction and peeling the ILM can allow the retina to reflatten or the hole to close. Purpose is mechanical resolution of traction; mechanism is removing tangential forces and facilitating retinal stability. Karger
Surgical Repair of Choroidal Neovascular Membrane (CNV): Rarely, when anti-VEGF and less invasive methods fail for mCNV, direct surgical excision or submacular surgery may be considered in expert hands. Purpose is removal of leaking or scar-forming neovascular tissue; mechanism is direct excision to prevent further vision loss. This is not standard first-line but can be used in select refractory lesions. BMJ Best Practice
Half-Fluence Photodynamic Therapy (PDT): Although pharmacologic in part (verteporfin), the act of targeted laser activation over a detained lesion is a procedural intervention; it has been used successfully in chronic subretinal fluid associated with DSM that failed other treatments. Purpose is localized alteration of choroidal permeability; mechanism is selective closure of abnormal choroidal leakage with minimal collateral damage. ResearchGate
Preventions (How to Reduce Risk or Slow Progression)
Early Myopia Control (Atropine/Ortho-K): Slowing axial elongation reduces the evolution of high myopia and structural stresses that underlie DSM development. PMCPMC
Regular Eye Exams with Imaging: Early detection of DSM and its complications (SRD, CNV) allows timely intervention before significant vision loss. EyeWikiPMC
Spend Time Outdoors (Especially for Children): Helps delay onset or progression of myopia. PMC
Avoid Excessive Near Work Without Breaks: Limiting prolonged sustained accommodation may help prevent myopic progression downstream. PMC
UV Eye Protection: Protecting eyes from cumulative light damage supports long-term retinal health. Prevention
Smoking Cessation: Reduces oxidative stress and retinal vulnerability to damage. PMC
Sleep Hygiene and Systemic Health: Good general health supports ocular microcirculation and reduces systemic risk factors. (General preventive principle.)
Nutrition Rich in Antioxidants: Eating foods that supply lutein, zeaxanthin, omega-3s, vitamins, and minerals builds a protective biochemical environment. JAMA NetworkPubMed
Avoid Unsupervised Use of Steroids: Especially systemic steroids that can exacerbate fluid-related retinal issues if used without ophthalmologic oversight. Review of Optometry
Timely Treatment of Early Complications: Addressing small CNV or fluid early (with anti-VEGF or PDT as indicated) prevents progression to larger, vision-threatening problems. BMJ Best Practice
When to See a Doctor
You should contact an eye doctor promptly if you notice any of the following: sudden blurring of central vision, new or worsening metamorphopsia (straight lines appearing wavy), a new dark or gray spot in your central vision, difficulty reading fine print, sudden floaters or flashes (which could signal retinal detachment), persistent distortion despite glasses correction, unexplained vision changes especially in one eye, symptoms of choroidal neovascularization (rapid central vision loss), or if previously stable subretinal fluid becomes symptomatic. Early detection of CNV or worsening SRD can preserve vision. OCT ClubPMC
What to Eat and What to Avoid
What to Eat
Leafy green vegetables (spinach, kale) for lutein/zeaxanthin. MDPI
Eggs (especially yolks) as a bioavailable source of lutein/zeaxanthin. Prevention
Fatty fish (salmon, tuna) for omega-3 fatty acids (DHA/EPA). Prevention
Citrus fruits for vitamin C. Prevention
Nuts and seeds for vitamin E and zinc support. Prevention
Colorful berries (e.g., bilberries, blueberries) rich in anthocyanins. PMC
Whole grains and foods with low glycemic index to reduce systemic oxidative burden. (General nutrition principle.)
Shellfish (oysters) for zinc. Prevention
Foods rich in copper (nuts, legumes) to balance zinc usage. ScienceDirect
Green tea for broad antioxidant benefit. Prevention
What to Avoid
Smoking (cigarette or tobacco). PMC
Excessive high-sugar, high-glycemic processed foods that increase oxidative stress. (General metabolic health inference.)
Unregulated high-dose supplements without medical advice (e.g., very high vitamin A or E). Verywell Health
Excessive alcohol, which can impair nutrient absorption and increase systemic inflammation. (General health principle.)
Prolonged, unbroken near work without breaks (exacerbating myopia progression). PMC
Overuse of systemic corticosteroids without ophthalmologic oversight. Review of Optometry
Dehydration (which can impair ocular microcirculation). (General physiology knowledge.)
Extreme Valsalva-provoking activities without caution in compromised eyes. (Precautionary.)
UV overexposure without protection. Prevention
Ignoring early visual symptoms—delaying evaluation. OCT Club
Frequently Asked Questions (FAQs)
Can Dome-Shaped Macula cause blindness?
Usually, DSM itself is stable and does not cause blindness, but complications like choroidal neovascularization or chronic fluid can damage central vision if untreated. Early detection reduces that risk. PMCBMJ Best PracticeWhat is the main imaging test to diagnose DSM?
Optical coherence tomography (OCT) is the primary tool; it shows the dome-like protrusion and any associated fluid or structural changes. EyeWikiIs there a cure for the dome shape?
No standard “cure” exists for the dome configuration; many cases are simply observed unless complications arise. Some surgical procedures (like macular buckling) modify the mechanical environment in select situations. PubMedPMCWhy do I have fluid under the retina with DSM?
Serous retinal detachment arises due to altered fluid dynamics from the dome altering choroidal and retinal pigment epithelium behavior. It can persist chronically in many patients. PMCCan the fluid go away on its own?
Sometimes it remains stable without worsening vision. In other cases, targeted treatments (like mineralocorticoid antagonists, PDT, or addressing secondary CNV) are tried. PMCResearchGateAre anti-VEGF injections helpful?
Anti-VEGF injections are highly effective when a choroidal neovascular membrane develops, improving vision and preventing further leakage. BMJ Best PracticeScienceDirectWill nutritional supplements help DSM?
Supplements like lutein, zeaxanthin, omega-3s, zinc, and antioxidants do not reverse DSM but support overall retinal health and may improve resilience to oxidative stress. JAMA NetworkScienceDirectCan myopia control slow DSM-related problems?
Reducing further myopic progression via low-dose atropine and orthokeratology lowers the structural stress that contributes to posterior staphyloma and may indirectly stabilize associated issues. PMCPMCIs surgery always needed?
No. Most patients are monitored. Surgery is reserved for complications like tractional macular holes, refractory detachments, or severe visual loss not responsive to less invasive therapy. KargerPMCWhat are the risks of stem cell therapies for retinal disease?
Experimental regenerative treatments carry risks such as immune reaction, unintended tissue growth, infection, and uncertainty about long-term benefit. They should only be pursued in regulated clinical trials. PMCPMCDoes DSM always worsen over time?
No; many eyes remain stable for years without significant vision change, especially if complications don’t develop. PubMedCan I use eye drops or medicine to flatten the dome?
There is no medicine that flattens the dome itself; some eye drops (carbonic anhydrase inhibitors) and oral meds (spironolactone) aim to reduce associated fluid. PubMedPMCShould I avoid any activities?
Avoiding eye trauma, excessive uncorrected near work, and uncontrolled systemic stressors is sensible. There’s no need for extreme restriction unless advised by your retinal specialist. (General precaution.) PMCHow often should I follow up?
Follow-up intervals depend on stability: stable, asymptomatic cases may be seen every 6–12 months, whereas those with fluid, CNV, or recent change may need monthly or more frequent review. EyeWikiCan lifestyle changes improve my vision with DSM?
Lifestyle (good diet, controlling myopia progression early, protecting from UV, avoiding smoking) supports eye health, but it does not reverse structural changes. MDPIPMC
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: August 02, 2025.
