The role of anterior segment biomarkers in the development and progression of myopia

Myopia is a major global health concern, projected to affect nearly half of the world's population by 2050. While axial elongation is known to be the underlying pathology in myopia, the pathophysiology of factors that drive axial elongation is not fully understood. Factors driving axial elongation include genetic factors and environmental factors such as outdoor activity time and the amount of near work. With advances in ocular imaging technology, there is interest in the role of anterior segment biomarkers in the onset and progression of axial elongation in myopia. Imaging modalities such as corneal tomography, anterior segment optical coherence tomography, optical biometry, and corneal biomechanical analyzers have enabled the precise measurement of corneal shape, anterior chamber depth, lens parameters, and biomechanical properties. These biomarkers have been implicated in myopia development, progression risk prediction, and response to interventions such as orthokeratology. In this review, we explore contemporary anterior segment imaging modalities and seek to better understand the complex relationship between anterior segment biomarkers and axial elongation in myopia. By understanding the role of these biomarkers, we may be better equipped in predicting myopia onset and progression and pave the way for potential treatments in myopia.