Cellular Biological Basis and Novel Breakthroughs in the Pathogenesis of Myopia - A Narrative Review

Myopia has evolved into a severe global public health concern, exhibiting an epidemiological trend of earlier onset and higher refractive errors particularly among adolescents. Complications induced by high myopia, such as retinal detachment and macular degeneration, pose grave threats to visual health. This paper is a narrative review. It summarizes advances in the cell biology of myopia, elucidates the mechanisms underlying myopia mediated by multiple intraocular cell types, interprets several interactive regulatory pathways, and reviews biomarkers, targeted interventions and detection technologies. Different from previous reviews, this paper links retinal light signaling, intraocular cross‑tissue communication and scleral remodeling, with a focus on corneal biomechanics and the crosstalk between immunity and aging. It establishes an integrated analytical framework of "retinal phototransduction - trans-tissue cellular communication - scleral matrix remodeling", from which three core mechanistic conclusions are drawn: 1) Myopia is a sterile, chronic low-grade inflammation driven by coordinated dysfunction of multiple ocular tissue cells; cellular senescence and localized inflammation form a positive feedback loop that continuously fuels excessive axial elongation. 2) Retinal glial cells and retinal pigment epithelium serve as relays for visual growth signals. Abnormal defocus disrupts their secretion of cytokines, breaking the homeostasis of scleral collagen synthesis and degradation. 3) The hypoxic microenvironment of the choroid can amplify scleral remodeling and exacerbate myopia progression. Integrating the multilayered signaling regulatory network formed by cells of the cornea, retina and sclera helps clarify the complete pathological logic underlying multicellular synergistic pathogenesis of myopia. It provides mechanistic evidence for the clinical development of an early myopia warning system, tissue-specific targeted pharmaceuticals and stratified individualized prevention and control regimens, and facilitates the shift of myopia intervention from conventional empirical management to a novel precision diagnosis and treatment paradigm grounded in cellular and molecular characteristics.