High Myopia Research Articles (Page 1)

To evaluate longitudinal changes in choroidal thickness (CT) in highly myopic eyes and their correlation with myopic maculopathy progression and visual outcomes. Retrospective cohort study on 1228 eyes from 781 highly myopic patients with a minimum 5-year follow-up (mean 11.5 ± 3.1 years). Myopic atrophic maculopathy (MAM) was graded according to ATN classification. Subfoveal CT was measured using spectral-domain OCT with enhanced depth imaging. Staphyloma classification followed Curtin's system. Mean subfoveal CT at baseline was 54.3 ± 32.7 μm, with decreasing values by MAM category: tessellated fundus (172.5 ± 42.6 μm), diffuse chorioretinal atrophy (63.7 ± 27.3 μm), patchy atrophy (39.2 ± 18.3 μm) and macular atrophy (7.2 ± 11.3 μm, often unmeasurable). Different thinning rates were observed: diffuse atrophy (3.1 ± 0.9 μm/year), patchy atrophy (2.1 ± 0.8 μm/year), macular atrophy (1.3 ± 0.7 μm/year) and tessellated fundus (1.2 ± 0.6 μm/year). Lowest CT values were observed in eyes with type IX staphyloma (22.4 ± 12.1 μm). Axial length ≥ 29 mm was associated with lower CT (32.4 ± 18.9 vs. 78.6 ± 36.2 μm, p < 0.001). Baseline CT <40 μm independently predicted macular atrophy development (OR 3.84, p < 0.001) and visual decline (OR 2.76, p < 0.001). Eyes with dome-shaped macula showed thicker CT at dome peak compared with peridome edges (62.3 ± 34.2 vs. 48.4 ± 22.7 μm, p = 0.002). Eyes developing myopic macular neovascularization (mMNV) had lower baseline CT (32.7 ± 17.8 vs. 58.6 ± 33.1 μm, p < 0.001). The fastest choroidal thinning occurred in eyes with diffuse chorioretinal atrophy, while eyes with severely reduced baseline CT had a higher risk for macular atrophy development and visual impairment. Different staphyloma types showed variable CT patterns.

Incomplete congenital stationary night blindness (icCSNB) is a subtype of inherited, non-progressive retinal diseases. Most cases of icCSNB result from mutations in the X-linked gene CACNA1F. We describe the clinical findings of two male siblings diagnosed with icCSNB, both carrying a novel variant c.4008 + 5G > T in CACNA1F inherited from their mother. We carried out a comprehensive ophthalmic assessment, including fundus imaging, optical coherence tomography (OCT) scanning and electroretinography. We performed genetic testing with next generation sequencing, in-silico and functional analyses to further characterise the novel variant. Two male siblings presented with high myopia and reduced visual acuities at age three. Examination and OCT demonstrated no significant abnormalities in both siblings. Full-field electroretinogram (ffERG) testing demonstrated markedly reduced amplitude to weak flashes and an electronegative waveform to strong flashes in dark-adapted ERGs, resembling that of icCSNB, leading to its diagnosis in both children. Next generation sequencing in the older sibling identified a novel hemizygous c.4008 + 5G > T variant in CACNA1F. In-silico analysis of this variant predicted that it would disrupt normal splicing of CACNA1F, though it was not possible to confirm this by RNA sequencing. This same variant was found in the younger sibling, as well as in their mother who had normal examination and ffERG findings. We report a novel CACNA1F variant not previously identified in the literature in three patients. Although functional analyses were unable to confirm pathogenicity of this variant, in-silico tools predicted that its effect is consistent with the pathogenesis of icCSNB. Reporting of this family further widens the genotypic spectrum of icCSNB.

BackgroundThis study aimed to assess the surgical outcomes of Ahmed glaucoma valve (AGV) implantation in high myopic eyes (axial length [AL] of ≥ 26.0 mm) and to determine whether high myopia independently poses a risk of surgical failure.MethodsWe retrospectively reviewed 68 eyes from 59 patients with refractory glaucoma who underwent AGV implantation. Eyes were categorised into high myopia (23 eyes, 33.8%) and control (45 eyes, 66.2%) groups. The primary outcome was the surgical success rate, defined as postoperative intraocular pressure (IOP) of 6–21 mmHg or a ≥ 20% reduction from baseline. Surgical success was further classified into criterion A (postoperative IOP ≤ 21 mmHg) and criterion B (postoperative IOP ≤ 15 mmHg). Surgical success rates were estimated using Kaplan–Meier analysis, and risk factors for surgical failure were identified via Cox proportional hazards modelling.ResultsAt 1 and 2 years, surgical success was significantly higher in the control group according to criterion A (p = 0.013 and 0.043, respectively). Based on criterion B, the control group also showed better surgical success, although the difference did not reach statistical significance. (p = 0.051). Postoperative IOP was lower in the control eyes throughout all postoperative periods, and the difference reached statistical significance at 6 months (p = 0.017). An AL ≥ 26 mm was a significant risk factor for surgical failure under both criterion A (hazard ratio [HR] = 8.30, p = 0.026) and criterion B (HR = 6.26, p = 0.009).ConclusionsAGV implantation in glaucoma eyes with high myopia showed lower surgical success compared to those without high myopia. Longer AL is a significant risk factor for surgical failure, underscoring the importance of careful monitoring after AGV implantation in such cases.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12886-025-04454-5.

Stickler syndrome is a rare genetic disorder that affects the connective tissue of different body systems. It is characterised by moderate to severe myopia, cataract, retinal detachment, hearing loss, facial dysmorphic features, cleft palate, and joint problems. Mutations in collagen genes including COL2A1, COL11A1, COL11A2, COL9A1, COL9A2, COL9A3, BMP4, and LOXL3 are associated with Stickler syndrome. Herein, we report the case of a 9-year-old girl with Stickler syndrome, who presents early onset of high-myopia and a mildly depressed nasal bridge. No hearing disorder was found, no abnormalities in bones and joints, and her communication and learning capability were also normal. To identify the underlying genetic cause, Whole Exome Sequencing (WES) was carried out using genomic DNA extracted from patient’s blood. A likely pathogenic heterozygous missense variant of the COL11A1 gene (NM_001854.4: c.1927G&gt;C), which had not been previously reported, was identified in the patient. The patient was subsequently diagnosed with Stickler syndrome Type II.

Myopia represents a growing global public health challenge, characterized by increasing prevalence and associated complications such as myopic macular degeneration and retinal detachment. Although genetic and environmental factors are well-recognized contributors, emerging evidence supports a pathological link between inflammation and myopia progression. Epidemiological studies indicate a higher incidence of myopia among individuals with systemic or ocular inflammatory conditions. Inflammation perturbs the ocular immune microenvironment by upregulating pro-inflammatory cytokines and matrix metalloproteinase-2, thereby accelerating extracellular matrix (ECM) degradation and scleral remodeling, which culminates in axial elongation. Conversely, excessive axial elongation in high myopia triggers choroidal microvascular dysfunction, tissue hypoxia, and disruption of the blood-retinal barrier, leading to elevated inflammatory cytokines in the aqueous humor and vitreous, thereby raising the possibility of a self-perpetuating loop. Anti-inflammatory agents, including diacerein, resveratrol, and lactoferrin, have demonstrated therapeutic potential in experimental models by modulating inflammatory pathways, reducing pro-inflammatory cytokines, and preserving ECM integrity. However, their clinical efficacy and long-term safety require further validation. Elucidating the complex interplay between inflammation and myopia is pivotal for the development of targeted interventions, moving the focus of myopia management beyond optical correction towards disease-modifying strategies.

BackgroundFukuyama congenital muscular dystrophy (FCMD) is a severe autosomal recessive α-dystroglycanopathy caused by biallelic variants in the FKTN gene, characterized by muscular, neurological, and ocular involvement. This study aimed to evaluate the ophthalmologic manifestations associated with specific FKTN variant subtypes in Korean patients with FCMD.MethodsWe conducted a retrospective review of nine patients with genetically confirmed FCMD who were followed at a single tertiary referral center between 2005 and 2024. Comprehensive ophthalmologic evaluations were correlated with molecular genotyping, including detection of founder retrotransposon (RT) insertions and splice-disrupting variants in the FKTN gene.ResultsSeven of nine patients (77.8%) harbored compound heterozygous variants comprising the RT insertion and deep intronic splice-site variants, while two patients carried non-founder variants. The mean age at last ophthalmic evaluation was 7.59 ± 4.74 years. High myopia (44.4%), strabismus (22.2%), and nystagmus (11.1%) were frequently observed. Fundus examination revealed optic disc abnormalities in 77.8% of patients, including small discs (55.6%), pale discs (33.3%), and peripapillary fibrotic membranes (33.3%). Additional retinal features included dark without pressure (33.3%), tessellated fundus (33.3%), and peripheral pigmentary degeneration (44.4%). Notably, rare but vision-threatening anomalies, such as persistent fetal vasculature and tractional retinal detachment, were observed only in patients with compound heterozygous variants and were absent in those carrying non-founder variants.ConclusionThis study demonstrates that Korean patients with FCMD carrying compound heterozygous variants comprising the RT insertion and deep intronic splice-site variants exhibit a recognizable ophthalmic phenotype characterized by optic disc and retinal abnormalities, highlighting the need for targeted and ophthalmologic surveillance in this patient population.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12886-025-04432-x.

The Paul Glaucoma Implant (PGI) is becoming increasingly used in many countries. The primary aim of this study was to identify the most important pre-, intra- and post-operative factors associated with successful intraocular pressure (IOP) control at one year. A total of two hundred and fifty -one eyes from 239 glaucoma patients undergoing PGI surgery were included in this prospective, multicentre, longitudinal study. Clinical data were collected on a REDCap platform using a standardised surgical protocol. Variables were recorded pre-, intra- and postoperatively. Univariable and multivariable logistic regression were used to identify predictors of complete success at one year. These results are expressed as Odds Ratios (OR) and their 95% confidence intervals (95% CI). Kaplan–Meier survival analysis was also performed. Mean IOP was significantly reduced from 25.3 ± 8.8 mmHg preoperatively to 13.1 ± 3.9 mmHg at one year (p < 0.001). The medication burden decreased from 3.03 ± 1.12 to 0.78 ± 0.96 (p < 0.001). Most complications were minor and self-limiting. Factors associated with complete success in univariable or multivariable analysis were: use of intraoperative antimetabolites (mitomycin or 5-fluorouracil) [OR 2.59; 95% CI 1.18–5.67], combined phacoemulsification-PGI surgery [OR 4.38; 95% CI 1.10–17.36] and removal of the ripcord after 4–5 months [OR 2.36; 95% CI 1.07–5.18]. High myopia was only associated in the univariable analysis (OR 0.50; CI 0.30–0.85; p = 0.010). Previous glaucoma surgery, hypertensive phase, surgeon experience and diagnosis of non-open angle glaucoma were not significantly associated with complete success. This study concluded that the effectiveness of the PGI can be enhanced by implementing certain strategies that have not shown similar benefits in Ahmed or Baerveldt glaucoma devices.

High myopia is a growing eye health problem in the modern era and carries an increased risk of ocular comorbidity. Contact lens use, refractive surgery, phakic intraocular lenses, retinal problems, and a history of retinal surgery are more common in eyes with high myopia. The anatomical differences in high myopic eyes and surgical interventions performed on the eye make cataract surgery different from the normal eyes. Lens power calculation and intraocular lens selection are different in myopic eyes, and potential retinal pathologies require long-term follow-up. Patients should be thoroughly informed about refractive surprises and complications.

Hereditary vitreoretinopathies (HVRs) are genetically based disorders affecting the vitreous and retina, potentially leading to severe vision loss. This review focuses on two major subtypes of HVRs: Stickler syndrome (SS) and VCAN-related vitreoretinopathies (primarily Wagner syndrome and erosive vitreoretinopathy [ERVR]). Stickler syndrome is a multisystemic collagenopathy typically caused by mutations in collagen genes such as COL2A1 and COL11A1. It is characterized by distinctive ocular findings (notable vitreous anomalies, high myopia, and an increased risk of retinal detachment), along with craniofacial, auditory, and skeletal manifestations. VCAN-related vitreoretinopathies result from mutations in the VCAN gene, which encodes the extracellular matrix proteoglycan versican. These conditions are typically characterized by specific ocular features, such as an ‘optically empty vitreous’ (as seen in Wagner syndrome), and generally lack prominent systemic manifestations. This review discusses the molecular genetic basis, detailed clinical phenotypes, and key elements for differential diagnosis of both disease groups, along with current ophthalmologic management strategies. Furthermore, genetic diagnostic methods used in these complex disorders, their diagnostic yields, genotype-phenotype correlations, diagnostic challenges, and future research directions are explored. Early and accurate diagnosis—especially when supported by molecular genetic testing—is vital for appropriate patient monitoring, prophylactic treatment planning to prevent complications such as retinal detachment, and genetic counseling for affected family members. A deeper understanding of these disorders will be achievable through ongoing research in ocular genetics and multidisciplinary approaches.

Intraocular lens (IOL) implantation is currently the most effective method for restoring vision following cataract surgery and is also used in cases of high myopia or hyperopia. However, IOL implantation eliminates accommodation, forcing patients to choose between corrected distance vision, requiring reading glasses for near tasks, or near vision supplemented by distance correction with spectacles. This limitation underscores the need for fully customized, patient-specific IOLs. To address this challenge, we performed femtosecond laser ablation experiments on polymethyl methacrylate (PMMA) IOLs using 200 fs pulses at 513 nm to investigate controlled surface modification. Laser-induced surface structuring offers a pathway to inscribe micron-scale patterns, including apodized features, in transparent polymers. To our knowledge, this is the first demonstration of femtosecond laser irradiation at 513 nm applied to IOL surfaces. Furthermore, this study is the first to combine scanning electron microscopy (SEM) and optical coherence tomography (OCT) as detection technologies to analyze and quantify ablation morphology and depth. The formation of smooth craters with minimal surrounding thermal damage highlights the potential of femtosecond laser processing as a promising tool for the development of customized, patient-tailored intraocular lenses.

Advancing Myopia Management: The Therapeutic Potential of Microbiota-Targeted Interventions.

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

Individualized Estimation of Baseline Retinal Nerve Fiber Layer Thickness Using Conditional Variational Autoencoder.

To compare inner retinal thinning after an internal limiting membrane (ILM) flap reposition technique with ILM peeling in full-thickness macular holes. This retrospective study included a total of 78 eyes (75 consecutive patients) with primary full-thickness macular holes undergoing vitrectomy between October 2022 and December 2023. Exclusion criteria were secondary macular holes, high myopia, glaucoma, and prior surgery except cataract surgery. Eyes were separated by surgical technique into Group A (ILM flap repositioning; n = 30) and Group B (ILM peeling alone; n = 48). We compared mean thickness/volume of parafoveal (3 mm) and perifoveal (6 mm Early Treatment Diabetic Retinopathy Study subfields) retinal nerve fiber layer, ganglion cell layer, and inner plexiform layer at 6 months after surgery (M6) to baseline (M0). Secondary, we assessed anatomical closure rate and visual acuity. Anatomical Type 1 closure was achieved in 90.00% (A) and 80.00% (B) without significant difference. For consistency in the subsequent analysis, only cases with successful closure were included. Preservation analysis at M6 showed thicker ( P = 0.006) and with more volume ( P = 0.010) in parafoveal retinal nerve fiber layer in Group A, whereas perifoveal ganglion cell layer remained thicker ( P = 0.001) and with more volume ( P = 0.002) in Group A. Inner plexiform layer did not differ between the groups. Visual acuity improved by time ( P < 0.001) without differing between the groups. Compared with ILM peeling, macular hole treatment with ILM flap repositioning results in better preserved retinal nerve fiber layer and ganglion cell layer, while maintaining a high closure rate and similar postoperative visual acuity.

Impact of Epiretinal Membrane on Anatomical and Visual Outcomes in Patients with Full-Thickness Macular Holes.

This study revealed the prevalence of paracentral scotoma in highly myopic eyes with early open angle glaucoma, and highlighted structural and vascular parameters associated with paracentral scotoma, which may facilitate the assessment of central visual function. To investigate the prevalence and associated factors of paracentral scotoma in patients with high myopia and early open angle glaucoma (OAG). In this cross-sectional study, myopic eyes with early OAG (mean deviation of visual field > -6dB) were categorized into the high myopia group and the low-to-moderate myopia group. Paracentral scotoma was defined as a visual field defect in one hemifield within 10 degrees of fixation. The prevalence of paracentral scotoma was compared between the 2 groups. Association between structural and vascular factors and paracentral scotoma was investigated by logistic regression analysis. A total of 220 myopic eyes with early OAG were enrolled, including 136 highly myopic eyes, and 84 low-to-moderate myopic eyes. Paracentral scotoma was more prevalent in the high myopia group (39.7% vs. 22.6%, P = 0.012). Multivariate logistic regression analysis showed that thinner circumpapillary retinal nerve fiber layer (cpRNFL) thickness in inferior-temporal and temporal-upper sectors, thinner inferior ganglion cell complex (GCC) thickness, lower radial peripapillary capillary (RPC) vessel density in inferior-temporal and temporal-lower sectors, and lower inferior perifoveal vessel density were significantly associated with paracentral scotoma in highly myopic eyes with early OAG (all P < 0.05). Compared with low-to-moderate myopia, highly myopic eyes with early OAG were more likely to develop paracentral scotoma. The measurement of cpRNFL thickness and RPC vessel density in the temporal and inferior-temporal sectors, GCC thickness, and perifoveal vessel density in the inferior sector may help assessment of central visual function in highly myopic eyes with early OAG.

Limited evidence has shown the relationship between systemic inflammation and high myopia. Thus, we conducted this study to explore this issue. A total of 2891 participants (2891 eyes) aged ≤40 years were included in this cross-sectional study. Four systemic inflammation markers were calculated through blood cell counts: systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Univariate and multivariate logistic regression analyses, as well as restricted cubic spline analyses, were used to assess the relationship between systemic inflammation markers and high myopia. The incidence of mild and moderate myopia was 67.24% (1944 eyes), and the incidence of high myopia was 4.6% (133 eyes) in this US population. After adjusting for covariates, multivariate logistic regression analysis revealed that high myopia was associated with white blood cell counts (odds ratio [OR] = 0.242, P = .027), neutrophils (OR = 4.052, P = .033), lymphocytes (OR = 4.989, P = .021), neutrophil-to-lymphocyte ratio (OR = 0.621, P = .025), and SII (OR = 1.002, P = .011). We also found that lymphocytes and the SII were nonlinearly associated with high myopia (all P < .05). Higher levels of lymphocytes and SII related to high myopia. Thus, the measurement of inflammatory markers should be taken into consideration when assessing high myopia.

Myopia arises primarily due to excessive axial elongation and is associated with an increased risk of ocular complications and visual impairment, particularly in high myopia. Although astigmatism may have implications on refractive development, the role of astigmatism in myopic eye growth and the effectiveness of myopia control strategies is unclear. A scoping review was conducted in March 2025 and updated in August 2025, using MEDLINE and PubMed to explore myopia prevalence and onset, progression and astigmatism (Aim 1) and myopia control and astigmatism (Aim 2). Literature was initially screened by title, abstract and finally by the relevance of the full manuscript. A total of 1004 studies were identified; 26 duplicates were removed; 911 were excluded following title screening and 20 were excluded following abstract screening. A total of 47 studies were included (Aim 1 = 30, Aim 2 = 17), with most conducted in Asia (n = 31). A higher prevalence of astigmatism was associated with myopia. Myopia progression and astigmatism may be related, although there is limited research on the effects of uncorrected astigmatism on the course of myopia. Additionally, there is limited research regarding the influence of astigmatism on the effectiveness of myopia control strategies, with conflicting findings between studies. Myopia progression and astigmatism may be interdependent. However, a causative role of astigmatism in promoting myopia is unclear. The diverse range of study designs and methodologies impairs the comparability of findings. Prospective research in children of differing ethnicities with a range of astigmatism is required to determine if astigmatism influences the effectiveness of myopia control interventions. This would provide an evidence base to inform clinical decision-making and management plans for myopic children with astigmatism, particularly in non-Asian populations where research is limited.

PurposeTo investigate the impact of myopia on the Brillouin biomechanics and morphology of crystalline lenses in Chinese adults.MethodsPatients with myopia were enrolled and divided into low-medium (spherical equivalent [SE] ≥ −5.75 D, N = 66) and high (SE ≤ –6.0 D, N = 72) myopia groups. All patients underwent routine ophthalmic examinations, including SE, axial length, and anterior chamber metrics (Pentacam) measurements. The Brillouin-related metrics of the crystalline lenses were measured using a Brillouin microscopy. The morphological parameters included the Width of Top Plateau (WTP), Width of Bottom Plateau (WBP), Bottom-Top (B-T), Slope of Anterior Cortex (SAC), and Slope of Posterior Cortex (SPC). The height of Plateau was a biomechanical parameter.ResultsThe study included 138 eyes (138 patients); the mean age was 28.43 ± 8.31 years. WBP, B-T, SAC, and SPC significantly differed between the high and low-medium myopia groups (all P<0.05). WBP, B-T, and SPC significantly correlated with SE in the high myopia group (Pearson’s r = 0.365, 0.287, and 0.294, respectively; all P<0.05) but not in the low-medium group. The SPC significantly decreased for all participants based on the SE values (P<0.05). The biomechanics and thickness of the nucleus displayed no discrepancies with SE in all participants (all P >0.05).ConclusionAn increase in the degree of myopia could be associated with posterior cortex thickening while maintaining stable biomechanics and morphology of the crystalline lens nucleus. Brillouin microscopy can serve as an effective technique for multidisciplinary lens biomechanical and morphological imaging.

To look at the outcomes of various interventions in treatment-naive pediatric rhegmatogenous retinal detachment (RRD). This study was conducted at a tertiary care hospital in North India. Children below 16 years with treatment-naive RRD with a minimum 6-month follow-up were enrolled retrospectively from July 2012 to June 2021 and prospectively from July 2021 to June 2022. Patient demographics at presentation, risk factors, preoperative ophthalmic findings including best-corrected visual acuity (BCVA), the choice of surgery and tamponade, and postoperative assessment parameters were recorded. The primary outcome measure was anatomical success after surgery. Secondary outcome measures included functional success, that is, postoperative BCVA at last follow-up, improvement in vision, number of surgeries required to achieve final anatomical success, and correlation of factors such as age and etiology with outcomes. Functional success was taken as postoperative BCVA ≥ logMAR 1.3. Among the 333 pediatric patients (348 eyes), the most common etiology was trauma (44.8%), followed by high myopia (17%) and idiopathic causes (15.5%). Primary anatomical success was achieved in 66.9% of cases, improving to 88.5% with additional surgeries. Functional success was recorded in 46.3% of cases. Combined scleral buckling (SB) and pars plana vitrectomy (PPV) provided the best anatomical (66.01%) and functional (48.32%) outcomes. Pediatric RRD presents significant management challenges. Combined SB + PPV yielded superior outcomes. Functional recovery remains limited, emphasizing the need for early detection, improved surgical strategies, and long-term follow-up for optimal visual rehabilitation.