Characteristics of higher-order aberrations and anterior segment tomography in patients with pathologic myopia

The association between ocular biometric components and corneal aberrations

CLINICAL RELEVANCE

Evaluating factors affecting corneal higher-order aberration component has a very important role in interpreting the characteristics of the formed image on the retina.

BACKGROUND

To determine the relationship between ocular biometric components and corneal higher-order aberrations in an elderly population.

METHODS

This report is related to a subsample of the Tehran Geriatric Eye study (TGES), a population-based cross-sectional study that was conducted on individuals aged 60 years and above in Tehran city, Iran using multistage stratified random cluster sampling. All study participants underwent ocular examinations including visual acuity measurement, refraction and slit-lamp biomicroscopy. Anterior segment imaging and corneal aberrometry were performed using Pentacam AXL.

RESULTS

In the present study, 644 eyes of 415 individuals (56.9% female) with mean age of 66.36 ± 4.70 years were evaluated. According to a multiple generalised estimating equation model, the root mean square of total higher-order aberrations was related to age (β = 0.081, p = 0.002), crystalline lens thickness (β = 0.08, p < 0.001), and corneal diameter (β = -0.04, p = 0.014). The root mean square of total coma aberration was directly related to the female sex (β = 0.02, p = 0.05), and crystalline lens thickness (β = 0.06, p < 0.001). There was a direct relationship between the root mean square of third- and fourth-order higher-order aberrations and crystalline lens thickness (p < 0.001). Spherical aberration was directly related to the male sex (β = -0.02, p = 0.004), axial length (β = 0.05, p < 0.001) and central corneal thickness (β = 0.001, p = 0.025), and was inversely related to anterior chamber depth (β = -0.07, p = 0.031) and crystalline lens thickness (β = -0.25, p < 0.001).

CONCLUSION

Ocular biometric components are related to corneal aberrations in the elderly. These factors need to be considered in respect of medical and surgical procedures required for the elderly.

Analysis of the relationship between lens morphology and aberrations in patients with myopia: a cross-sectional study

PURPOSE

To investigate the relationship between lens morphology and aberrations in patients with myopia.

METHODS

This cross-sectional study included 155 patients with myopia in their right eyes. Spherical power and cylindrical power were achieved by cycloplegic autorefraction. The eyes were divided into three groups for analysis based on their spherical equivalent (SE) values. The 4 mm and 6 mm ocular and internal aberrations were measured using the OPD-scan III. Lens parameters were measured using CASIA2, including lens thickness (LT), radius of anterior/posterior lens surface curvature (RAL/RPL), lens decentration (DEC), and lens tilt (TILT). The differences of lenticular parameters and aberration parameters among the three groups analyzed with ANOVA or Kruskal Wallis test. Pearson correlation or Spearman correlation analysis was performed to evaluate the relationships between the lens parameters and aberrations. A p value < 0.05 indicated statistical significance.

RESULTS

The difference in LT, RAL, DEC and TITL among the three groups was statistically significant (p < 0.05). And there were differences among differences in internal high-order aberrations, spherical aberration, and coma aberration(p < 0.05).Spherical power was positively correlated with LT and TITL (p < 0.05) and negatively correlated with DEC, RAL, and RPL (p < 0.05). Cylindrical power was positively correlated with LT (p < 0.05) and negatively correlated DEC (p < 0.05); The lenticular parameters (LT, RAL, DEC, and TILT) were mainly correlated with the ocular and internal spherical aberration. LT and DEC were correlated with ocular and internal higher-order aberrations and coma aberration.

CONCLUSION

DEC and LT were the main factors affecting aberrations in patients with myopia.

Higher order aberrations and visual function in a young Asian population of high myopes

Purpose

To examine the associations between higher order aberrations (HOAs), visual performance, demographics, and ocular characteristics in a young Asian population with high myopia.

Methods

This was a retrospective review of military pre-enlistees conducted between March 2014 to September 2018. Visual acuity and contrast sensitivity were tested under photopic, mesopic and simulated night conditions. Ocular, corneal and internal HOAs were measured with a Hartmann-Shack wavefront aberrometer (KR-1W, Topcon Co., Tokyo, Japan).

Results

522 eyes of 263 consecutive subjects with severe high myopia (defined as spherical equivalent refraction [SER] ≤ -10.00D) in at least one eye, and high myopia (SER ≤ -6.00D) in the fellow eye, [mean (SD) SER -11.85 (2.03D)] were analysed. The mean (SD) age of subjects was 18.5 (1.6) years. Chinese eyes had significantly greater internal total HOA root-mean-square (RMS) compared to Malay eyes [mean difference (SD) 0.0246 (0.007) μm, p < 0.001). More negative SER was associated with greater ocular total HOA (p = 0.038), primary coma (p = 0.003) and tetrafoil (p = 0.025) RMS, as well as more positive ocular (p = 0.003) and internal primary spherical aberration (p = 0.009). Greater ocular total HOAs was associated with reduced visual acuity in simulated night conditions and low contrast, decreased contrast sensitivity under mesopic and simulated night conditions (all p < 0.05).

Conclusions

Greater HOAs were associated with Chinese ethnicity and more negative SER in a young Asian population with high myopia. Greater HOAs were associated with poorer visual performance in low luminance and reduced contrast conditions.

Corneal higher order aberrations by Sirius topography and their relation to different refractive errors

PURPOSE

To compare the root mean square (RMS) of anterior corneal higher-order aberrations (HOAs) in ametropic and emmetropic eyes.

METHODS

This retrospective observational study was conducted at the Department of Ophthalmology, Tishreen University Hospital, Latakia, Syria. Study eyes were divided into four groups based on refractive error: mild-to-moderate myopia, hypermetropia, myopic astigmatism, and emmetropic eyes as controls. The following anterior corneal HOAs were evaluated using the Scheimpflug-Placido Sirius (CSO, Italy) tomographer over 6 mm pupil: Root mean square (RMS) total corneal HOAs, RMS trefoil, RMS coma and RMS spherical aberrations.

RESULTS

RMS values of total HOAs, trefoil and coma showed statistically significant differences in all four groups (P < 0.05, all). HOAs were noted to be lowest in the control group (0.18 ± 0.09, 011 ± 0.08 and 0.09 ± 0.08 μm, respectively) and highest in the myopic astigmatism group (0.31 ± 0.16, 0.15 ± 0.12, 0.17 ± 0.14 μm, respectively). RMS spherical aberration was lowest in the astigmatism group (0.00 ± 0.16 μm) with a statistically significant difference from that in the control group (0.05 ± 0.07 μm, P = 0.049).

CONCLUSION

The mean RMS values of total HOAs, trefoil and coma were highest in the astigmatism group and lowest in the control group. However, spherical aberration was minimal in the astigmatism group. A better understanding and targeted treatment of higher-order aberrations in ametropic human eyes, and in particular eyes with astigmatism, may enhance visual quality and performance in the treatment of refractive errors. Recognising atypical HOAs may also assist in the early detection of pathological conditions such as keratoconus.

Factors associated with reduced visual acuity in myopes with and without ocular pathologies after optical correction

PURPOSE

Considering that a certain proportion of high myopes have reduced visual acuity even after full optical correction, this study aimed to investigate the association between various refractive error components (sphere, cylinder and axis orientation) and reduced visual acuity in individuals with low to high myopia with and without pathologic myopia lesions.

METHODS

We analysed data from randomly selected eyes of 11,258 individuals with myopia (mean ± SD spherical equivalent (SE) -3.2 ± 2.9D; range: -0.5D to -21.5D). In total, 10,528 individuals had no pathologic myopia lesions. Sphere, cylinder and SE refraction were classified into mild, moderate and high categories. Astigmatism was defined as with-the-rule, against-the-rule or oblique based on the axis orientation. Reduced best-corrected visual acuity was defined as ≥0.18 logMAR. Logistic regression was performed to test factors associated with reduced visual acuity with and without pathologic myopia lesions.

RESULT

Overall, 6.4% (N = 720/11,258) of myopes had reduced best-corrected visual acuity. High sphere (≤-6.0D; Odd ratios [OR]: 16.1; 95% CI: 2.1-126.5), high cylinder (<-2.0 DC; OR: 2.5; 95% CI: 1.8-3.4), against-the-rule (OR: 1.5; 95% CI: 1.1-2.0) and oblique astigmatism (OR: 1.6; 95% CI: 1.2-2.1) were significantly (p ≤ 0.008) associated with reduced visual acuity in the absence of pathologic myopia lesions. Both moderate SE and high myopic SE were also associated with reduced visual acuity. In the presence of pathologic myopia lesions, tessellated fundus (OR: 6.9; 95% CI: 3.5-14.1), chorioretinal atrophy (OR: 7.7; 95% CI: 2.6-19.9) and choroidal neovascularisation (OR: 37.4; 95% CI: 3.3-419.3) were significantly (p ≤ 0.003) associated with reduced visual acuity.

CONCLUSION

Even after full optical correction, both refractive components and pathologic myopia lesions can independently cause reduced visual acuity, regardless of the degree of myopia.

Corneal Biometric Features and Their Association With Axial Length in High Myopia

PURPOSE

To characterize the morphologic features of corneal parameters and their correlation with axial length (AL) elongation in patients with high axial myopia.

DESIGN

Cross-sectional comparative study.

METHODS

A total of 299 eyes with high myopia (299 patients) and 266 eyes of age- and sex-matched control subjects (266 patients) were examined by anterior segment swept-source optical coherence tomography (SS-OCT) and an IOL Master. Central corneal thickness (CCT), thinnest corneal thickness (TCT), corneal volume (CV), and anterior corneal curvature (CC), posterior CC, and total CC were obtained, and their correlation with AL was investigated using multiple linear regression model.

RESULTS

The CCT, TCT, CV, and anterior, posterior, and total CC of patients with high myopia were smaller than those of the control subjects. The CCT, TCT, and CV had a continuous downward trend with AL. However, CC decreased rapidly with AL when AL was <26 mm and the slope decreased when AL was 26 to 28 mm. This linear association was absent when AL was >28 mm. Multiple linear regression showed that the CCT (β = -1.98, P = .007), TCT (β = -1.63, P = .019), and CV (β = -0.13, P = .001) were associated with AL. Anterior, posterior, and total CCs were negatively associated with AL when AL was <26 mm (all P < .001) and when AL was between 26 and 28 mm (all P < .05).

CONCLUSIONS

CC decreases may serve as a refractive compensation on myopia when AL is <28 mm. However, this effect does not exist when AL is >28 mm. Consideration should be given to the special distribution of cornea curvature for IOL calculations in subjects with high myopia.

Extended Depth of Focus Versus Monofocal IOLs in Patients With High Myopia: Objective and Subjective Visual Outcomes

PURPOSE

To compare the objective and subjective outcomes between the extended depth of focus (EDOF) Mini Well intraocular lens (IOL) and the aspheric monofocal Mini-4-Ready IOL (both SIFI S.p.A.) in patients with high myopia.

METHODS

In this prospective comparative study, 40 patients with high myopia (axial length ≥ 26 mm) were enrolled: 20 patients were bilaterally implanted with the EDOF Mini Well IOL (EDOF group) and 20 patients were bilaterally implanted with the Mini-4-Ready IOL (monofocal group). Three-month follow-up data included corrected and uncorrected distance visual acuity at 4 m and 80, 67, and 40 cm, defocus curves, subjective and objective contrast sensitivity, objective optical quality (calculated with Optical Quality Analysis System; Visiometrics SL), halometry, and reading performance. Subjective visual quality was evaluated with National Eye Institute Refractive Error Quality of Life Instrument 42 scores.

RESULTS

All visual acuities were significantly better in the EDOF group (P ⩽ .04) except monocular and binocular uncorrected and corrected distance visual acuities for distance (P ≥ .50). Defocus curves for myopic and hyperopic values were better in the EDOF group (P ⩽ .05), apart from +0.50 to -0.50 D (P ≥ .16). Contrast sensitivity curves was worse in the EDOF group in the mesopic-with-glare condition (P ⩽ .04). No differences were found in halometric values (P ≥ .15) and OQAS outcomes (P ≥ .47). National Eye Institute Refractive Error Quality of Life Instrument 42 subscale scores were better for expectation, near vision, activity limitations, and dependence on correction in the EDOF group (P ⩽ .04).

CONCLUSIONS

Intermediate and near visual acuities were better in the EDOF group than in the monofocal group, with a comparable visual quality index between groups. [J Refract Surg. 2022;38(3):158-166.].

Monochromatic higher order aberrations in highly myopic eyes with Staphyloma

BACKGROUND

Prevalence of high myopia is continuously increasing, thus, patients affected with staphyloma are abundant worldwide. Assessment of the quality of vision in these patients is mandatory for a proper clinical counselling, specially when undergoing surgical procedures that require intraocular lenses implantation. Thus, the purpose of the study was to assess monochromatic higher order aberrations (HOAs) in highly myopic eyes with staphyloma with or without a dome-shaped macula.

METHODS

Participants underwent spectral-domain optical coherence tomography, ocular axial biometry, dual Scheimpflug photography and integrated Placido disk topography, and Hartmann-Shack wavefront analysis. Five groups were evaluated: a low-moderate myopia control group (< 6.00 diopters, n = 31) and four high myopia (≥6.00 diopters) groups: eyes without staphyloma (n = 18), eyes with inferior staphyloma (n = 14), eyes with posterior staphyloma without dome-shaped macula (n = 15) and eyes with posterior staphyloma with dome-shaped macula (n = 17). Subsequently, two new groups (including all participants) were created to assess differences between myopia with and without staphyloma. One-way analysis of covariance was performed using age and lens densitometry as covariates.

RESULTS

Statistically significant (p ≤ 0.05) differences in anterior corneal fourth-order HOAs were observed between the low-moderate myopia and no-dome-shaped macula (Mean: 0.16 μm) and dome-shaped macula posterior staphyloma groups (Mean: 0.12 μm) in younger patients (≤45 years old). The same groups also showed (p ≤ 0.05) significant differences for anterior corneal primary spherical aberration (Mean: 0.19 and 0.13 μm, respectively). In addition, anterior corneal tetrafoil was significantly higher (p = 0.04) in dome-shaped macula compared to no-dome-shaped macula (Mean: 0.18 vs 0.06 μm, respectively). When all participants were grouped together, significantly lower mean anterior corneal primary spherical aberration (0.15 μm vs. 0.27 μm, p = 0.004) and higher internal primary spherical aberration (0.04 μm vs. -0.06 μm, p = 0.04) was observed in staphyloma compared to no-staphyloma myopic patients.

CONCLUSIONS

Eyes with high myopia and staphyloma have less positive anterior corneal primary spherical aberration and less negative internal primary spherical aberration, suggesting that the anterior corneal surface tends to mimic in a specular fashion the posterior pole profile. This corneal behaviour appears to change in patients older than 45 years.

Profiles of intraocular higher-order aberrations in healthy phakic eyes: prospective cross-sectional study

Background

Ocular wavefront aberration is a crucial optical factor affecting retinal imaging. Internal aberrations contributed to compensation mechanism of ocular aberration. However, previous studies mainly focused on total and corneal higher order aberrations, and little is known about the profile of internal HOA (IHOA) in healthy subjects.

Methods

Participants with healthy crystalline lenses were prospective enrolled. The root mean square (RMS) of IHOAs for a pupil diameter of 4 mm were measured with an iTrace aberrometer. Lenticular parameters were measured with a swept source anterior segment optical coherence tomography (AS-OCT). Regression analyses were used to determine factors associated with logarithmic IHOAs.

Results

Sixty-six Chinese participants (132 eyes) ranging from 5 to 59 years were analyzed. Logarithmic IHOA was positively associated with axial length (AL) (coefficient =0.101, P=0.016), and negatively associated with ocular refraction (coefficient =-0.032, P=0.023). Logarithmic internal coma increased by 0.161/mm (P=0.016) as AL became longer and decreased by 0.081/diopter (P<0.001) as ocular refraction became hyperopic. Lens tilt (coefficient =-0.121, P=0.037), decentration (coefficient= 3.027, P=0.003), and radius of anterior lens surface curvature (RAL) (coefficient= 0.096, P=0.026) were associated with logarithmic internal trefoil. lens tilt was also associated with logarithmic internal spherical aberration (coefficient =-0.195, P=0.018) and second astigmatism (coefficient =-0.132, P=0.030). Binocularly, the extent of coma, trefoil was different, while that of spherical aberration, secondary astigmatism was consistent. The vectors of the same type of IHOAs were nearly paralleled.

Conclusions

IHOAs are mainly affected by ocular refraction, RAL, lens tilt and decentration. Intraocular differences and directions of higher-order aberrations follow certain rules, and their effects on visual function warrant further study.

<p>Inter-Ocular Asymmetry in Anterior Corneal Aberrations Using Placido Disk-Based Topography</p>

Objective

Inter-ocular asymmetry in anterior corneal high-order aberrations has previously not been investigated. This study aims to investigate the normal range of inter-ocular asymmetry in corneal high-order aberrations (HOAs) using a Placido disk-based corneal topographer to explore the relationship between the HOA parameters of the anterior corneal for each eye individually and the refractive error.

Patients and Methods

A total of 257 subjects (98 males and 159 females) were participated, with an age range of 6 to 81 years (average of 40.2 ±17.53). Participants were divided into three groups: myopia (spherical equivalent (SEQ) of refraction ≥−0.50 D), hypermetropia (SEQ ≥+0.50 D), and emmetropia. For all patients, high-order aberrations were measured using a corneal topographer (CA.200TM; Topcon). Inter-ocular asymmetry was represented by RMS (root mean square) for three, five, and seven mm as pupil entry; aberrations for five mm pupil (vertical and oblique trefoil, vertical and horizontal comma, and primary spherical aberration) were recorded using the instrument’s built-in software.

Results

Hypermetropes exhibit the highest inter-ocular asymmetry of all RMS values, mostly in spherical aberrations, and higher-order trefoil values. Oblique trefoil aberrations had the highest interocular asymmetry in the myopic groups. The interocular asymmetry in horizontal coma values was the highest in emmetropes and the lowest in hypermetropes.

Conclusion

To our knowledge, this is the first observational study of inter-ocular differences in high-order aberrations of the anterior corneal surface of the human eye. This study’s results could be used to establish normal values of inter-ocular asymmetry of HOAs of the anterior cornea. The use of such normal values should be investigated further to serve as a guideline for clinicians when establishing the best management route for the patient’s refractive error.

Habitual higher order aberrations affect Landolt but not Vernier acuity

To assess whether the eye's optical imperfections are relevant for hyperacute vision, we measured ocular wave aberrations, visual hyperacuity, and acuity thresholds in 31 eyes of young adults. Although there was a significant positive correlation between the subjects' performance in Vernier- and Landolt-optotype acuity tasks, we found clear differences in how far both acuity measures correlate with the eyes' optics. Landolt acuity thresholds were significantly better in eyes with low higher order aberrations and high visual Strehl ratios (r² = 0.22, p = 0.009), and significantly positively correlated with axial length (r² = 0.15, p = 0.03). A retinal image quality metric, calculated as two-dimensional correlation between perfect and actual retinal image, was also correlated with Landolt acuity thresholds (r² = 0.27, p = 0.003). No such correlations were found with Vernier acuity performance (r² < 0.03, p > 0.3). Based on these results, hyperacuity thresholds are, contrary to resolution acuity, not affected by higher order aberrations of the eye.

IMI - Clinical Myopia Control Trials and Instrumentation Report

The evidence-basis based on existing myopia control trials along with the supporting academic literature were reviewed; this informed recommendations on the outcomes suggested from clinical trials aimed at slowing myopia progression to show the effectiveness of treatments and the impact on patients. These outcomes were classified as primary (refractive error and/or axial length), secondary (patient reported outcomes and treatment compliance), and exploratory (peripheral refraction, accommodative changes, ocular alignment, pupil size, outdoor activity/lighting levels, anterior and posterior segment imaging, and tissue biomechanics). The currently available instrumentation, which the literature has shown to best achieve the primary and secondary outcomes, was reviewed and critiqued. Issues relating to study design and patient selection were also identified. These findings and consensus from the International Myopia Institute members led to final recommendations to inform future instrumentation development and to guide clinical trial protocols.

Evaluation of Corneal Higher-Order Aberrations by Scheimpflug-Placido Topography in Patients with Different Refractive Errors: A Retrospective Observational Study

Purpose

To report the characteristics of anterior and posterior corneal high-order aberrations in patients with different refractive errors.

Setting

This study was conducted at Sohag Refractive Center, Sohag, Egypt.

Design

This is a retrospective observational study.

Methods

This study evaluated 750 patients (750 eyes) who were seeking refractive surgery. The eyes were stratified into five groups (150 eyes/group) based on refractive error: mild-to-moderate myopia, high myopia, hyperopia, simple myopic astigmatism, and simple hypermetropic astigmatism. All patients were subjected to comprehensive ophthalmological examination including corneal topography and corneal aberrometry using the Scheimpflug–Placido topography (Sirius, CSO, Italy).

Results

Coma aberration was statistically significant when compared in all five groups (P=0.01). It was highest in the hypermetropia group (0.26 ± 0.12 μm) but lower in the moderate myopia, high myopia, myopic astigmatism, and hypermetropic astigmatism groups. Spherical aberration was lowest in the hypermetropia group and significantly different from that in the other groups. Trefoil was statistically insignificant when all groups were compared (P=0.062) but was highest in the myopic astigmatism group (0.24 ± 0.25 μm). Total RMS peaked in the hypermetropia group (0.99 ± 0.70).

Conclusions

In normal corneas and regular refractive errors, the cornea-induced high-order aberration was minimal, and all types of refractive errors were associated with certain types of high-order aberrations, with a significant increase in spherical aberration in the hypermetropia group.

Clinical Evaluation of LASEK for High Myopia Correction between the Triple-A Profile and the Zyoptix Tissue Saving Profile

Purpose

To compare the effects of correcting high myopia using the MEL®90 Triple-A profile LASEK at a 500 Hz pulse rate (Triple-A group) versus the Zyoptix tissue-saving ablations of Technolas 217z laser platform at 100 Hz (TS group).

Methods

This retrospective study included 50 eyes in the Triple-A group and 42 eyes in the TS group with manifest refraction spherical equivalent (MRSE) of -6 diopters (D) to -10 D. We compared uncorrected distance visual acuity, MRSE, corrected distance visual acuity, and postoperative complications at 1 month, 3 months, and 6 months.

Results

At 6 months after refractive surgery, the efficacy index of Triple-A group was significantly higher than that of the TS group (1.03 ± 0.12 vs 1.00 ± 0.11, P=0.04). The MRSE postoperatively in the Triple-A group was significantly lower than that in the TS group (0.25 ± 0.18 vs 0.38 ± 0.23, P < 0.01). The safety indices in the two groups were almost the same after 6 months of surgery (1.03 ± 0.07 vs 1.04 ± 0.11, P=0.63). The proportion of eyes which achieved ±0.13 D was significantly higher in the Triple-A group than that in the TS group at 1 month (80% vs 59.5%, P=0.03), 3 months (82% vs 61.9%, P=0.03) and 6 months (84% vs 64.3%, P=0.03). The changes in refraction 6 months after surgery comparing with 1 month after surgery were 0.12 ± 0.10 D in the Triple-A group and 0.13 ± 0.08 D in the TS group (P=0.56). All (100%) of the patients in the Triple-A group and 50% of the patients in the TS group had a UDVA of 20/16 at 6 months after surgery (P < 0.01). The induced spherical aberrations and total HOAs in the Triple-A group were significantly lower than those in the TS group (0.17 ± 0.02 μm vs 0.23 ± 0.02 μm, P < 0.01; 0.20 ± 0.04 μm vs 0.39 ± 0.03 μm, P < 0.01) at 6 months after surgery. The mean reduced corneal thickness was 113.06 ± 10.5 μm in the Triple-A profile group and 121.43 ± 23.46 μm in the TS group (P=0.02). No patient in either group had haze and high intraocular pressure 6 months after surgery.

Conclusion

For treatment of high-myopia patients, the Triple-A profile was more effective, predictable, and accurate than the Zyoptix tissue-saving profile. Meanwhile, the Triple-A profile had less induced spherical aberrations, total HOAs, and cornea ablation depth than the Zyoptix tissue-saving profile. Patients in the Triple-A group with 500 Hz pulse rate treatment achieved superior results. The two surgical procedures were equivalent in terms of safety and stability.

Imaging in myopia: potential biomarkers, current challenges and future developments

Myopia is rapidly increasing in Asia and around the world, while it is recognised that complications from high myopia may cause significant visual impairment. Thus, imaging the myopic eye is important for the diagnosis of sight-threatening complications, monitoring of disease progression and evaluation of treatments. For example, recent advances in high-resolution imaging using optical coherence tomography may delineate early myopic macula pathology, optical coherence tomography angiography may aid early choroidal neovascularisation detection, while multimodal imaging is important for monitoring treatment response. However, imaging the eye with high myopia accurately has its challenges and limitations, which are important for clinicians to understand in order to choose the best imaging modality and interpret the images accurately. In this review, we present the current imaging modalities available from the anterior to posterior segment of the myopic eye, including the optic nerve. We summarise the clinical indications, image interpretation and future developments that may overcome current technological limitations. We also discuss potential biomarkers for myopic progression or development of complications, including basement membrane defects, and choroidal atrophy or choroidal thickness measurements. Finally, we present future developments in the field of myopia imaging, such as photoacoustic imaging and corneal or scleral biomechanics, which may lead to innovative treatment modalities for myopia.