Myopia: Histology, clinical features, and potential implications for the etiology of axial elongation

The challenges of diagnosing glaucoma in myopic cases and the important role of Bruch's membrane opening-minimum rim width in the diagnosis of myopic glaucoma

BACKGROUND

Glaucoma is a progressive neurodegenerative disease that can lead to blindness; furthermore, axial myopia is associated with retinal and optic nerve changes that mimic glaucoma. Diagnosing glaucoma in myopic eyes is challenging due to anatomical variations, emphasizing the need for precise OCT-based evaluations.

OBJECTIVE

To evaluate the retinal nerve fiber layer (RNFL) thickness and Bruch's Membrane Opening-Minimum Rim Width (BMO-MRW) parameters in myopic patients with and without glaucoma by using Spectralis® optical coherence tomography (OCT), in order to reveal the relationship between axial length (AL) and OCT parameters and also to determine the OCT parameters that should be considered when diagnosing glaucoma in myopic cases.

MATERIAL AND METHOD

This prospective and cross-sectional study included 95 eyes from 95 cases. There were a total of 54 patients over 40 years of age without any systemic disease or glaucoma, and 41 patients without any systemic disease but with mild or moderate glaucoma, according to the Hodapp staging system. Optical biometry using the Lenstar® 900 and Heidelberg Engineering Spectralis® OCT Glaucoma Module Premium Edition (GMPE) with an anatomic positioning system (APS) were performed on all patients, along with a full ophthalmological examination. The cases were divided into subgroups according to the AL results of optical biometry as short (<24 mm) and long (≥24 mm). The measurement results were recorded and compared statistically.

RESULTS

A total of 54 healthy subjects consisting of 27 with short AL and 27 with long AL were included. In the glaucoma group, 20 out of 41 subjects had short AL, while 21 had long AL. Using measurements in GMPE mode with APS, no statistically significant difference was found between the eyes with the short and long AL in the healthy group, both in terms of global RNFL thickness and BMO-MRW analyses. In the glaucoma group, there was no statistically significant difference between eyes with short and long AL in terms of RNFL and MRW analyses. In the myopic group, the highest AUC value of the RNFL measurements in different circular scans of the GMPE module was found in the inferotemporal area. Using the GMPE software with the APS to measure RNFL thickness, in particular in the inferotemporal quadrant, together with the BMO-MRW, really helped to make a definite diagnosis of glaucoma in myopic patients.

CONCLUSION

In conclusion, utilizing GMPE with APS in the diagnosis of glaucoma provides accurate outcomes in myopic cases. The RNFL thickness and BMO-MRW values of the inferotemporal quadrant are particularly valuable in diagnosing glaucoma in myopic patients.

Correlation of retinal curvature with ocular biometry in patients with myopia

PURPOSE

To evaluate the relationship between retinal curvature (RC) and ocular biometry in patients with myopia.

METHOD

The clinical data of 74 patients with myopia (148 eyes) were retrospectively analyzed. Macular 24×20 mm optical coherence tomography (OCT) scans were acquired using an ultra-widefield swept-source optical coherence tomography (UWF SS-OCT) system. The software then identified the Bruch's membrane and integrated it with the axial length (AL) for morphological correction, yielding a fitted three-dimensional retinal model. From this model, an RC map was generated, detailing the Gaussian curvature at each point. The maximum retinal curvature (RCmax) and central macular retinal curvature (RCc) were analyzed.

RESULTS

A total of 148 eyes were analyzed. The analysis revealed that RCmax was negatively correlated with AL (r=-0.266, P < 0.05) and positively correlated with mean keratometry (Km) (r = 0.285, P < 0.05). RCc was also positively correlated with Km (r = 0.167, P < 0.05), whereas RCmax and RCc were positively correlated with each other (r = 0.450, P < 0.05).

CONCLUSIONS

In eyes with large innate eyeballs (characterized by a smaller Km), the RCmax was smaller, and acquired axial elongation (characterized by a larger AL) led to a reduction in RCmax, and vice versa. Eyes with large innate eyeballs also showed a smaller RCc, and vice versa.

Longitudinal changes in the position and thickness of the peak peripapillary retinal nerve fiber layer in school children

PURPOSE

This study investigated the relationship between changes in the position and thickness of the peak circumpapillary retinal nerve fiber layer (cpRNFL) and axial elongation in schoolchildren.

METHODS

This prospective cohort study involved the right eyes of 75 elementary school students examined over a period of six years (from the age of 8-9 years to 14-15 years). During the first and final years, all participants underwent optical axial length measurements, color fundus photography, and cpRNFL thickness measurements using optical coherence tomography. The supratemporal (ST) and infratemporal (IT) peak angles (ST and IT angle) were defined as those formed by the ST/IT peak position of the cpRNFL curve, the center of the optic disc, and the fovea. The RNFL thickness at the peaks (ST and IT thicknesses) was also determined. The Wilcoxon signed-rank test was used to compare the cpRNFL parameters and axial lengths in the first and final years.

RESULTS

The mean axial length was significantly longer in the final year (24.82 mm) than in the first year (23.34 mm). The mean ST and IT angles were significantly lower in the final year (67.6° and 58.2°) than in the first year (74.2° and 64.0°). The mean IT thickness was significantly greater in the final year (195.1 μm) than in the first year (185.0 μm); however, no significant changes in ST thickness were observed.

CONCLUSION

The ST and IT peaks shifted toward the line connecting the fovea and the center of the optic disc between ages 8-9 and 14-15 years, and IT thickness increased. These changes indicate that nerve fibers are concentrated on the temporal side of the optic disc, especially in the IT area.

KEY MESSAGES

WHAT IS KNOWN : The circumpapillary retinal nerve fiber layer (cpRNFL) in normal eyes exhibits a double-hump pattern, with individual variability in the position of the peaks. Additionally, the mechanisms underlying these differences remain unclear.

WHAT IS NEW

Eyes with greater axial elongation tended to have narrower supratemporal (ST) and infratemporal (IT) angles and increased IT thickness. Greater axial elongation during childhood growth caused a significant shift of the cpRNFL peaks toward the fovea and increased IT thickness. Based on the plate hypothesis, the shift and compression of nerve fibers during growth may serve as a potential predictor of normal-tension glaucoma onset in the future.

Visual field of eyes with peripapillary intrachoroidal cavitation and its association with deep optic nerve head structural changes

PURPOSE

To evaluate the location-specific association of deep optic nerve head (ONH) structures and background characteristics with visual field (VF) sensitivity in eyes with peripapillary intrachoroidal cavitation (PICC).

DESIGN

Prospective cross-sectional study.

SUBJECTS

129 eyes of 93 consecutive cases with PICC determined on fundus photographs and confirmed on optical coherence tomography (OCT).

METHODS

PICC location was determined on ONH-centered OCT radial slices according to Garway-Heath sectors. VF defect (VFD) corresponding to the location of PICC sector was considered absent when the pattern deviation probability plot showed no point with a probability less than 1% within the corresponding 24-2 Humphrey VF sector. Sectoral mean total deviation (TD) was calculated for structure-function analysis. The presence of full thickness retinal defect was determined, and PICC depth and deep ONH parameters were calculated with OCT slices.

MAIN OUTCOME MEASURES

A best-fit multivariable linear mixed model was applied to identify factors associated with sectoral mean TD corresponding to PICC location. Explanatory variables included age, sex, axial length, intraocular pressure, presence of full thickness retinal defect, circumpapillary retinal nerve fiber layer thickness (cpRNFLT), PICC depth, Bruch's membrane opening (BMO) area, scleral flange opening (SFO) area and SFO/BMO offset magnitude.

RESULTS

Among 254 sectors with PICC, 136 sectors (54%) did not present corresponding VFD. Suspected VFD was most frequent in the temporal (34/50, 68%) and inferior temporal (67/104, 64%) sectors. In the best-fit multivariable analysis, worse sectoral TD in the PICC sectors was associated with the presence of full thickness retinal defect (p=0.036) and thinner cpRNFLT (p<0.001) but was not associated with PICC depth or other deep ONH parameters.

CONCLUSIONS

Although PICC alone did not necessarily cause corresponding VFD, PICC in the temporal sectors should be carefully examined for VFD. Full thickness retinal defect, a myopia-induced tissue disruption, and cpRNFL thinning at the PICC location were significantly associated with worse VF, while PICC size and other myopia-related deep ONH structural changes were not. Identification of these factors provides a foundation for understanding VF sensitivity reduction in eyes with characteristic highly myopic ONH changes.

The role of atropine in myopia control: insights into choroidal and scleral mechanisms

In this study, we investigate the inhibitory effects of atropine on the progression of experimental myopia by targeting the functions of the choroid and sclera and exploring its potential therapeutic mechanisms. Form deprivation myopia (FDM) was induced in C57BL/6 mice, with treatment groups receiving atropine. We assessed the effects on ocular morphology, extracellular matrix (ECM) protein expression, choroidal and scleral thickness, and choroidal vascular index (CVI) through histopathology, immunofluorescence, and quantitative quantitative polymerase chain reaction (qPCR). In vitro, mouse scleral fibroblasts (MSFs) were treated with Na2S2O4 to induce hypoxia, followed by atropine treatment. Atropine treatment significantly reduced axial elongation and ECM remodeling in FDM mice, as indicated by a decrease in collagen volume fraction. It restored choroidal and scleral thickness and increased CVI, suggesting improved microcirculation. Atropine also modulated ECM protein expression and reduced the hypoxia marker Hypoxia-Inducible Factor-1α (HIF-1α). In vitro, atropine protected MSFs from hypoxia-induced damage, preserved cytoskeletal integrity, and modulated key signaling pathways, including P53 and β-catenin. These findings suggest that atropine holds promise for controlling myopia progression by improving choroidal microcirculation, reducing scleral hypoxia, and regulating ECM remodeling, supporting its therapeutic application in myopia management.

Sustained Experimental Myopia Exacerbates the Effect of Eye Growth on Retinal Ganglion Cell Density and Function

The aim of this study is to describe the effect that sustained myopic eye growth has on the cellular distribution and function of retinal ganglion cells as myopia progresses over time. Ganglion cell density and the photopic negative response (PhNR) were assessed using immunochemistry and electroretinography (ERG), respectively, on twelve common marmoset eyes (Callithrix jacchus). Myopia was induced in six eyes using negative defocus (three eyes from 2 to 6 months of age, 6-month-old myopes; three eyes from 2 to 12 months of age, 12-month-old myopes). These six treated eyes were compared to six age-matched control eyes. Marmosets induced with myopia for four months showed a reduced pan-retinal ganglion cell density, which continued to decrease in the peripapillary area of marmosets induced with sustained myopia for ten months. Ganglion cell density decreased as a function of axial length. Full-field ERGs revealed a dampening of the PhNR in the 12-month-old, but not 6-month-old myopes. The myopic changes observed in ganglion cell density and retinal function suggest a reorganization of the ganglion cell template during myopia development and progression that increases over time with sustained myopic eye growth and translates into functional alterations at later stages of myopia development in the absence of degenerative changes. It remains unknown whether these changes positively or negatively impact retinal function and health.

PMPred-AE: a computational model for the detection and interpretation of pathological myopia based on artificial intelligence

Introduction

Pathological myopia (PM) is a serious visual impairment that may lead to irreversible visual damage or even blindness. Timely diagnosis and effective management of PM are of great significance. Given the increasing number of myopia cases worldwide, there is an urgent need to develop an automated, accurate, and highly interpretable PM diagnostic technology.

Methods

We proposed a computational model called PMPred-AE based on EfficientNetV2-L with attention mechanism optimization. In addition, Gradient-weighted class activation mapping (Grad-CAM) technology was used to provide an intuitive and visual interpretation for the model's decision-making process.

Results

The experimental results demonstrated that PMPred-AE achieved excellent performance in automatically detecting PM, with accuracies of 98.50, 98.25, and 97.25% in the training, validation, and test datasets, respectively. In addition, PMPred-AE can focus on specific areas of PM image when making detection decisions.

Discussion

The developed PMPred-AE model is capable of reliably providing accurate PM detection. In addition, the Grad-CAM technology was also used to provide an intuitive and visual interpretation for the decision-making process of the model. This approach provides healthcare professionals with an effective tool for interpretable AI decision-making process.

All-trans retinoic acid and fluid transport in myopigenesis

Myopia, or near-sightedness, is rapidly growing in prevalence, with significant long-term implications for ocular health. There is thus great impetus to better understand molecular signaling pathways leading to myopia. We and others have reported that all-trans retinoic acid (atRA) is involved in myopigenic signaling, yet the understanding of how atRA is transported and exerts a myopigenic influence is poor. Here we measured the concentrations of atRA in the serum in wild-type C57BL/6 mice under control conditions and after atRA feeding, previously shown to induce myopia. We also developed a mathematical model that describes fluid fluxes and the advective-diffusive transport of atRA in choroid and sclera, including atRA synthesis in the choriocapillaris, atRA degradation by scleral cells, and binding of atRA to the carrier protein serum albumin. This model, developed for both mice and humans, showed that atRA produced in the choriocapillaris was able to permeate well into the sclera in both mice and humans at biologically-relevant concentrations, and that atRA feeding greatly increased tissue levels of atRA across both the choroid and sclera. We were also able to identify which parameters most influence atRA concentration in ocular tissues, guiding future experimental work. Our findings support atRA's role in myopigenic signaling.

Efficacy of Asymmetric Myopic Peripheral Defocus Lenses in Spanish Children: 24-Month Randomized Clinical Trial Results

Background/Objectives: Asymmetric myopic peripheral defocus lenses (MPDLs) have proven to be effective in slowing the progression of myopia in Spanish children over a period of 12 months. The purpose of this study was to assess the MPDL spectacles' efficacy in slowing myopia progression over a 24-month period in children. Methods: This study extends the follow-up period of the double-masked, prospective, and randomized clinical trial previously published to 24 months. Children from 6 to 12 years were assigned to two groups: a control group wearing spherotorical single vision lenses (SVLs) or a treatment group wearing MPDL lenses. Inclusion criteria included children with myopia less than -0.50 D, astigmatism below 1.50 D, and best-corrected visual acuity of at least 20/20. Participants underwent cycloplegic autorefractive examination and axial length (AL) measurements at the baseline and six and twelve months in the study already published, and twenty-four months later in the present study. Lifestyle factors, including outdoor activities and digital device use, were also assessed. Baseline characteristics, including age, refractive error, and AL, were comparable between groups. Dropout rates were 15.9%, with 14 participants lost to follow-up, distributed equally between the two groups. Results: After 24 months of follow-up, 69 children remained in this study, comprising 34 participants in the SVL cohort and 35 in the MPDL cohort. Over 24 months, the MPDL group showed significantly less AL elongation than the SVL group (0.27 ± 0.23 mm and 0.37 ± 0.24 mm; p = 0.0341). The mean relative AL increase was 1.10 ± 0.95% in the MPDL group, compared to 1.56 ± 1.02% in the SVL group (p = 0.0322). Younger children exhibited faster AL growth, while digital device use and outdoor activities did not affect AL changes. Conclusions: MPDL spectacle lenses substantially slowed myopia progression over a 24-month period, with 28.7% less progression in absolute AL growth and 29.8% in relative AL growth compared to SVL. These results indicate that MPDL lenses are an effective method for slowing myopia progression.

Anatomic Relationship Among Descemet's Membrane, Trabecular Meshwork, Scleral Spur, and Ciliary Muscle

Purpose

The purpose of this study was to examine anatomic relationships between Descemet's membrane (DM) and neighboring tissues.

Methods

Human eyes enucleated due to malignant uveal melanoma were histomorphometrically examined.

Results

In all 50 eyes included in the study (age = 59.2 ± 13.3 years), a cellular tissue (mean thickness at the DM end = 14.2 ± 19.5 µm), originating in the transitional zone, extended into the space between the peripheral DM and corneal stroma for a length of 142 ± 71 µm. This length decreased with the longer part of the DM covered with Hassall-Henle-bodies (beta = -0.30, B = -0.28, 95% confidence interval [CI] = -0.54 to -0.03, P = 0.03) and was not related with age (P = 0.84), axial length (P = 0.94), transitional zone length (P = 0.51), and the DM-scleral spur distance (P = 0.72). The DM thinned toward its end and the DM-like components appeared getting together and merging with transitional zone tissue fibers. The transitional zone length (mean = 267 ± 115 µm) varied from 82 µm to 586 µm, increased with longer DM-scleral spur distance (beta = 0.80, B = 0.67, 95% CI = 0.52 to 0.82, P < 0.001), and was not related with axial length (P = 0.74) or age (P = 0.18). The DM-scleral spur distance (mean = 660 ± 136 µm, range = 302 µm-979 µm) was not related with axial length (P = 0.60) or age (P = 0.06). The scleral spur dimensions (basis = 193 ± 103 µm, height = 151 ± 46 µm, length = 231 ± 75 µm) were not related with the DM-scleral spur distance (all P > 0.35), axial length (all P > 0.07), and age (all P > 0.25). In all eyes, the scleral spur tip was orientated anteriorly, with the longitudinal ciliary muscle inserting at its posterior side.

Conclusions

DM is firmly connected with the transitional zone tissue, and indirectly through the corneoscleral TM, with the scleral spur. With the latter connected through the longitudinal ciliary muscle and Bruch's membrane with the optic disc, the DM is part of an anatomic spherical unit of the globe.

Choroidal thickening and retinal dopamine increase in mice at high altitude

The mechanisms underlying the low incidence of myopia at high altitudes remain unclear. Choroidal thickness and the dopaminergic system have been shown to be closely associated with myopia development. This study aimed to investigate the effects of high altitude exposure on choroidal thickness and the dopaminergic system. Mice were subjected to acute hypobaric hypoxia at an altitude of 5000 m for durations ranging from 2 to 72 h, as well as chronic exposure at an altitude of 3670 m for a period of 3 months. Choroidal thickness was assessed using hematoxylin and eosin (H&E) staining of ocular tissues. The retinal dopamine (DA) levels and its primary metabolite, 3,4-dihydroxyphenylacetic acid (DOPAC), were quantified via high-performance liquid chromatography (HPLC). The expression levels of dopamine D1 receptor (D1R) and dopamine D2 receptor (D2R) were evaluated using immunofluorescence techniques. Study results indicated that choroidal thickness significantly increased after 6 h of high altitude exposure. Retinal dopamine levels showed significant increases in both the 2-10 h and 3 months high altitude groups. Conversely, retinal DOPAC levels decreased in the 2 h and 4 h groups but increased significantly at 72 h. Following high altitude exposure, D1R expression correlated positively with DA levels, while D2R expression exhibited a negative correlation. In conclusion, high-altitude exposure is associated with significant increases in choroidal thickness and retinal DA levels, with D1R and D2R expression patterns varying in response to changes in retinal DA. These findings may represent a key molecular mechanism contributing to the lower incidence of myopia observed at high altitudes.

Prevalence, Features, and Risk Factors of Macular Retinoschisis in High Myopic Population: The Beijing Eye Study 2011

PURPOSE

To investigate the prevalence, features, and risk factors of macular retinoschisis (MRS) in highly myopic eyes and their morphological features in a Chinese population.

DESIGN

Population-based, cross-sectional study. From the Beijing Eye Study 2011, a total of 213 highly myopic eyes from 129 participants were included.

METHODS

All participants underwent spectral-domain optical coherence tomography with a macula cube scan of 30°×30°centered in the fovea. High myopia was defined as a refractive error ≤-6 diopters or an axial length ≥26.0 mm. MRS presence and its subtypes were assessed based on location, and affected retinal layers were evaluated. Prevalence, features, and associated factors of MRS and its subtypes in highly myopic population were assessed.

RESULTS

Of 213 highly myopic eyes (129 participants), MRS was observed in 48 eyes, with a prevalence of 22.5% (95% CI, 16.9-28.6) per eye, or 36 participants with 27.9% (95% CI, 20.5-35.7) per subject. In addition to well-documented factors such as older age and higher myopia, the prevalence of MRS was found to be related with a higher intraocular pressure (P = .013, odds ratio [OR], 1.25; 95% CI, 1.05-1.48), a thinner subfoveal choroidal thickness (P = .006, OR, 0.86; 95% CI, 0.77-0.96), a wider Gamma zone (P = .003, OR, 1.99; 95% CI, 1.05-3.11), the presence of glaucoma (P = .010, OR, 3.37; 95% CI, 1.34-8.48), and the presence of epiretinal membrane (P = .023, OR, 3.13; 95% CI, 1.17-8.36) after multivariate analysis. Eyes with advanced high myopia (P = .021) and wider gamma zone (P = .005) were more likely to develop foveal MRS. Eyes with glaucoma tended to have a higher prevalence of outer retinal MRS compared with inner retinal MRS (60.9% vs 36.0%), although the difference was not statistically significant (P = .06). MRS located in the foveal region or affecting the outer retina was related with a significantly worse best-corrected visual acuity (BCVA) compared with MRS that was perifoveally located or affected other regions (P < .05).

CONCLUSIONS

The prevalence of MRS was 27.9% among the elderly highly myopic population. MRS occurring in the foveal region or involving the outer retina demands increased vigilance due to its significant impact on BCVA. The findings contribute to a deeper understanding of MRS, offering insights into its mechanisms and vision prognosis.

Risk factors for rapid axial length growth in a prospective cohort study of 3-year to 9-year-old Chinese children

AIMS

To identify factors contributing to rapid axial length (AL) growth in children aged 3-9 years.

METHODS

Four thousand four hundred thirty-five children were followed from 2019 to 2022. AL and corneal curvature were measured using an IOLMaster 500, while refractometry and visual acuity were also assessed. Baseline data included demographics and parental myopia status, with annual updates on height, weight and behavioural factors. Latent class growth model was used to discover AL trajectories, whereas multiple logistic regression was used to identify determinants of rapid AL elongation.

RESULTS

For all participants, baseline age and parental myopia influenced AL growth. Specifically, children aged 3-6 years exhibited faster AL elongation when engaging in persistent excessive homework time (OR, 2.86, 95% CI 1.31 to 6.95) and near-work activities (OR, 2.13, 95% CI 1.12 to 4.10). For the 7-9-year group, the risk factors of rapid AL growth included being female (OR, 2.05, 95% CI 1.45 to 2.90) and need myopia correction at baseline (OR, 3.19, 95% CI 2.02 to 5.02). Notably, actively engaging in outdoor activities had a protective effect in the 7-9-year group (OR, 0.65, 95% CI 0.43 to 0.97).

CONCLUSIONS

This study delineates AL growth trajectories in children aged 3-9 years and highlights distinct risk factors for rapid AL growth. These findings underscore the necessity of implementing age-specific strategies for myopia prevention and control.

An Evidence-Based Narrative Review of Scleral Hypoxia Theory in Myopia: From Mechanisms to Treatments

Myopia is one of the dominant causes of visual impairment in the world. Pathological myopia could even lead to other serious eye diseases. Researchers have reached a consensus that myopia could be caused by both environmental and genetic risk factors. Exploring the pathological mechanism of myopia can provide a scientific basis for developing measures to delay the progression of myopia or even treat it. Recent advances highlight that scleral hypoxia could be an important factor in promoting myopia. In this review, we summarized the role of scleral hypoxia in the pathology of myopia and also provided interventions for myopia that target scleral hypoxia directly or indirectly. We hope this review will aid in the development of novel therapeutic strategies and drugs for myopia.

Real-world outcomes on myopia management efficacy of diverse segmented defocus optics (DSDO) and defocus incorporated multiple segments (DIMS) spectacle lenses in Chinese children: An initial 12-month prospective clinical study

PURPOSES

To investigate the 12-month effectiveness of Diverse Segmented Defocus Optics (DSDO) and Defocus Incorporated Multiple Segments (DIMS) spectacle lenses in a real-world clinical population in myopic and pre-myopic Chinese children.

METHODS

About 364 subjects prescribed DSDO or DIMS were enrolled. Axial length (AL) and cycloplegic spherical equivalent refraction (SER) changes over 12 months were measured. The subjects were further divided into age sub-group (6-9; 10-14) and SER sub-group (+0.75D≤SER<-0.50D; -0.50D≤SER<-2.00D; -2.00D≤SER<-4.00D; SER≤-4.0D). Contrast sensitivity and visual experience were also reported. The rate of myopia progression was compared with historical single-vision spectacles (SVS) lenses data to evaluate the effectiveness of the regime.

RESULTS

317 subjects were analyzed. At 12-month, AL changes in the DSDO and DIMS group were 0.16±0.16 mm and 0.21±0.22 mm, respectively (P = 0.0202). DSDO spectacle lenses had better control effect in +0.75D≤SER<-0.50D and SER≤-2.0D sub-groups. The proportion of participants had no greater than 0.20 mm AL elongation was 65.00% and 55.41% of in DSDO and DIMS group separately. Myopia control effect in DSDO group was 47%-69% and 33%-62% in DIMS group compared to historical SVS lenses.

CONCLUSIONS

Both DSDO and DIMS spectacle lenses retarded AL elongation. DSDO showed more stable myopia control effect comparing to DIMS, especially in groups of SER≤-2.0D sub-groups and older patients. DSDO showed initial potential myopia prevention effect in pre-myopic children compared with historical SVS lenses data. However, the small sample and no control group in pre-myopes of this study are key limitations. Further research is needed to confirm and understand DSDO's role for pre-myopic children.

Association of a COL1A1 gene haplotype with pathologic myopia in a Northern Chinese Han population

To investigate the relationship between COL1A1 variations and the susceptibility to pathologic myopia (PM) among the general population in Northern China, we included 525 PM patients and 1105 non-myopic controls. All PM patients underwent comprehensive ophthalmologic examinations. DNA was extracted from peripheral venous blood samples and genotyped using the MassArray System. Statistical analyses, including Hardy-Weinberg equilibrium, χ2 test, and linkage disequilibrium analysis, were conducted to compare the genotypic and allelic distributions of SNPs between PM patients and controls. The results showed no significant differences in the genotypic and allelic distributions of rs2075555, rs2269336, and rs1107946 between the PM and control groups. However, haplotype analysis revealed that the G-G-C and T-C-A haplotypes are risk factors for PM (G-G-C: OR = 1.399, 95% CI = 1.206-1.623, P < 0.001, Pc < 0.001; T-C-A: OR = 1.248, 95% CI = 1.064-1.456, P = 0.007, Pc = 0.021). Although individual SNPs in COL1A1 were not significantly associated with PM, specific haplotypes (G-G-C and T-C-A) were identified as risk factors. This suggests a potential role of COL1A1 in the development of PM.

Structural changes in the retina and choroid in patients with different degrees of myopia

To observe the structural changes of retina and choroid in patients with different degrees of myopia. We recruited 219 subjects with different degrees of myopia for best corrected visual acuity, computer refraction, intraocular pressure, axial length (AL), optical coherence tomography (OCT) imaging, and other examinations. Central macular retinal thickness (CRT), subfoveal choroidal thickness (SFCT), nasal retinal thickness (NRT), temporal retinal thickness (TRT), nasal choroidal thickness (NCT) and temporal choroidal thickness (TCT) were measured by optical coherence tomography. ImageJ software was used to measure the retinal area and choroidal area (CA), and Niblack was used to binarize all OCT images to measure the choroidal vessel area (CVA) and choroidal matrix area (CMA). We found that CRT, SFCT, NRT, TRT, NCT, TCT, CA, CVA, and CMA were significantly reduced in the pathological myopia (PM) group. AL was negatively correlated with NRT, SFCT, CMA, CVA and choroidal stromal index. There was a significant positive correlation between AL and choroidal vascular index. The choroidal vascular index in the PM group was significantly increased compared with the other groups. We established a univariate receiver operating curve to analyze the diagnostic value of all parameters for PM. Spherical equivalent, AL, SFCT, TCT, NCT, CA, CVA, and CMA had high diagnostic value for PM, among which CMA had the highest accuracy. There are changes in choroidal structure in adults with different degrees of myopia. Choroidal thickness, CVA and CMA decrease significantly with the increase of myopia, and are correlated with AL. The decrease of CMA has higher diagnostic value in myopia.

New Horizons in Myopia Management: Bridging Epidemiology and Clinical Innovation

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DNA methylation biomarkers and myopia: a multi-omics study integrating GWAS, mQTL and eQTL data

BACKGROUND

This study aimed to identify DNA methylation biomarkers associated with myopia using summary-data-based Mendelian randomization (SMR).

METHODS

A systematic search of the PubMed, Web of Science, Cochrane Library, and Embase databases was conducted up to March 27, 2024. SMR analyses were performed to integrate genome-wide association study (GWAS) with methylation quantitative trait loci (mQTL) and expression quantitative trait loci (eQTL) studies. The heterogeneity in the dependent instrument (HEIDI) test was utilized to distinguish pleiotropic associations from linkage disequilibrium.

RESULTS

The systematic review identified 26 DNA methylation biomarkers in five studies, with no overlap observed among those identified by different studies. After integrating GWAS with multi-omics data of mQTL and eQTL, six genes were significantly associated with myopia: PRMT6 (cg00944433 and cg15468180), SH3YL1 (cg03299269, cg11361895, and cg13354988), ZKSCAN4 (cg01192291), GATS (cg17830204), NPAT (cg04826772), and UBE2I (cg03545757 and cg08025960).

CONCLUSIONS

We identified six methylation biomarkers associated with the risk of myopia that may be helpful to elucidate the etiology mechanisms of myopia. Further experimental validation studies are required to corroborate these findings.

Distortion-Corrected Posterior Ocular Shape in Myopic Eyes Assessed by Ultrawide OCT Detects Deformations Associated With Vision-Threatening Changes

Purpose

To develop a quantitative tool for assessing the posterior ocular shape using widefield, volumetric optical coherence tomography (OCT) in eyes with myopia.

Methods

This observational, cross-sectional study included 178 eyes from 113 participants. Participants underwent a standardized eye examination, including ocular biometry and a custom ultrawide OCT. True ocular shape was reconstructed by tracing the beam propagation from the system to the posterior eye. Gaussian curvature quantified the localized ocular shape, which was further categorized into five distinct categories. An ocular shape irregularity (OSI) was calculated using principal component analysis. Linear regression with breakpoints analyzed the relationship between ocular shape parameters and axial length (AL).

Results

Increased curvature mean and variance were associated with more severe myopia (P < 0.001). Curvature categories (convex, normal, concave, and highly concave) differed significantly between the groups (all P < 0.001). Their correlations with AL revealed significant breakpoints between 27.1 and 27.2 mm. OSI, as a single metric for quantifying ocular shape distortion, was associated with more severe myopia (P < 0.001), and its correlation with AL revealed a breakpoint at 27.2 mm with a fourfold increase in slope steepness beyond this pivot. Determination of OSI was highly reproducible and could also be obtained with fewer scans.

Conclusions

Eyes exceeding 27.2 mm in length exhibit pronounced shape changes. Our framework can be seamlessly integrated into commercial OCTs for ocular shape deformation detection, which could aid in identifying eyes with pathologic myopia.

Posterior Eye Shape in Myopia

Purpose

To explore prevalence and associated factors of abnormalities of the posterior eye shape in dependence of axial length.

Design

Population-based study.

Participants

Of the participants (n = 3468) of the Beijing Eye Study, we included all eyes with an axial length of ≥25 mm, and a randomized sample of eyes with an axial length of <25 mm.

Methods

Using 30°-wide, serial horizontal, and fovea-centered radial, OCT images, we examined location and depth of the most posterior point of the retinal pigment epithelium/Bruch's membrane line (PP-RPE/BML).

Main Outcome Measures

Prevalence and depth of an extrafoveal PP-RPE/BML.

Results

The study included 366 eyes (314 individuals). On the radial OCT scans, the PP-RPE/BML was located in the foveola in 190 (51.9%) eyes, in 121 (33.1%) eyes in the 6 o'clock part of the vertical meridian (distance to foveola: 1.73 ± 0.70 mm), and in 54 (14.8%) eyes in the 12 o'clock part of the vertical meridian (fovea distance: 2.01 ± 0.66 mm). On the horizontal OCT scans, the PP-RPE/BML was located in the foveola in 304 (83.1%) eyes, between foveola and optic disc in 36 (9.8%) eyes (fovea distance: 1.59 ± 0.76 mm), and temporal to the foveola in 26 (7.1%) eyes (fovea distance: 1.20 ± 0.60 mm). Higher prevalence of an extrafoveal PP-RPE/BML correlated with longer axial length (odds ratio [OR]: 1.55; 95% confidence interval [CI]: 1.28, 1.89), higher corneal astigmatism (OR: 1.78; 95% CI: 1.14, 2.79), and female sex (OR: 2.74; 95% CI: 1.30, 5.77). The curvature of the RPE/BML at the posterior pole was similar to the RPE/BML curvature outside of the posterior pole in 309 (84.4%) eyes, and it was steeper (i.e., smaller curvature radius) in 57 (15.6%) eyes. In these eyes, axial length was longer (24.41 ± 1.78 mm versus 27.74 ± 1.88 mm; P < 0.001).

Conclusions

With longer axial length, the foveola is more often located outside of the geometrical posterior pole. It may be of importance for biometric axial length measurements. An extrafoveal location of the PP-RPE/BML may be due to an axial elongation-associated, meridionally asymmetric enlargement of Bruch's membrane in the fundus midperiphery.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Clinical and anatomical features of myopia

The purpose of the review is to summarize clinical and anatomically-related aspects of myopia. Recent studies have revealed macular atrophy as myopic maculopathy (MMP) stage-4 was accompanied by a central Bruch´s membrane (BM) defect associated with a subretinal proliferation (as sign of previous macular neovascularization). Patchy atrophies (MMP-stage 3) could be differentiated into those without versus with BM defects/subretinal proliferations. BM defects and subretinal proliferations were associated with each other (OR: 78.3; P < 0.001). Fundus tessellation as MMP-stage-1 correlated with visual acuity reduction, suggesting pathological changes already at MMP stage 1, in addition to a leptochoroid as risk factor. Myopic parapapillary beta zone (potentially caused by an axial elongation-related enlargement of the retinal pigment epithelium [RPE] layer opening; characterized by small or no alpha zone, few or no RPE drusen at its border, normal BM thickness) can be differentiated from glaucomatous parapapillary beta zone (characterized by alpha zone, RPE drusen, and thickened BM). The overlying retinal layers extended into the parapapillary zones, deeper than the superficial layers. Prevalence of non-glaucomatous optic neuropathy increased non-linearly with longer axial length in highly myopic eyes and was a major cause for vision loss in high myopia. In patients aged 85 + years, prevalence of MMP stage 3 or 4 in highly myopic eyes (axial length ≥ 26.5 mm) was about 75 %. Myopia was associated with a lower prevalence of diabetic retinopathy, age-related macular degeneration and angle-closure glaucoma, while high myopia, more than moderate myopia, was associated with higher prevalence and incidence of open-angle glaucoma.

PM2.5 Exposure as a Risk Factor for Optic Nerve Health in Type 2 Diabetes Mellitus

(1) Objective: This study investigated the relationship between long-term particulate matter (PM2.5) exposure and optic disc parameters-vertical cup-to-disc ratio (vCDR), vertical optic disc diameter (vDD), and vertical optic cup diameter (vCD)-in patients with type 2 diabetes mellitus (T2DM). (2) Methods: A cross-sectional analysis was conducted using data from 65,750 T2DM patients in the 2017-2018 Shanghai Cohort Study of Diabetic Eye Disease (SCODE). Optic disc parameters were extracted from fundus images, and PM2.5 exposure was estimated using a random forest model incorporating satellite and meteorological data. Multivariate linear regression models were applied, adjusting for confounders including age, gender, body mass index, blood pressure, glucose, time of T2DM duration, smoking, drinking, and physical exercise. (3) Results: A 10 μg/m3 increase in PM2.5 exposure was associated with significant reductions in vCDR (-0.008), vDD (-42.547 μm), and vCD (-30.517 μm) (all p-values < 0.001). These associations persisted after sensitivity analyses and adjustments for other pollutants like O3 and NO2. (4) Conclusions: Long-term PM2.5 exposure is associated with detrimental changes in optic disc parameters in patients with T2DM, suggesting possible optic nerve atrophy. Considering the close relationship between the optic nerve and the central nervous system, these findings may also reflect broader neurodegenerative processes.

Intraocular amphiregulin and axial elongation in non-human adolescent primates

The purpose of the experimental interventional study was to examine the influence of intraocularly applied amphiregulin, a member of the epidermal growth factor (EGF) family, on axial length in young non-human primates. It included three non-human primates (Macaca mulatta), aged 4-6 years. The left eyes received three intravitreal injections of amphiregulin (400ng/50 μl) in intervals of 4 weeks, while the right eyes received three intravitreal injections of phosphate buffered solution (50 μl) at the same time points. Ocular biometry was performed in weekly intervals. At baseline, the left eyes (study eyes) were shorter than the right (control) eyes (20.69 ± 0.21 mm versus 20.79 ± 0.24 mm; P < 0.001), with an inter-eye axial length (AL) difference (left minus right eye) of -0.10 ± 0.23 mm. Inter-eye AL difference increased (P < 0.001) to 0.15 ± 0.18 mm at study end, at 12 weeks after baseline. Axial elongation during the study was higher (P < 0.001) in the left eyes (20.69 ± 0.21 mm to 21.05 ± 0.29 mm or 0.36 ± 0.30 mm) than in the right eyes (20.79 ± 0.24 mm to 20.90 ± 0.31 mm or 0.11 ± 0.17 mm). In a parallel manner, inter-eye difference in vitreous cavity depth combined with lens thickness (left eye minus right eye) increased from -0.04 ± 0.17 mm at baseline to -0.02 ± 0.21 mm (P = 0.02), 0.04 ± 0.10 mm (P = 0.002), and to 0.42 ± 0.67 mm (P < 0.001) at 5, 6, and 12 weeks after baseline, respectively. The results suggest that intravitreally applied amphiregulin as EGF family member led to an increase in axial length in adolescent non-human primates. It supports the hypothesis of amphiregulin as EGF family member being involved in the process of axial elongation.

Genome-Wide Association Analysis Identifies LILRB2 Gene for Pathological Myopia

Pathological myopia (PM) is one of the leading causes of blindness, especially in Asia. To identify the genetic risk factors of PM, a two-stage genome-wide association study (GWAS) and replication analysis in East Asian populations is conducted. The analysis identified LILRB2 in 19q13.42 as a new candidate locus for PM. The increased protein expression of LILRB2/Pirb (mouse orthologous protein) in PM patients and myopia mouse models is validated. It is further revealed that the increase in LILRB2/Pirb promoted fatty acid synthesis and lipid accumulation, leading to the destruction of choroidal function and the development of PM. This study revealed the association between LILRB2 and PM, uncovering the molecular mechanism of lipid metabolism disorders leading to the pathogenesis of PM due to LILRB2 upregulation.

AI-based fully automatic analysis of retinal vascular morphology in pediatric high myopia

PURPOSE

To investigate the changes in retinal vascular structures associated with various stages of myopia by designing automated software based on an artificial intelligence model.

METHODS

The study involved 1324 pediatric participants from the National Children's Medical Center in China, and 2366 high-quality retinal images and corresponding refractive parameters were obtained and analyzed. Spherical equivalent refraction (SER) degree was calculated. We proposed a data analysis model based on a combination of the Convolutional Neural Networks (CNN) model and the attention module to classify images, segment vascular structures, and measure vascular parameters, such as main angle (MA), branching angle (BA), bifurcation edge angle (BEA) and bifurcation edge coefficient (BEC). One-way ANOVA compared parameter measurements between the normal fundus, low myopia, moderate myopia, and high myopia groups.

RESULTS

The mean age was 9.85 ± 2.60 years, with an average SER of -1.49 ± 3.16D in the right eye and - 1.48 ± 3.13D in the left eye. There were 279 (12.38%) images in the normal group and 384 (16.23%) images in the high myopia group. Compared with normal fundus, the MA of fundus vessels in different myopic refractive groups was significantly reduced (P = 0.006, P = 0.004, P = 0.019, respectively), and the performance of the venous system was particularly obvious (P < 0.001). At the same time, the BEC decreased disproportionately (P < 0.001). Further analysis of fundus vascular parameters at different degrees of myopia showed that there were also significant differences in BA and branching coefficient (BC). The arterial BA value of the fundus vessel in the high myopia group was lower than that of other groups (P = 0.032, 95% confidence interval [CI], 0.22-4.86), while the venous BA values increased (P = 0.026). The BEC values of high myopia were higher than those of low and moderate myopia groups. When the loss function of our data classification model converged to 0.09, the model accuracy reached 94.19%.

CONCLUSION

The progression of myopia is associated with a series of quantitative retinal vascular parameters, particularly the vascular angles. As the degree of myopia increases, the diversity of vascular characteristics represented by these parameters also increases.

Macula Characteristics in Young Saudi Male Patients with Myopia: A Comparative Hospital-Based Study

BACKGROUND

Myopia is associated with changes in the posterior segment of the eye, including the macula, which may contribute to potential blindness. Therefore, the study aims to evaluate the macula integrity in young myopic patients through optical coherence tomography (OCT).

METHODS

A cross-sectional study was conducted at Qassim University optometry clinics from January to June 2024, involving 30 healthy young males with myopia and 30 with emmetropia. Clinical examination and OCT imaging were used to gather data on macular volume and thickness. The results were analyzed using descriptive statistics and correlation analysis.

RESULTS

The study included 60 myopic eyes and 60 emmetropic eyes. The participants' mean age was 22.10 ± 1.65 years (p = 0.135). A significant difference was found between myopic and emmetropic eyes in fovea, parafovea, perifovea, and total macula thickness and volume (P < 0.05). Additionally, the study showed a significant positive correlation between the magnitude of myopia and fovea thickness (r = 0.297, p = 0.011) and negative correlations with perifovea thickness (r = -0.418, p < 0.001), total macula thickness (r = -0.353, p = 0.003), and total macula volume (r = -0.352, p = 0.003). However, parafoveal thickness had no significant correlation with the severity of myopia (r= -0.107; p=0.207). Fovea thickness was higher in high myopia (255.40 ± 23.51 µm) compared to low (238.69 ± 15.98 µm) and moderate (248.15 ± 8.70 µm) myopia. Perifovea thickness, macula thickness, and macula volume were significantly lower in high myopia (p ˃ 0.05).

CONCLUSION

Myopia influences macular parameters compared to emmetropia. It increases fovea thickness and decreases total macula thickness and volume as well as perifovea thickness. High myopia has more alterations in macula parameters.

Platelet-rich Fibrin Membrane Transplantation for the Treatment of Highly Myopic Macular Hole Retinal Detachment

INTRODUCTION

Highly myopic macular hole retinal detachment (MHRD) is often associated with a poor prognosis, and there is currently no optimal treatment. Platelet-rich fibrin (PRF), an autologous blood product, has been shown to promote tissue regeneration. This prospective, randomized, controlled study investigated the efficacy of conventional internal limiting membrane (ILM) peeling versus PRF membrane transplantation in highly myopic MHRD.

METHODS

Eyes with highly myopic MHRD were randomly assigned to either a conventional ILM peeling group (IP group, n = 19) or a PRF membrane transplantation group (PMT group, n = 21). The study followed participants for a period of 6 months. The primary outcome measure was macular hole (MH) closure assessed using optical coherence tomography. Secondary outcomes included best-corrected visual acuity (BCVA), central retinal thickness (CRT), superficial vascular density (SVD), deep vascular density (DVD), rate of retinal reattachment, and any complications encountered.

RESULTS

MH closure was achieved in a significantly greater proportion of eyes in the PMT group (21/21, 100.00%) compared to the IP group (15/19, 78.95%) (P = 0.042). Retinal reattachment was accomplished in all patients (100.00%) within both groups. Except for an insignificant difference in BCVA observed at 1 week post-surgery in the IP group, significant improvements in BCVA and CRT were documented in both groups across all other post-operative time points. Final BCVA (P = 0.040), CRT (P = 0.002), SVD (P = 0.002), and DVD (P = 0.013) were all significantly higher in the PMT group compared to the IP group. No serious complications were identified in either group.

CONCLUSIONS

This study demonstrated the superiority of PRF membrane transplantation compared to conventional ILM peeling in promoting MH closure and enhancing retinal vascular density in patients with highly myopic MHRD. Additionally, PRF membrane transplantation effectively restores retinal reattachment, improves visual function, and increases retinal thickness without introducing additional complications.

TRIAL REGISTRATION NUMBER

www.

CLINICALTRIALS

gov , NCT06200727.

Exploration of Choroidal Thinning Located Temporal to the Fovea: A Pilot Study

Background/Objectives: Posterior staphyloma (PS) is a hallmark of pathological myopia, corresponding to a circumscribed outpouching of the eyeball with choroidal thinning and inward scleral deformation at its edges. Its pathogenesis is still unclear, thus constituting a research priority as the prevalence of myopia is increasing worldwide. Recently, it has been suggested that the optic nerve sheaths or oblique muscles are potential promoters of PS through the traction or compression effect that they apply to the eye wall. The inferior oblique muscle (IOM) inserts 1-2 mm from the macula. The projection of its insertion is accessible using Optical Coherence Tomography (OCT). Before launching prospective studies, we sought to detect any choroidal thinning (ChT) in the temporal vicinity of the macula and to measure the distance between it and the fovea (FT-distance). Methods: This retrospective cross-sectional pilot study included 120 eyes. Using Spectralis®-OCT, the area centered by the Bruch's membrane opening-fovea axis was analyzed for ChT and FT-distance. Results: Of the 112 defined eyes, 70% (78 eyes) had ChT. Pachymetry was significantly thinner (p = 0.018) in eyes with than without ChT. The mean FT-distance was 3601.9 ± 93.6 µm. Conclusions: The location of ChT coincided with the insertion distance of the IOM, suggesting a link between them. The association between the presence of ChT and a thinner pachymetry suggests a reduced scleral resistance, as a thinner pachymetry is related to a thinner sclera. Our results suggest a link between ocular deformation and the IOM, which may be relevant for the pathogenesis of PS, warranting further investigation.

Myopia and Other Refractive Error and Their Relationships to Glaucoma Screening

PRCIS

A large disk, a large parapapillary delta zone and a long axial length may be used as screening criteria to detect glaucomatous optic neuropathy in highly myopic eyes.

PURPOSE

To describe aspects for screening of glaucomatous optic neuropathy in dependence of refractive error, under special consideration of high myopia.

METHODS/RESULTS

Studies on the anatomy of the myopic optic nerve head and results of investigations on the relationship between glaucomatous optic neuropathy and axial myopia were included.

CONCLUSIONS

In the range from hyperopia to moderate myopia, refractive error is not a strong glaucoma risk factor and may not be included in glaucoma screening strategies. Care should be taken, that in moderate myopia, a shift of Bruch´s membrane opening usually into the temporal direction leads to parapapillary gamma zone and a corresponding shortening of the horizontal disk diameter. In these moderately myopic eyes, a secondarily small optic disk with a correspondingly small optic cup should not lead to an overlooking of intrapapillary glaucomatous changes. Prevalence of glaucomatous or glaucoma-like optic nerve atrophy (GOA) steeply increases with longer axial length in highly myopic eyes (cutoff approximately -8 diopters/axial length 26.5 mm), with prevalences higher than 50% in extremely high myopia. Besides longer axial length, morphological parameters associated with GOA in highly myopic eyes are a secondarily enlarged disk and large parapapillary delta zone. Both parameters, together with long axial length, may be used as screening criteria in high myopia for GOA. The latter is characterized by an abnormal neuroretinal rim shape, that is, vessel kinking close to the intrapapillary disk border. Factors associated with nonglaucomatous optic neuropathy are larger gamma zone and longer axial length, potentially due to an axial elongation-related retinal nerve fiber stretching.

Myopia and Rate of Peripapillary Retinal Nerve Fiber Layer Thickness in Diabetic Patients Without Retinopathy: A 2-Year Longitudinal Study

PURPOSE

The aim of this study was to investigate the association between myopia and longitudinal changes in peripapillary retinal nerve fiber layer (pRNFL) thickness in type 2 diabetic patients without diabetic retinopathy (DR).

METHODS

A total of 1069 participants with a median follow-up time of 1.9 years were included in this study. The participants were categorized into four groups based on the presence of myopia (≤ -0.5 diopter [D]) and diabetes without DR, including a control group (n = 412), diabetes group (n = 416), myopia group (n = 115), and diabetes + myopia group (n = 126). Peripapillary average and sectoral RNFL measurements were obtained using 6 × 6 mm swept-source optical coherence tomography (SS-OCT) scans centered at the optic disc. The change rate of pRNFL, adjusted for age and sex, was calculated and compared among the four groups to investigate the impact of myopia and diabetes.

RESULTS

The baseline estimated pRNFL thickness after adjustment for covariates was 113.7 μm, 116.2 μm, 108.0 μm, and 105.6 μm in the control, diabetes, myopia, and diabetes + myopia group, respectively (diabetes > control > myopia = diabetes + myopia, p < 0.001). The respective average pRNFL loss in the four groups was -0.48 μm/year, -1.11 μm/year, -1.23 μm/year, and -2.62 μm/year (all p < 0.01). The diabetes + myopia group exhibited a greater rate of average pRNFL reduction compared to the other groups (all p < 0.001). Multivariate analysis using a linear mixed-effects model showed that age, diabetes, axial length (AL), and baseline pRNFL thickness were significantly associated with the rate of average pRNFL reduction.

CONCLUSIONS

The diabetes group showed a faster rate of average pRNFL thickness reduction compared to healthy controls, regardless of the presence of myopia. The average pRNFL thickness decreased more rapidly when diabetes and myopia were present simultaneously than in the individual diabetes or myopia group. Both diabetes and myopia were associated with accelerated pRNFL loss.

Bruch's Membrane Opening Changes in Eyes With Myopic Macular Degeneration: AIER-SERI Adult High Myopia Study

Purpose

The purpose of this study was to assess the choroidal thickness and the Bruch's membrane opening size and their relationship to visual acuity in eyes with myopic macular degeneration (MMD).

Methods

This was a population-based, cross-sectional study. Patients over the age of 30 years with high myopia (spherical equivalent ≤-5 diopters [D]) were recruited. The eyes were grouped according to the International Meta-Analysis for Pathologic Myopia (META-PM) classification based on fundus photographs and diffuse atrophy was subdivided into peripapillary diffuse choroidal atrophy (PDCA) or macular diffuse choroidal atrophy (MDCA). Swept-source optical coherence tomography imaging was performed and then the subfoveal choroidal thickness (SFCT) and Bruch's membrane opening diameter (BMOD) were measured.

Results

Of the 470 study participants recruited, 373 patients (691 eyes), with a mean age of 42.8 ± 7.2 years, were eligible for the study and included in the analysis. There was no significant difference in SFCT between MDCA and patchy atrophy (M3) groups (P = 1.000), and the BMOD enlarged significantly from no myopic macular lesions to M3 (the P values of multiple comparison tests were all <0.005). Simple linear regression analysis showed that BMOD correlated positively with age (P < 0.001) and axial length (P < 0.001). Multiple linear regression analysis showed that best corrected visual acuity (BCVA) was significantly correlated with age (P = 0.041), axial length (P = 0.001), and BMOD (P = 0.017), but not with SFCT (P = 0.231).

Conclusions

The significant variation of BMOD among MMD groups and the correlation between BMOD and BCVA in MMD eyes suggest that BMOD may be an imaging biomarker for monitoring MMD.

Association Between Myopia and Pupil Diameter in Preschoolers: Evidence from a Machine Learning Approach Based on a Real-World Large-Scale Dataset

INTRODUCTION

Previous studies have explored the connections between various ocular biological parameters with myopia. Our previous study also found that pupil data can predict the myopic progression during the interventions for myopia. However, studies exploring the association between pupil diameter and myopia in preschoolers with myopia were lacking. Hence this study was aimed to investigate the association between pupil diameter and myopia in preschoolers with myopia based on a real-world, large-scale dataset.

METHODS

Data containing 650,671 preschoolers were collected from a total of 1943 kindergartens in Shenzhen, China. Refraction and pupil parameters were collected. After data filtering, the occurrence of myopia and its association with age, gender, pupil diameter, and other variables, were analyzed. Random forest (RF) and eXtreme gradient boosting (XGBoost) were selected from seven machine learning algorithms to build the model. The mean decrease accuracy (MDA), mean decrease Gini (MDG), and gain feature importance (GFI) techniques were employed to quantify the importance of pupil diameter and other features.

RESULTS

After the assessments, 51,325 valid records with complete pupil data were included, and 3468 (6.76%) were identified as myopia based on the calculated cycloplegic refraction. Preschoolers with myopia presented reduced pupil diameter and greater variation (5.00 ± 0.99 mm) compared to non-myopic preschoolers (6.22 ± 0.67 mm). A nonlinear relationship was found according to the scatterplots between pupil diameter and refraction (R2 = 0.14). Especially preschoolers with myopia had reduced pupil diameter compared to emmetropic preschoolers, but hyperope did not experience additional pupil enlargement. After adjusting for other covariates, this relationship is still consistent (P < 0.001). XGBoost and RF algorithms presented the highest performance and validated the importance of pupil diameter in myopia.

CONCLUSIONS

Based on a real-world large-scale dataset, the current study illuminated that preschoolers with myopia had a reduced pupil diameter compared to emmetropic preschoolers with a nonlinear pattern. Machine learning algorithms visualized and validated the pivotal role of pupil diameter in myopia.

TRIAL REGISTRATION

chictr.org Identifier: ChiCTR2200057391.

Forecasting Myopic Maculopathy Risk Over a Decade: Development and Validation of an Interpretable Machine Learning Algorithm

Purpose

The purpose of this study was to develop and validate prediction model for myopic macular degeneration (MMD) progression in patients with high myopia.

Methods

The Zhongshan High Myopia Cohort for model development included 660 patients aged 7 to 70 years with a bilateral sphere of ≤-6.00 diopters (D). Two hundred twelve participants with an axial length (AL) ≥25.5 mm from the Chinese Ocular Imaging Project were used for external validation. Thirty-four clinical variables, including demographics, lifestyle, myopia history, and swept source optical coherence tomography data, were analyzed. Sequential forward selection was used for predictor selection, and binary classification models were created using five machine learning algorithms to forecast the risk of MMD progression over 10 years.

Results

Over a median follow-up of 10.9 years, 133 patients (20.2%) showed MMD progression in the development cohort. Among them, 69 (51.9%) developed newly-onset MMD, 11 (8.3%) developed patchy atrophy from diffuse atrophy, 54 (40.6%) showed an enlargement of lesions, and 9 (6.8%) developed plus signs. Top six predictors for MMD progression included thinner subfoveal choroidal thickness, longer AL, worse best-corrected visual acuity, older age, female gender, and shallower anterior chamber depth. The eXtreme Gradient Boosting algorithm yielded the best discriminative performance (area under the receiver operating characteristic curve [AUROC] = 0.87 ± 0.02) with good calibration in the training cohort. In a less myopic external validation group (median -5.38 D), 48 patients (22.6%) developed MMD progression over 4 years, with the model's AUROC validated at 0.80 ± 0.008.

Conclusions

Machine learning model effectively predicts MMD progression a decade ahead using clinical and imaging indicators. This tool shows promise for identifying "at-risk" high myopes for timely intervention and vision protection.

Retinal Changes From Hyperopia to Myopia: Not All Diopters Are Created Equal

Purpose

To quantitatively characterize retinal changes across different quantiles of refractive error in 34,414 normal eyes of 23,064 healthy adults in the UK Biobank.

Methods

Twelve optic disc (OD), foveal and vascular parameters were derived from color fundus photographs, correcting for ocular magnification as appropriate. Quantile regression was used to test the independent associations between these parameters and spherical equivalent refraction (SER) across 34 refractive quantiles (high hyperopia to high myopia)-controlling for age, sex and corneal radius.

Results

More negative SER was nonlinearly associated with greater Euclidian (largely horizontal) OD-fovea distance, larger OD, less circular OD, more obliquely orientated OD (superior pole tilted towards the fovea), brighter fovea, lower vascular complexity, less tortuous vessels, more concave (straightened out towards the fovea) papillomacular arterial/venous arcade and wider central retinal arterioles/venules. In myopia, these parameters varied more strongly with SER as myopia increased. For example, while every standard deviation (SD) decrease in vascular complexity was associated with 0.63 D (right eye: 95% confidence interval [CI], 0.58-0.68) to 0.68 D (left eye: 95% CI, 0.63-0.73) higher myopia in the quantile corresponding to -0.60 D, it was associated with 1.61 D (right eye: 95% CI, 1.40-1.82) to 1.70 D (left eye: 95% CI, 1.56-1.84) higher myopia in the most myopic quantile. OD-fovea angle (degree of vertical separation between OD and fovea) was found to vary linearly with SER, but the magnitude was of little practical importance (less than 0.10 D variation per SD change in angle in almost all refractive quantiles) compared with the changes in OD-fovea distance.

Conclusions

Several interrelated retinal changes indicative of an increasing (nonconstant) rate of mechanical stretching are evident at the posterior pole as myopia increases. These changes also suggest that the posterior pole stretches predominantly in the temporal horizontal direction.

Global prevalence of myopic macular degeneration in general population and patients with high myopia: A systematic review and meta-analysis

The prevalence of myopic macular degeneration (MMD) in the general population and patients with high myopia worldwide has not been fully investigated. Therefore, we screened all population-based studies that reported the prevalence of MMD, and pooled prevalence of MMD using a random-effect model. Subgroup analyses were performed to explore the differences in MMD prevalence in the general population and patients with high myopia according to ethnicity, region of residence (urban/rural), and grading system. Finally, 16 studies were included in this meta-analysis. Results obtained from 2,963 patients from seven countries on four continents indicated that the pooled prevalence of MMD in patients with high myopia was 49.0% (95% CI: 31.5%-66.7%). Results obtained from 71,052 participants from 10 countries on four continents suggested that the pooled prevalence of MMD in the general population was 1.7% (95% CI: 1.1%-2.6%). In the general population, living in urban areas and East Asians were associated with a high prevalence of MMD. Among patients with high myopia, only East Asians were at a higher risk of developing MMD. In conclusion, MMD was particularly prevalent in patients with high myopia. Compared with Europeans, East Asians (Chinese and Japanese) have a higher propensity of developing MMD, both in the general population and in patients with high myopia. It remains unclear whether the higher prevalence of MMD in patients with high myopia in East Asia is caused by differences in given age or given degree of myopia.Systematic review registration number: 202270014 (INPLASY.COM).

Degradation of Photopic and Mesopic Contrast Sensitivity Function in High Myopes With Partial Posterior Vitreous Detachment

Purpose

The purpose of this study was to evaluate the effects of posterior vitreous detachment (PVD) on visual quality in patients with high myopia, as well as investigate the associated factors of photopic and mesopic contrast sensitivity function (CSF) in high myopia.

Methods

Visual quality was comprehensively assessed in patients with high myopia. Visual acuity, contrast sensitivity (CS) at four spatial frequencies (3, 6, 12, and 18 cycles per degree [c.p.d.]) under photopic and mesopic conditions, as well as the modulation transfer function cutoff value (MTFcutoff), the objective scatter index (OSI), the Strehl ratio (SR), and internal aberrations, were measured in this cross-sectional study.

Results

This study included 94 eyes from 47 subjects with bilateral high myopia, including 23 eyes with complete PVD (cPVD), 21 eyes with partial PVD (pPVD), and 50 eyes without PVD (nPVD). There was no significant difference in visual quality between the cPVD group and the nPVD group. Whereas in eyes with pPVD, there was a degradation of overall photopic CSF (versus nPVD, P = 0.048), photopic CS at 3 c.p.d. (versus cPVD, P = 0.009 and versus nPVD, P = 0.032), photopic CS at 18 c.p.d. (versus nPVD, P = 0.033), overall mesopic CSF (versus nPVD, P = 0.033), and secondary astigmatism (versus cPVD, P = 0.044). Under photopic conditions, the factors affecting CSF were pPVD and SR, whereas the factors affecting mesopic CSF were pPVD, OSI, and ganglion cell-inner plexiform layer thickness.

Conclusions

The pPVD impaired visual quality in patients with high myopia compared to nPVD or cPVD, and pPVD could be a factor explaining CSF at both photopic and mesopic illumination.

Translational Relevance

Clinicians need to closely monitor patients with high myopia with pPVD due to the potential decline in visual quality and the development of vitreoretinal disorders.

Prevalence of Myopic Maculopathy Among the Very Old: The Ural Very Old Study

Purpose

To assess the prevalence of myopic macular degeneration (MMD) in very old individuals.

Methods

The population-based Ural Very Old Study (UVOS) included 1526 (81.1%) of 1882 eligible inhabitants aged ≥85 years. Assessable fundus images were available for 930 (60.9%) individuals (mean age, 88.6 ± 2.7 years). MMD was defined by macular patchy atrophies (i.e., MMD stage 3 and 4 as defined by the Pathologic Myopia Study Group).

Results

MMD prevalence was 21 of 930 (2.3%; 95% CI, 1.3-3.3), with 10 individuals (1.1%; 95% CI, 0.4-1.7) having MMD stage 3 and 11 participants (1.2%; 95% CI, 0.5-1.9) MMD stage 4 disease. Within MMD stage 3 and 4, prevalence of binocular moderate to severe vision impairment was 4 of 10 (40%; 95% CI, 31-77) and 7 of 11 (64%; 95% CI, 30-98), respectively, and the prevalence of binocular blindness was 2 of 10 (20%; 95% CI, 0-50) and 3 of 11 (27%; 95% CI, 0-59), respectively. In minor myopia (axial length, 24.0 to <24.5 mm), moderate myopia (axial length, 24.5 to <26.5 mm), and high myopia (axial length, ≥26.5 mm), MMD prevalence in the right eyes was 0 of 46 eyes (0%), 3 of 40 eyes (8%; 95% CI, 0-16), and 7 of 9 (78%; 95% CI, 44-100), respectively; MMD prevalence in the left eyes was 1 in 48 eyes (2%; 95% CI, 0-6), 4 of 36 eyes (11%; 95% CI, 0-22), and 3 of 4 eyes (75%; 95% CI, 0-100), respectively. In multivariable analysis, a higher MMD prevalence (odds ratio, 8.89; 95% CI, 3.43-23.0; P < 0.001) and higher MMD stage (beta, 0.45; B, 19; 95% CI, 0.16-0.22; P < 0.001) were correlated with longer axial length but not with any other ocular or systemic parameter.

Conclusions

MMD prevalence (stages 3 and 4) in very old individuals increased 8.89-fold for each mm axial length increase, with a prevalence of ≥75% in highly myopic eyes. In old age, highly myopic individuals have a high risk of eventually developing MMD with marked vision impairment.

Association between Axial Length to Corneal Curvature Radius Ratio and Myopia in Adult Patients

Purpose

To analyze the distribution characteristics of axial length to corneal curvature radius ratio (AL/CR) and other ocular biometric parameters in adult myopia patients and their association with myopia.

Methods

A cross-sectional study was conducted among patients with no eye diseases except ametropia who attended the optometry clinic of the First Affiliated Hospital of Hainan Medical College from January 2022 to June 2022. In total, 187 eyes (right eye) of 187 myopic patients aged 18-35 years were selected by random sampling. Based on the results of spherical equivalent (SE, (D)) obtained by postdilation optometry, all subjects were divided into three groups: mild myopia (≤-0.50D and >-3.00D, 42 eyes), moderate myopia (≤-3.00D and >-6.00D, 80 eyes), and high myopia (≤-6.00D, 65 eyes). The axial length (AL), corneal curvature radius (CR), and AL/CR were measured and compared between the three groups. The association between AL and AL/CR of the eye and SE was analyzed by multiple linear regression. Also, the predictive ability of AL/CR for high myopia was investigated by ROC curve.

Results

There were no statistically significant differences in age, gender, or intraocular pressure between the three groups. The mean values of AL/CR in mild, moderate, and high myopia groups were 3.17 ± 0.06, 3.31 ± 0.08, and 3.43 ± 0.10, respectively, and the difference between the groups was statistically significant (P < 0.001). Linear regression analysis showed that both AL and AL/CR were strongly negatively correlated with SE (P < 0.05), while CR had a weak positive correlation with SE without statistically significant differences (P > 0.05). The adjusted linear regression equation shows that for every 0.1 unit increase in AL/CR, SE increases by 1.54 D. Compared with 0.830 (95% confidence interval: 0.769 to 0.900) for AL, the area under ROC curve of AL/CR was 0.896 (95% confidence interval: 0.851 to 0.941), indicating that the diagnostic value of AL/CR for high myopia was higher than that of AL (P <  0.01). When the Youden index reached its maximum (0.626), the AL/CR cutoff point was 3.309, and the sensitivity and specificity were 0.954 and 0.672, respectively.

Conclusion

This study showed that AL and AL/CR in adult myopia patients were significantly negatively correlated with SE, and the corralation between AL/CR and SE is greater than that between AL and SE. Therefore, AL/CR can be used to analyze the dynamic changes of SE in the development of adult myopia independently of optometry on a certain basis, and it is especially suitable for the diagnosis of high myopia in adults. This trial is registered with ChiCTR2300069070.

Influencing factors comparing different vault groups after phakic implantable collamer lens implantation: review and meta-analysis

BACKGROUND

Studies on the factors affecting vault after posterior chamber phakic Implantable Collamer Lens (ICL) have been carried out, but most of them are single-centered and subjective selections of parameters. The present study aimed to systematically analyze the factors for vault.

METHODS

A systematic review of case series, case-control, and cohort studies derived from the articles published in PubMed, the Cochrane Library, Embase, Web of Science, CNKI, CBM, Wanfang and VIP, as well as ClinicalTrials, which were conducted to search for studies on factors of vault using four core terms: phakic intraocular lenses, vault, risk factor and observational study, from January 01, 1997, to February 20, 2023. The included studies were meta-analyzed quantitatively and described qualitatively. Subsequently, meta-regression and subgroup analysis were used.

RESULTS

We identified 13 studies (1,607 subjects), and 14 factors were considered. Meta-analysis showed that anterior chamber depth (ACD), horizontal corneal white-to-white (hWTW), ICL-size, and age are dual effects of the abnormal vaults; anterior chamber volume (ACV) and lens thickness (LT) are a one-way effect; while axial length (AL), ICL- spherical equivalent (ICL-SE) and Km are insignificant. In addition, descriptive analysis of anterior chamber angle (ACA), horizontal sulcus to sulcus (hSTS), ciliary processes height (T value), crystalline lens rise (CLR), and gender showed that all factors except gender tend to have significant effects on vault. Sensitivity analysis showed stable combined results. Country and design respectively affect the heterogeneity in ACD and ICL-size at low vault, while design affects the heterogeneity in ACD at high vault. No publication bias exists.

CONCLUSIONS

Vault after ICL is related to multiple factors, especially anterior segmental biologic parameters, and they are weighted differently. We hope to provide a reference for the selection and adjustment of ICL.

Effectiveness of a Spectacle Lens with a Specific Asymmetric Myopic Peripheral Defocus: 12-Month Results in a Spanish Population

BACKGROUND

Different designs of ophthalmic lenses have been studied to control the progression of myopia in children. This study aims to evaluate the short-term efficacy of a new design of ophthalmic lens with asymmetric myopic peripheral defocus (MPDL) on myopia progression in children compared to a control group wearing a single-vision lens (SVL).

METHODS

Children aged 5 to 12 with myopia up to -0.50 D, astigmatism and anisometropia under 1.50 D, and corrected visual acuity over 20/20 were randomized to either the study group (MPDL) or control group (SVL). The myopia progression was evaluated by measuring axial length (AL) growth (IOL Master; Zeiss) over a period of one year.

RESULTS

Ninety-two subjects were recruited. Forty-six children were randomly assigned to the control group, and 46 to the study group. In total, 83 children completed the clinical trial, with a mean age of 10.81 [9.53-11.92] years, among which 59.04% were female. After one year of treatment, there was less AL elongation in the study group compared to the control group (0.14 ± 0.14 mm vs. 0.23 ± 0.15 mm, p = 0.014).

CONCLUSIONS

The MPDL significantly reduced the absolute growth of AL by 39% (p = 0.014) and relative growth of AL by 37.3% (p = 0.012) after 12 months in comparison to the control group in a Spanish population.

A Novel Exploration of the Choroidal Vortex Vein System: Incidence and Characteristics of Posterior Vortex Veins in Healthy Eyes

Purpose

The purpose of this study was to investigate the incidence and characteristics of posterior vortex veins (PVVs) in healthy eyes and explore their relationship with age and refractive status.

Methods

This retrospective cross-sectional analysis encompassed 510 eyes from 255 consecutive healthy participants. Wide-field optical coherence tomography angiography (WF-OCTA) imaging was used to assess the presence of PVVs. Eyes were classified according to refractive status (emmetropia, low and moderate myopia, and high myopia) and age (minors and adults). The incidence and characteristics of eyes with PVVs were analyzed.

Results

Participants (mean age = 30.60 ± 21.12 years, 47.4% men) showed a mean refractive error of -2.83 ± 3.10 diopters (D; range = -12.00 to +0.75). PVVs were observed in 16.1% (82/510) of eyes. Of these, 39% (32/82) had PVVs in one eye and 61% (50/82) in both eyes. The mean number of PVVs per eye was 1.65 ± 1.05 (range = 1-6). PVVs are mainly around the optic disc (78%, 64/82) of eyes with PVVs and less in the macular area (6.1%, 5/82) or elsewhere (15.9%, 13/82). PVV incidence correlated with refractive status: 10.3% (22/213) in emmetropia, 16.6% (31/187) in low and moderate myopia, and 26.4% (29/110) in high myopia (P = 0.001), but not with age. Refractive status was the key predictor of PVV occurrence (odds ratio [OR] = 1.45, 95% confidence interval [CI] = 1.02-2.06, P = 0.038).

Conclusions

This study confirms PVVs' presence in healthy eyes, highlighting their inherent existence and susceptibility to alterations due to refractive conditions. These findings enhance our understanding of the vortex vein system and its distribution within the eyes.

Bruch's membrane and Brücke's muscle in the pars plana region

PURPOSE

To examine Bruch's membrane (BM) in association with the longitudinal part of the ciliary muscle (LPCM) in the pars plana region.

METHODS

Using light microscopy, we histomorphometrically assessed BM and the LPCM in the pars plana region.

RESULTS

The histomorphometric study included 51 eyes (51 patients; mean age: 60.8 ± 15.0 years; axial length: 26.0 ± 3.3 mm; range: 21.0-36.0 mm). The LPCM (total length: 4.60 ± 1.10 mm) ended 1.15 ± 0.56 mm anterior to the ora serrata. Within the pars plana region, the LPCM (length: 2.58 ± 0.98 mm) had direct contact with BM for 1.95 ± 0.99 mm (71.1 ± 18.4% of the BM undersurface), while a capillary layer was interposed between the BM and the LPCM for 0.70 ± 0.40 mm (29.0 ± 18.4%). In the pars plana region free of LPCM close to the ora serrata, the percentage of BM covered by the capillary layer was higher than in the pars plana region containing the LPCM (63.0 ± 42.1% vs. 29.0 ± 18.4%; p < 0.001). At the LPCM end, BM was in direct contact with a collagenous tissue from the LPCM and was focally thickened as compared to BM with an underlying capillary layer (9.5 ± 5.3 μm vs. 4.3 ± 1.2 μm; p < 0.001).

CONCLUSIONS

The direct contact of BM with the LPCM in the pars plana in association with focal BM thickening at the LPCM end suggests an insertion of LPCM on the BM. Taking into account the biomechanical strength of BM, it may imply a functional unit of the LPCM with BM in the process of accommodation with a secondary movement of the posterior BM and tertiary thickening of the subfoveal choroidal space.

Optic Nerve Head Curvature Flattening Is Associated with Central Visual Field Scotoma

This study aimed to develop a new index, the average curvature ratio (ACR), to represent the optic nerve head (ONH) tilting and investigate its clinical relevance. Myopic eyes were included and divided into two subgroups: flat ONH (ACR < 1.0) and convex ONH (ACR ≥ 1.0). The occurrences of central and peripheral visual field (VF) defects were compared between the two groups. A total of 375 myopic eyes were recruited, and 231 and 144 eyes were included in the flat and convex ONH groups, respectively. Central scotoma occurred more frequently in the flat ONH group. According to the Patella-Anderson criteria, the number of eyes with central scotoma was 103 (44.6%) in the flat and 44 (30.6%) in the convex ONH groups (p = 0.009). According to Kook's criteria, the number of eyes with central scotoma was 122 (52.8%) in the flat and 50 (34.7%) in the convex ONH groups (p < 0.001). Peripheral scotoma was not significantly different between the groups. In the correlation analysis, the ACR was positively correlated with spherical equivalence, but not with axial length or central corneal thickness. The ACR reflects the degree of the ONH tilt and is a good index for estimating central VF damage in myopic eyes.

Three cases of macular retinal detachment exacerbated during follow-up with myopic foveoschisis around myopic choroidal neovascularization

Purpose

Myopic choroidal neovascularization (CNV) and myopic traction maculopathy are major complications of pathologic myopia, and myopic foveoschisis (MF) is one of several symptoms that can be included under the general term "myopic traction maculopathy"; however, only a few cases will have MF around the myopic CNV. We report three cases with MF around myopic CNV that followed different clinical courses observed using swept-source optical coherence tomography.

Observations

Case 1 was a 69-year-old woman with an axial length of 29.71 mm, myopic CNV, and MF in the left eye. One month after intravitreal injection of ranibizumab (IVR), a macular retinal detachment (RD) expanded. Vitrectomy and gas tamponade were performed during month 2; the macular RD and MF resolved gradually thereafter. Case 2 was a 54-year-old man with an axial length of 30.59 mm, myopic CNV, and MF in the right eye; after IVR, a macular RD developed and gradually expanded until month 4; the RD and MF resolved spontaneously and resolved during month 8. Case 3 was a 66-year-old woman with an axial length of 28.63 mm, myopic CNV, and MF in the left eye. A macular RD expanded 1 month after a previous vitrectomy for MF; after intravitreal injection of aflibercept, the macular RD and MF resolved gradually in month 12. In all cases, the CNV was accompanied by subretinal fluid, and two of the three cases had outer lamellar holes.

Conclusion and Importance

The MF around the myopic CNV may lead to exacerbated MF and RD during follow-up, and the subretinal fluid caused by the CNV might facilitate MF progression. Since this condition is rare, further investigation of this entity is needed to determine appropriate management.

High Myopia Normative Database of Peripapillary Retinal Nerve Fiber Layer Thickness to Detect Myopic Glaucoma in a Chinese Population

PURPOSE

To develop and validate the performance of a high myopia (HM)-specific normative database of peripapillary retinal nerve fiber layer (pRNFL) thickness in differentiating HM from highly myopic glaucoma (HMG).

DESIGN

Cross-sectional multicenter study.

PARTICIPANTS

A total of 1367 Chinese participants (2325 eyes) with nonpathologic HM or HMG were included from 4 centers. After quality control, 1108 eyes from 694 participants with HM were included in the normative database; 459 eyes from 408 participants (323 eyes with HM and 136 eyes with HMG) and 322 eyes from 197 participants (131 eyes with HM and 191 eyes with HMG) were included in the internal and external validation sets, respectively. Only HMG eyes with an intraocular pressure > 21 mmHg were included.

METHODS

The pRNFL thickness was measured with swept-source (SS) OCT. Four strategies of pRNFL-specified values were examined, including global and quadrantic pRNFL thickness below the lowest fifth or the lowest first percentile of the normative database.

MAIN OUTCOMES MEASURES

The accuracy, sensitivity, and specificity of the HM-specific normative database for detecting HMG.

RESULTS

Setting the fifth percentile of the global pRNFL thickness as the threshold, using the HM-specific normative database, we achieved an accuracy of 0.93 (95% confidence interval [CI], 0.90-0.95) and 0.85 (95% CI, 0.81-0.89), and, using the first percentile as the threshold, we acheived an accuracy of 0.85 (95% CI, 0.81-0.88) and 0.70 (95% CI, 0.65-0.75) in detecting HMG in the internal and external validation sets, respectively. The fifth percentile of the global pRNFL thickness achieved high sensitivities of 0.75 (95% CI, 0.67-0.82) and 0.75 (95% CI, 0.68-0.81) and specificities of 1.00 (95% CI, 0.99-1.00) and 1.00 (95% CI, 0.97-1.00) in the internal and external validation datasets, respectively. Compared with the built-in database of the OCT device, the HM-specific normative database showed a higher sensitivity and specificity than the corresponding pRNFL thickness below the fifth or first percentile (P < 0.001 for all).

CONCLUSIONS

The HM-specific normative database is more capable of detecting HMG eyes than the SS OCT built-in database, which may be an effective tool for differential diagnosis between HMG and HM.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Collagen Mimetic Peptides Promote Repair of MMP-1-Damaged Collagen in the Rodent Sclera and Optic Nerve Head

The structural and biomechanical properties of collagen-rich ocular tissues, such as the sclera, are integral to ocular function. The degradation of collagen in such tissues is associated with debilitating ophthalmic diseases such as glaucoma and myopia, which often lead to visual impairment. Collagen mimetic peptides (CMPs) have emerged as an effective treatment to repair damaged collagen in tissues of the optic projection, such as the retina and optic nerve. In this study, we used atomic force microscopy (AFM) to assess the potential of CMPs in restoring tissue stiffness in the optic nerve head (ONH), including the peripapillary sclera (PPS) and the glial lamina. Using rat ONH tissue sections, we induced collagen damage with MMP-1, followed by treatment with CMP-3 or vehicle. MMP-1 significantly reduced the Young's modulus of both the PPS and the glial lamina, indicating tissue softening. Subsequent CMP-3 treatment partially restored tissue stiffness in both the PPS and the glial lamina. Immunohistochemical analyses revealed reduced collagen fragmentation after MMP-1 digestion in CMP-3-treated tissues compared to vehicle controls. In summary, these results demonstrate the potential of CMPs to restore collagen stiffness and structure in ONH tissues following enzymatic damage. CMPs may offer a promising therapeutic avenue for preserving vision in ocular disorders involving collagen remodeling and degradation.

Deep learning-based estimation of axial length using macular optical coherence tomography images

Background

This study aimed to develop deep learning models using macular optical coherence tomography (OCT) images to estimate axial lengths (ALs) in eyes without maculopathy.

Methods

A total of 2,664 macular OCT images from 444 patients' eyes without maculopathy, who visited Beijing Hospital between March 2019 and October 2021, were included. The dataset was divided into training, validation, and testing sets with a ratio of 6:2:2. Three pre-trained models (ResNet 18, ResNet 50, and ViT) were developed for binary classification (AL ≥ 26 mm) and regression task. Ten-fold cross-validation was performed, and Grad-CAM analysis was employed to visualize AL-related macular features. Additionally, retinal thickness measurements were used to predict AL by linear and logistic regression models.

Results

ResNet 50 achieved an accuracy of 0.872 (95% Confidence Interval [CI], 0.840-0.899), with high sensitivity of 0.804 (95% CI, 0.728-0.867) and specificity of 0.895 (95% CI, 0.861-0.923). The mean absolute error for AL prediction was 0.83 mm (95% CI, 0.72-0.95 mm). The best AUC, and accuracy of AL estimation using macular OCT images (0.929, 87.2%) was superior to using retinal thickness measurements alone (0.747, 77.8%). AL-related macular features were on the fovea and adjacent regions.

Conclusion

OCT images can be effectively utilized for estimating AL with good performance via deep learning. The AL-related macular features exhibit a localized pattern in the macula, rather than continuous alterations throughout the entire region. These findings can lay the foundation for future research in the pathogenesis of AL-related maculopathy.

Prevalence and Associations of Nonglaucomatous Optic Nerve Atrophy in High Myopia: The Ural Eye and Medical Study

PURPOSE

To assess the prevalence of nonglaucomatous optic nerve atrophy (NGOA) in highly myopic individuals.

DESIGN

Population-based study.

PARTICIPANTS

The Ural Eye and Medical Study included 5899 (80.5%) of 7328 eligible individuals (80.5%).

METHODS

Nonglaucomatous optic nerve atrophy, graded into 5 arbitrary stages, was characterized by decreased visibility of the retinal nerve fiber layer (RNFL) on photographs, neuroretinal rim pallor, abnormally thin retinal arteriole diameter, and abnormally thin peripapillary RNFL as measured by OCT.

MAIN OUTCOME MEASURES

Nonglaucomatous optic nerve atrophy prevalence and degree.

RESULTS

Of 5709 participants (96.9%) with axial length measurements, 130 individuals (2.3%) were highly myopic, of whom 116 individuals (89.2%; age, 57.8 ± 11.1 years; axial length, 27.0 ± 1.2 mm) had available fundus photographs and OCT images and were included into the study. Nonglaucomatous optic nerve atrophy prevalence was 34/116 individuals (29.3%; 95% confidence interval [CI], 21.0-38.0), and mean NGOA degree in eyes with NGOA was 1.7 ± 1.0 arbitrary units. Higher NGOA degree correlated (multivariable analysis; regression coefficient, r2 = 0.59) with longer axial length (β, 0.22; P = 0.007), wider temporal parapapillary γ zone width (β, 0.50; P < 0.001), higher prevalence of diabetes (β, 0.20; P = 0.005), and higher systolic blood pressure (β, 0.15; P = 0.03). Higher NGOA prevalence was associated with longer axial length (odds ratio [OR], 7.45; 95% CI, 2.15-25.7), wider temporal parapapillary γ zone (OR, 6.98; 95% CI, 2.61-18.7), and higher systolic blood pressure (OR, 1.05; 95% CI, 1.01-1.10).

CONCLUSIONS

In this ethnically mixed population from Russia with an age of 40 years or more, high axial myopia showed a relatively high prevalence of NGOA, increasing with longer axial length and wider temporal parapapillary γ zone. For each 1 mm of axial elongation and γ zone widening, the odds for NGOA increased 7.45-fold and 6.98-fold, respectively. The axial elongation-associated and γ zone-related increase in the distance between the retinal ganglion cells and the optic disc may lead to a lengthening and stretching of the retinal ganglion cell axons and may be of importance pathogenetically. In highly myopic eyes, NGOA may be a reason for visual field and central visual acuity loss, unexplainable by myopic macular pathologic features.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Mendelian randomization study confirms causal relationship between myopia and vitreous disorders

PURPOSE

This study aims to investigate the potential bidirectional causal relationship between myopia and vitreous disorders from a genetic perspective, as vitreous disorders have been found to be closely associated with myopia development.

METHODS

To achieve this, a two-sample Mendelian randomization (MR) design was employed. The study utilized pooled statistics from independent genome-wide association studies. Myopia was chosen as the exposure factor, while five different vitreous disorders were considered as outcomes. The primary analytical method was the inverse variance weighting (IVW) method, supplemented by sensitivity analysis.

RESULTS

The study yielded significant findings indicating a positive association between myopia and vitreous disorders. The genetic prediction of myopia consistently demonstrated a positive correlation with vitreous disorders, as evidenced by IVW (odds ratio [OR] = 18.387; P < 0.01), MR Egger (OR = 2784.954; P < 0.01), weighted median (OR = 30.284; P < 0.01), and weighted mode (OR = 57.381; P < 0.01). All sensitivity analyses further validated these associations. Furthermore, a significant association was observed between myopia and other unspecified vitreous body disorders (IVW: OR = 57.729; P < 0.01).

CONCLUSION

Studies mainly conducted in European populations have confirmed that myopia, extending beyond early high myopia, plays a crucial role in influencing vitreous disorders and that there is a unidirectional causal relationship between myopia and vitreous disorders. Additionally, a causal relationship was identified between myopia and other unspecified vitreous disordes. These findings introduce fresh perspectives for the clinical management of unspecified vitreous disorders and contribute to the understanding of the effect of myopia on vitreous disorders. Myopia prevention and treatment will aid in slowing down the process of vitreous liquefaction and subsequently decrease the incidence of malignant eye conditions.