Development and Validation of a Diagnostic Nomogram for Pathologic Myopia in Patients with High Myopia and Tessellated Fundus: A Cross-Sectional Study.

Purpose: Early identification of pathological changes in high myopia (HM) with tessellated fundus (TF) remains challenging. To address this, a diagnostic nomogram was developed and validated to aid clinical screening of pathologic myopia (PM) in HM patients with TF. Patients and Methods: A cross-sectional study was performed at The First Affiliated Hospital of Guangxi Medical University between May 10, 2023, and March 31, 2024. Patients with HM, defined as a spherical refractive error of ≤ -6.0 D or an axial length of ≥ 26.5 mm, who presented with TF were enrolled. The collected clinical data were randomly divided into training and validation sets at a 7:3 ratio. A diagnostic nomogram was constructed from independent predictive factors. Its discrimination, calibration, and clinical utility were assessed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results: Data from 418 eyes with TF were included in this study. Independent predictors for PM, in descending order of association, were axial length, optic disc tilt ratio, spherical equivalent, education level, and extent of peripapillary atrophy. The nomogram demonstrated robust performance in both sets. In the training set, the area under the ROC curve (AUC) was 0.851 (95% CI: 0.808-0.895), with a sensitivity of 0.775 and a specificity of 0.736. In the validation set, the AUC was 0.827 (95% CI: 0.755-0.900), with a sensitivity of 0.773 and a specificity of 0.700. Conclusion: This simple predictive model, developed and validated using common interpretable clinical and fundus imaging features, serves as a valuable tool for screening PM in HM patients with TF.