Key Summary:
- High myopia was linked to five distinct 3D globe remodelling patterns.
- Focal deformation was associated with greater macular and tractional complications.
- 3D shape analysis may refine surveillance, pending prospective validation.
HIGH myopia was associated with distinct 3D globe remodelling trajectories that identified structural and functional changes beyond axial elongation, according to a 15-year MRI cohort study.
Study Design
The study included 30 participants with bilateral high myopia, defined as a spherical equivalent refraction of −6.00 D or worse, comprising 60 eyes. Participants were randomly selected from 95 individuals who underwent imaging in September 2011 and were rescanned in September 2025.
Researchers reconstructed the globes using orbital 3D MRI and classified them into six shape categories. Paired classifications, global enlargement and staphyloma status were then used to identify five remodelling patterns: quiescence, proportional expansion, focal emergence, focal progression and shape transition.
Focal Deformation Linked to Worse Outcomes
The distribution of remodelling patterns varied according to baseline age and globe contour. Overall, 21 eyes (35.0%) followed a quiescent pattern, 12 (20.0%) showed proportional expansion, 14 (23.3%) developed focal emergence, six (10.0%) demonstrated focal progression and seven (11.7%) underwent shape transition.
Among individuals younger than 20 years, 10 of 12 eyes (83.3%) underwent proportional expansion. By comparison, 13 of 24 eyes (54.2%) among individuals aged 40 years or older followed focal progression or shape transition.
No deformed eye returned to a spheroidal contour. Eyes with focal emergence experienced the greatest decline in best-corrected visual acuity, at 0.26 logMAR, and mean deviation, at −3.50 dB. Shape transition was associated with the largest increase in pattern standard deviation, at 1.95 dB.
At similar levels of axial elongation, eyes developing focal deformation had higher frequencies of myopic macular degeneration (MMD) progression: 91.7% versus 58.8%; p=0.02. They also had higher frequencies of incident or progressive posterior staphyloma: 91.7% versus 17.6%; p<0.001, and myopic traction maculopathy (MTM): 58.3% versus 11.8%; p=0.003.
3D Shape Analysis Could Refine Surveillance
The findings suggest that high myopia may involve clinically relevant changes in globe geometry that are not captured by axial length alone. The observed age and contour associations also indicate that remodelling trajectories may differ across stages of highly myopic eye development.
For clinicians, longitudinal 3D globe shape assessment could therefore offer a complementary framework for identifying eyes at greater risk of structural and functional deterioration. In particular, the emergence or progression of focal deformation may help identify eyes requiring closer surveillance for MMD, posterior staphyloma and MTM.
However, the study involved only 30 participants and assessed two time points. The researchers concluded that prospective validation is required before 3D shape analysis can be incorporated into clinical practice. The findings therefore support further investigation of globe geometry as a potential addition to axial length when monitoring patients with high myopia.
Reference
Chen S et al. Longitudinal trajectories of 3-Dimensional eye shape and pathological sequelae in high myopia. JAMA Ophthalmol. 2026;DOI:10.1001/jamaophthalmol.2026.3684.
Featured Image: Serg Zastavkin on Adobe Stock
- Author:
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
