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Imaging in myopia: potential biomarkers, current challenges and future developments
  1. Marcus Ang1,2,3,4,
  2. Chee Wai Wong1,2,3,
  3. Quan V Hoang1,2,3,5,
  4. Gemmy Chui Ming Cheung1,2,3,
  5. Shu Yen Lee1,2,3,
  6. Audrey Chia1,2,3,
  7. Seang Mei Saw1,2,3,
  8. Kyoko Ohno-Matsui6,
  9. Leopold Schmetterer1,2,3,7,8,9
  1. 1 Singapore National Eye Centre, Singapore, Singapore
  2. 2 Opthamology and visual sciences department, Duke–National University of Singapore Medical School, Singapore, Singapore
  3. 3 Singapore Eye Research Institute, Singapore, Singapore
  4. 4 Cornea and External Eye Diseases, Moorfields Eye Hospital, London, UK
  5. 5 Department of Ophthalmology, Columbia University Medical Center, New York City, New York, USA
  6. 6 School of Public Health, National University of Singapore, Singapore, Singapore
  7. 7 Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
  8. 8 Lee Kong Medical School, Nanyang Technological University, Singapore, Singapore
  9. 9 Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
  1. Correspondence to Dr Marcus Ang, Singapore National Eye Centre, Singapore 168751, Singapore; marcus.ang{at}


Myopia is rapidly increasing in Asia and around the world, while it is recognised that complications from high myopia may cause significant visual impairment. Thus, imaging the myopic eye is important for the diagnosis of sight-threatening complications, monitoring of disease progression and evaluation of treatments. For example, recent advances in high-resolution imaging using optical coherence tomography may delineate early myopic macula pathology, optical coherence tomography angiography may aid early choroidal neovascularisation detection, while multimodal imaging is important for monitoring treatment response. However, imaging the eye with high myopia accurately has its challenges and limitations, which are important for clinicians to understand in order to choose the best imaging modality and interpret the images accurately. In this review, we present the current imaging modalities available from the anterior to posterior segment of the myopic eye, including the optic nerve. We summarise the clinical indications, image interpretation and future developments that may overcome current technological limitations. We also discuss potential biomarkers for myopic progression or development of complications, including basement membrane defects, and choroidal atrophy or choroidal thickness measurements. Finally, we present future developments in the field of myopia imaging, such as photoacoustic imaging and corneal or scleral biomechanics, which may lead to innovative treatment modalities for myopia.

  • imaging
  • optics and refraction
  • sclera and episclera
  • optic nerve
  • diagnostic tests/investigation

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  • Correction notice Since this article was first published online, the author Donny V Hoang has been updated to Quan V Hoang.

  • Contributors All authors met the ICMJE criteria: (1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published.

  • Funding This study was funded by Singapore Imaging Eye Network (SIENA) from the Singapore National Medical Research Council (NMRC).

  • Competing interests GCMC serves on the speaker bureau for Topcon and Zeiss. MA is a speaker for Zeiss, Nidek, Allergan, Santen and Johnson & Johnson Vision.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional data can be obtained from the corresponding author.