Molecular and Biomechanical Changes in the Anterior Segment of High Myopic Eyes

High myopia (HM) is a vision-threatening ocular disorder characterized by excessive axial elongation. While previous studies have primarily focused on structural and functional impairments in the posterior segment-including the optic nerve, posterior sclera, and macular region-recent evidence indicates that adaptive remodeling also occurs in anterior segment structures, such as the cornea, anterior sclera, and lens. In this review, we examine the molecular mechanisms underlying anterior segment remodeling in high myopia, investigate the associated biomechanical alterations using ex vivo and in vivo measurement techniques, and analyze the interrelationships among these changes. Furthermore, we highlight how multimodal imaging technologies, when integrated with artificial intelligence algorithms, enable the quantitative assessment of biomechanical parameters. These advances may contribute to improved prediction of myopia progression, risk stratification for associated complications, and the development of personalized therapeutic strategies. Finally, we discuss the current challenges and translational bottlenecks in this area.