Relationship between choroidal thickness changes and macrophage polarization in high myopia

Area of Science:

• Ophthalmology
• Immunology
• Pathology

Background:

• High myopia is a leading cause of global blindness, characterized by progressive choroidal thinning.
• Traditional theories attribute choroidal thinning to mechanical stretch or reduced blood flow.
• Emerging evidence points to active immune-inflammatory processes in the choroid.

Purpose of the Study:

• To review recent findings in myopia and immunology.
• To propose a pathological framework for high myopia involving immune-inflammatory remodeling.
• To explore the role of macrophage polarization in choroidal degeneration.

Main Methods:

• Systematic review of myopia and immunology literature.
• Integration of clinical imaging, intraocular fluid analysis, and animal experimental data.
• Focus on the sequence: mechanical stretch/hypoxia-immune imbalance-macrophage polarization-choroidal remodeling.

Main Results:

• Proposed framework: mechanical stretch/hypoxia induces immune imbalance, leading to macrophage polarization and destructive choroidal remodeling.
• Macrophages, upon sensing stress, contribute to choroidal degeneration via cytokine release, matrix metabolism changes, and vascular regression.
• Identified gaps in human tissue data and macrophage subset-specific interventions.

Conclusions:

• Immune-inflammatory processes, particularly macrophage polarization, are central to high myopia pathogenesis.
• Understanding these mechanisms offers potential for novel prevention and treatment strategies.
• Future research should focus on human data, specific macrophage interventions, spatial transcriptomics, and immune modulation.