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Pathologic Myopia Globe Shape and Long-Term Prognosis.

Ruilin Xiong1,2, Shaoying Tan3,4,5, Yunqian Li1,2

  • 1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, China.

JAMA Ophthalmology
|May 28, 2026
PubMed
Summary
This summary is machine-generated.

Three-dimensional eye shape significantly impacts high myopia outcomes. Specific shapes like nasal distortion and conical eyes increase risks for vision loss, emphasizing personalized risk prediction for better management.

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Area of Science:

  • Ophthalmology
  • Medical Imaging
  • Genetics

Background:

  • Three-dimensional (3D) eye shape is increasingly recognized as a critical factor in predicting the long-term structural and functional prognosis of high myopia.
  • Understanding these shape variations is crucial for developing targeted interventions.

Purpose of the Study:

  • To investigate whether distinct 3D eye shape subtypes, identified through high-resolution magnetic resonance imaging (MRI), can predict 15-year structural and functional outcomes in individuals with high myopia.
  • To establish correlations between specific eye shape morphologies and the progression of high myopia-related complications.

Main Methods:

  • A prospective cohort study involving individuals with high myopia (spherical equivalent ≤-6.00 D) was conducted over 15 years.
  • Participants underwent biennial ophthalmic examinations, with baseline assessments and follow-ups recorded.
  • Eye shapes were categorized into six subtypes: spheroidal, ellipsoidal, conical, nasally distorted, temporally distorted, and barrel shaped, with spheroidal and ellipsoidal considered non-deformed.

Main Results:

  • Analysis of 152 eyes revealed morphology-dependent axial elongation rates, with nasally distorted eyes showing the fastest progression (0.095 mm/y).
  • Nasally distorted eyes exhibited significantly faster elongation (0.050 mm/y) and higher odds of rapid elongation (OR, 5.74).
  • Deformed eye shapes, particularly nasal and conical, were associated with increased risks of macular choroidal thinning (OR, 7.24), myopic macular degeneration progression, and visual field defects.

Conclusions:

  • Baseline three-dimensional eye shape is a significant predictor of long-term structural and functional outcomes in high myopia.
  • Nasally distorted and conical eye shapes represent high-risk phenotypes, suggesting the utility of eye shape stratification for personalized risk assessment and early intervention strategies.
  • These findings underscore the importance of incorporating detailed eye morphology into the management of high myopia.