Progress in Retinal and Eye Research最新文献

{"title":"Clinical histopathology and pathogenesis of macular telangiectasia type 2.","authors":"Dimitrios P Ntentakis, Anastasia Maria Ntentaki, Eleni Delavogia, Gustavo Sakuno, Victor S M C Corrêa, Nikolaos E Efstathiou, Mary E Aronow, Emily Y Chew, Joan W Miller, Demetrios G Vavvas","doi":"10.1016/j.preteyeres.2025.101401","DOIUrl":"https://doi.org/10.1016/j.preteyeres.2025.101401","url":null,"abstract":"<p><p>Macular telangiectasia type 2 (MacTel) is a rare neurodegenerative retinal disease defined by a unique combination of reduced macular pigment, a characteristic angiographic pattern, and a localized clinical presentation. The condition typically affects the temporal perifovea and leads to progressive visual impairment. No definitive treatment exists. Current management is limited to intravitreal anti-vascular endothelial growth factor (VEGF) injections for end-stage neovascular complications and the recently approved Encelto implant (Neurotech Pharmaceuticals, Inc.), which delivers ciliary neurotrophic factor (CNTF) for neuroprotection. To clarify the still enigmatic pathophysiology of MacTel, we conducted a comprehensive review of all human histopathology reports published in English through December 31, 2024. Findings were systematically evaluated with respect to tissue processing techniques, postmortem fixation times, disease stage at last recorded ophthalmologic evaluation, diagnostic certainty, inclusion of control specimens, and the anatomic origin of analyzed retinal sections. This approach aimed to identify histopathologic features most likely to represent core disease mechanisms. Each of the features identified as most likely to be pathophysiologically relevant was independently assessed for clinical and histopathologic specificity. These features were then further interpreted in the context of genetic, metabolic, and anatomic associations reported in the literature. Donor demographics, coexisting ocular conditions, and systemic comorbidities were also reviewed to support the development of an integrative hypothesis for MacTel pathogenesis. Drawing on this synthesis, we propose a histopathology-informed model of disease pathophysiology and outline a provisional timeline for the contribution of key factors to clinical expression. We also review current neuroprotective strategies and provide targeted recommendations for future therapeutic development and histopathologic research. The conceptual framework developed in this work -grounded in rigorous analysis of the most consistent and methodologically validated histopathologic findings, and interpretation of their mechanistic context- may serve as a model for deciphering rare retinal diseases and for generating focused, hypothesis-driven questions to guide future investigation.</p>","PeriodicalId":21159,"journal":{"name":"Progress in Retinal and Eye Research","volume":" ","pages":"101401"},"PeriodicalIF":14.7,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions to Reduce Incidence and Progression of Myopia in Children and Adults.","authors":"Jason C Yam, Xiu Juan Zhang, Ebenezer Zaabaar, Yuyao Wang, Yuelan Gao, Yuzhou Zhang, Xiaotong Li, Ka Wai Kam, Fangyao Tang, Wai Kit Chu, Xiangtian Zhou, Wei Zhang, Xiangui He, Pei-Chang Wu, Kathryn A Rose, Ian Morgan, Mingguang He, Kyoko Ohno-Matsui, Jost B Jonas, Mingzhi Zhang, Clement C Tham, Li Jia Chen, Chi Pui Pang","doi":"10.1016/j.preteyeres.2025.101410","DOIUrl":"https://doi.org/10.1016/j.preteyeres.2025.101410","url":null,"abstract":"<p><p>The alarming increase in childhood myopia has emerged as a significant public health concern. Due to its long-term consequences, there is also an expanding interest in adult-onset myopia. This review provides a comprehensive summary of interventions for slowing the onset and progression of myopia and discusses factors influencing their efficacy. Outdoor time is an effective intervention for at-risk pre-myopes, which can reduce myopia onset by up to 50% and has been implemented on a large scale in some countries through school reforms. 0.05% atropine and repeated low-level red light (RLRL) have also shown the potential to prevent myopia onset by approximately 50%, though the cost-benefit of implementing them on a large scale warrants more research. Low-concentration atropine, various designs of peripheral defocus spectacles, contact lenses, and RLRL effectively slow myopia progression by at least 50%. A history of higher baseline myopia status, faster baseline progression, parental myopia, high-risk lifestyle, and less outdoor time requires rigorous interventions. When combined with RLRL or atropine concentrations higher than 0.025%, orthokeratology significantly improves myopia control in fast progressors and/or high myopes. Combining low-concentration atropine with peripheral defocus glasses or dual-focus contact lenses also yields better efficacy than monotherapy. There is limited research on adult myopia control, but offering comprehensive lifestyle and visual environment recommendations remains essential. Consistent use of these interventions and thorough safety monitoring are crucial for building clinical confidence. The success of myopia control hinges on personalization, given the diverse factors influencing efficacy and the challenges of large-scale implementation.</p>","PeriodicalId":21159,"journal":{"name":"Progress in Retinal and Eye Research","volume":" ","pages":"101410"},"PeriodicalIF":14.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Widefield OCT angiography\" [Progress in Retinal and Eye Research. 107 (2025) 101378].","authors":"Yali Jia, Tristan T Hormel, Thomas S Hwang, An-Lun Wu, Guangru B Liang, Yukun Guo, Xiang Wei, Shuibin Ni, Yifan Jian, J Peter Campbell, Steven T Bailey, John C Morrison, David Huang","doi":"10.1016/j.preteyeres.2025.101408","DOIUrl":"https://doi.org/10.1016/j.preteyeres.2025.101408","url":null,"abstract":"","PeriodicalId":21159,"journal":{"name":"Progress in Retinal and Eye Research","volume":" ","pages":"101408"},"PeriodicalIF":14.7,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbiome signatures and their role in uveitis: Pathogenesis, diagnostics, and therapeutic perspectives.","authors":"Kajal Agrawal, Ashley Shuen Ying Hong, Carlos Cifuentes-González, Vanitha Shyamili Kumar, William Rojas-Carabali, Shengjuan Zhang, Qingfeng Wang, Alejandra de-la-Torre, Marlies Gijs, Tejpal Gill, James T Rosenbaum, Seesandra V Rajagopala, Sapna Gangaputra, Alessandro Conforti, R Paul Ross, Peizeng Yang, Sunny Wong, Rupesh Agrawal","doi":"10.1016/j.preteyeres.2025.101409","DOIUrl":"10.1016/j.preteyeres.2025.101409","url":null,"abstract":"<p><p>Non-infectious uveitis is a group of complex inflammatory eye diseases shaped by genetic susceptibility, immune dysregulation, and environmental cues. Among these, the mucosal microbiome-including gut, oral, and ocular surface microbial communities-has emerged as a key player in modulating systemic and ocular immune responses. Recent evidence supports a gut-eye axis wherein microbial dysbiosis alters intestinal barrier function, perturbs T cell homeostasis, and drives systemic immune activation that can breach ocular immune privilege. Specific taxa, such as Prevotella and Faecalibacterium, as well as microbial metabolites including short-chain fatty acids, have been implicated in promoting or mitigating ocular inflammation. Human leukocyte antigen (HLA) alleles, notably HLA-B27 and HLA-A29, influence both microbiome composition and disease phenotype, suggesting a gene-microbiome-immunity triad of interaction in uveitis pathogenesis. Drawing on insights from metagenomics, metabolomics, in vitro and in vivo experimental and murine models, this review delineates four key mechanisms-immune imbalance, antigenic mimicry, epithelial barrier disruption, and bacterial translocation-that underpin the key roles of microbiome in uveitis. We combine current literature and integrate findings from our research programs to highlight diagnostic and therapeutic opportunities. Microbiome-informed strategies, such as rational probiotic design, dietary modulation, and targeted microbial therapies, hold promise for complementing existing immunosuppressive regimens. Translating these insights into clinical practice requires robust multi-omic studies, longitudinal cohorts, mechanistic studies, and precision-guided intervention trials. By framing uveitis within a mucosal immunological context, this review proposes a future precision medicine roadmap for integrating microbiome science into ocular inflammatory disease management.</p>","PeriodicalId":21159,"journal":{"name":"Progress in Retinal and Eye Research","volume":" ","pages":"101409"},"PeriodicalIF":14.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The physiology of dark adaptation: Progress and future directions","authors":"Gordon L. Fain ,&nbsp;M. Carter Cornwall","doi":"10.1016/j.preteyeres.2025.101407","DOIUrl":"10.1016/j.preteyeres.2025.101407","url":null,"abstract":"<div><div>Exposure of the eye to bright bleaching light produces a large decrease in photoreceptor sensitivity, followed by a slow return during adaptation to darkness. Although much progress has been made understanding the nature of this phenomenon, particularly its biochemistry, less is known about the physiology of dark adaptation. In this review, we summarize the evidence for desensitization produced by photoproducts of bleaching, especially apo-opsin, that is opsin without bound chromophore. We describe the relationship between these studies and diseases such as vitamin A deprivation and congenital stationary night blindness; the effects of analogs of chromophore on photoreceptor sensitivity; and the roles of transducin, rhodopsin kinase, and arrestin. We review many specialized features of dark adaptation in cones, including the role of retinal G protein-coupled receptor (RGR) opsin. For both rod and cone dark adaptation, we summarize some of the principal uncertainties in our understanding. We hope our review will provide a guide to past work as well as an indicator of many possible areas of future research.</div></div>","PeriodicalId":21159,"journal":{"name":"Progress in Retinal and Eye Research","volume":"109 ","pages":"Article 101407"},"PeriodicalIF":14.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensuses and controversies on causes, diagnosis and management of diabetic macular edema (DME).","authors":"Danny S C Ng, Paisan Ruamviboonsuk, Rajendra S Apte, Sanyam Bajimaya, Carmen K M Chan, Andrew Chang, Carol Y Cheung, Shih-Jen Chen, Varun Chaudhary, Voraporn Chaikitmongkol, Jay Chhablani, Taraprasad Das, Suber S Huang, Jost B Jonas, Timothy Y Y Lai, Chi-Chun Lai, Jin Ma, Marion R Munk, Raja Narayanan, Nishant V Radke, Min Sagong, Charumathi Sabanayagam, Sobha Sivaprasad, Masahiko Shimura, Koh-Hei Sonoda, Jennifer K Sun, Gavin S W Tan, Brijesh Takkar, Gianni Virgili, Stela Vujosevic, Min Wang, Seung-Young Yu, Xinyuan Zhang, Jingfa Zhang, Tien-Yin Wong, Dennis S C Lam","doi":"10.1016/j.preteyeres.2025.101406","DOIUrl":"https://doi.org/10.1016/j.preteyeres.2025.101406","url":null,"abstract":"<p><p>Diabetic macular edema (DME) is the most common cause of vision-threatening diabetic retinopathy (VTDR) with an increasing prevalence tied to the global epidemic in diabetes. Despite significant advances, the management of DME remains a dynamic field with many unresolved controversies. Optical coherence tomography (OCT) allows objective assessment, however, correlation between vision and morphological changes can be inconsistent, causing disagreements on treatment strategies. DME is a complex disease with multifactorial pathophysiological pathways, leading to heterogenous treatment responses. There is a lack of standardized definition of treatment 'non-response\" and protocol for switching to second-line or adjuvant treatments. New anti-vascular endothelial growth factor (anti-VEGF) drugs and multi-targeted therapies seem to demonstrate improved durability, but long-term data is not yet available. Research in artificial intelligence (AI) is developing rapidly, however, rigorous appraisal of its reliability and generalizability are necessary before its implementation. Significant vision loss from DME in pregnant women, young children and elderly patients with systemic comorbidities are challenging conundrums. An international panel of experts (IPE) comprising 36 experts from 16 countries formulated and voted on the consensus statements in 5 key areas: 1) Diagnostic controversies around classification and imaging; 2) Treatment controversies; 3) Management paradigm between protocol-based and individualized approaches; 4) Emerging controversies in novel therapeutics and AI application, and 5) Special considerations for specific patient populations. There is an imminent need for mutual agreement on the best-possible approach to DME management in order to promote the optimal patient outcomes and to identify specific issues that require prioritization of resources and research.</p>","PeriodicalId":21159,"journal":{"name":"Progress in Retinal and Eye Research","volume":" ","pages":"101406"},"PeriodicalIF":14.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145177923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Keeping the lights on: a new role for an old drug to support cone survival in Retinitis Pigmentosa","authors":"Debora Napoli ,&nbsp;Beatrice Di Marco ,&nbsp;Giulia Salamone ,&nbsp;Noemi Orsini ,&nbsp;Raffaele Mazziotti ,&nbsp;Enrica Strettoi","doi":"10.1016/j.preteyeres.2025.101403","DOIUrl":"10.1016/j.preteyeres.2025.101403","url":null,"abstract":"<div><div>Retinitis Pigmentosa (RP) is an incurable disorder characterized by progressive vision loss due to photoreceptor degeneration, typically following a rod-cone sequence. Rods die first, driven by primary genetic mutations; cones then degenerate secondarily through bystander mechanisms. As cones mediate daylight and high-acuity vision, crucial to human visual function, even partial preservation of these cells can profoundly enhance quality of life, regardless of the underlying genetic defect. Although significant progress has been made in understanding RP genetics and developing targeted therapies such as gene augmentation, a universal cure remains out of reach. This review centers on the biological drivers of secondary cone degeneration, with a focus on oxidative stress, metabolic dysfunction, and inflammation. Inflammation, now recognized as a key contributor to RP progression, involves the activation of microglia and infiltration by macrophages, both of which exacerbate retinal damage and offer promising therapeutic targets. We briefly survey current treatment modalities that have advanced to clinical application, including gene therapies, retinal prostheses, and neuroprotective strategies. Building on this therapeutic landscape, we propose a rationale for exploring ocular glucocorticoids—specifically dexamethasone—as a treatment avenue. Recent in vivo evidence from the rd10 mouse model demonstrates that intraocular dexamethasone, a long-approved agent for ocular inflammation, can preserve cone photoreceptors and protect the retinal pigment epithelium, a critical barrier for retinal homeostasis.</div><div>Glucocorticoids may thus represent a class of mutation-agnostic therapeutics with strong translational promise. Their repurposing for RP could help safeguard photoreceptors and visual function, addressing a pressing and unmet clinical need.</div></div>","PeriodicalId":21159,"journal":{"name":"Progress in Retinal and Eye Research","volume":"109 ","pages":"Article 101403"},"PeriodicalIF":14.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decoding pediatric inherited retinal dystrophies: Bridging genetic complexity and clinical heterogeneity","authors":"Domenico Mordà ,&nbsp;Simona Alibrandi ,&nbsp;Concetta Scimone ,&nbsp;Carmela Rinaldi ,&nbsp;Sergio Zaccaria Scalinci ,&nbsp;Giorgia Abate ,&nbsp;Rosalia D'Angelo ,&nbsp;Antonina Sidoti ,&nbsp;Luigi Donato","doi":"10.1016/j.preteyeres.2025.101405","DOIUrl":"10.1016/j.preteyeres.2025.101405","url":null,"abstract":"<div><div>pediatric inherited retinal dystrophies (IRDs) are a clinically and genetically heterogeneous group of disorders characterized by progressive visual function impairment, often manifesting from early childhood. These conditions arise from dysfunction in retinal morphogenesis, phototransduction, and cellular maintenance pathways, involving photoreceptors, the retinal pigment epithelium, and glial systems. This review provides an integrated analysis of the molecular underpinnings, phenotypic variability, diagnostic advancements, and emerging therapeutic avenues for pediatric IRDs. By systematically retracing the literature and leveraging over a decade of laboratory experience, we dissect each major form of pediatric IRD—such as Leber congenital amaurosis, retinitis pigmentosa, Stargardt disease, achromatopsia, and syndromic entities like Usher and Bardet-Biedl syndromes—emphasizing genotype-phenotype correlations and shared pathogenic pathways. Additionally, we discuss next-generation sequencing, advanced bioinformatics, and AI-based diagnostics, along with gene therapy, genome editing, and emerging biotechnologies. By mapping IRDs to molecular networks through Cytoscape and functional genomics, we identify converging pathogenic mechanisms and therapeutic targets. This compendium aims to serve as a reference for clinicians, researchers, and genetic counselors navigating the evolving IRD landscape.</div></div>","PeriodicalId":21159,"journal":{"name":"Progress in Retinal and Eye Research","volume":"109 ","pages":"Article 101405"},"PeriodicalIF":14.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eyelid dermatitis: Work-up and future diagnostic innovative solutions","authors":"Elena Borzova ,&nbsp;Steffen Heegaard ,&nbsp;Elke O. Kreps ,&nbsp;Vanessa Smith ,&nbsp;Maurizio Cutolo ,&nbsp;Enzo Berardesca ,&nbsp;Erika Ponzini ,&nbsp;Stephanie M. Willerth ,&nbsp;Christopher J. Corrigan ,&nbsp;Alain Taïeb ,&nbsp;Werner Aberer ,&nbsp;Riichiro Abe ,&nbsp;Howard I. Maibach ,&nbsp;Jacob P. Thyssen","doi":"10.1016/j.preteyeres.2025.101399","DOIUrl":"10.1016/j.preteyeres.2025.101399","url":null,"abstract":"<div><h3>Background</h3><div>Eyelid dermatitis (ED) is an interdisciplinary medical challenge affecting thousands of patients worldwide. ED management can be difficult in view of the numerous differential diagnoses and limited treatment options. We review the diagnostic work-up for ED patients, with a special focus on the latest innovative solutions.</div></div><div><h3>Observations</h3><div>The diagnostic work-up of ED should include medical history, exposure analysis (direct contact, transfer by hands, airborne exposure, rarely ingestion) ocular complaints, clinical severity scores for eyelid manifestations, and consider general and specialized scoring systems. Patch testing and Schirmer test modifications can be used to delineate the underlying aetiology and to narrow the ED differential diagnosis. Metal release assays (nickel spot test, cobalt spot test) as well as gold jewelry avoidance can inform on clinically relevant metal allergy in selected cases. Repeated open application tests with cosmetic products can be used on the retroauricular skin. Transepidermal water loss (TEWL) measurements should be adapted for the eyelids. Further research on eyelid microbiome and transcriptomic biomarkers in the tear fluid and/or eyelid keratinocytes is required. Atopy patch testing with house dust mites (HDMs) can be helpful in selected cases but needs further standardization. Machine learning algorithms may aid image analysis for automated patch test readings and may leverage transcriptomic data for diagnostic classifications, particularly in ambiguous cases, and treatment monitoring in ED.</div></div><div><h3>Conclusions and relevance</h3><div>ED diagnosis can be challenging and may require the collaboration of ophthalmologists, dermatologists, allergists, and rheumatologists. Diagnostic innovations exist but their value in the diagnostic work-up is currently unclear.</div></div>","PeriodicalId":21159,"journal":{"name":"Progress in Retinal and Eye Research","volume":"109 ","pages":"Article 101399"},"PeriodicalIF":14.7,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and histological aspects of the anatomy of myopia, myopic macular degeneration and myopia-associated optic neuropathy","authors":"Jost B. Jonas ,&nbsp;Rahul A. Jonas ,&nbsp;Songhomitra Panda-Jonas","doi":"10.1016/j.preteyeres.2025.101402","DOIUrl":"10.1016/j.preteyeres.2025.101402","url":null,"abstract":"<div><div>Axial myopia is characterized by a panoply of morphological, clinical and histological, features in association with longer axial length. It includes changes in the region peripheral to the optic nerve head (reduction in the density of photoreceptors and retinal pigment epithelium (RPE) cells and retinal thinning); in the optic nerve head region in moderately myopic eyes (shift of Bruch's membrane (BM) opening typically in the temporal/inferior direction, leading to a secondary BM overhang into the nasal intrapapillary compartment, BM absence in the temporal parapapillary region (“gamma zone”), and optic disc ovalization due to shortening of the ophthalmoscopically visible horizontal disc diameter; and widening of the RPE opening leading to myopic parapapillary beta zone), and in highly myopic eyes (BM opening enlargement resulting in a circular gamma zone, elongation and thinning of the lamina cribrosa (“secondary macrodisc”) and of the peripapillary scleral flange (“parapapillary delta zone”); and in the macular region with an elongation of the fovea–optic disc distance, reduction in angle kappa, straightening/stretching of the papillomacular retinal blood vessels and retinal nerve fibers (leading to a re-arrangement of the retinal nerve fibers with a myopia-specific regional distribution of the retinal nerve fiber layer thickness profile), choroidal thinning most pronounced at the posterior pole and affecting mainly the medium-sized and large choroidal vessel layer), and scleral thinning. Pathologic changes in the macular region are extrafoveally located, linear RPE layer defects (lacquer cracks), potentially widening to round RPE layer defects (patchy atrophies), in some eyes with central BM defects; BM defects with RPE layer defects in the foveal region, accompanied by macular neovascularization or subsequent subretinal RPE cell proliferation (“macular atrophy”); myopic macular retinoschisis; and staphylomas. With longer axial length, the prevalence of non-glaucomatous optic neuropathy and glaucoma-like/glaucomatous optic neuropathy steeply increases beyond an axial length of 26.0–26.5 mm. With BM thickness being independent of axial length and in view of eye shape change from an oblate or sphere in emmetropia to a prolate rotational ellipsoid in myopia, the myopia specific morphological changes may be associated with a primary BM enlargement in the region peripheral to the optic disc.</div></div>","PeriodicalId":21159,"journal":{"name":"Progress in Retinal and Eye Research","volume":"109 ","pages":"Article 101402"},"PeriodicalIF":14.7,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}