Imaging Innovations in Pathological Myopia: Understanding Biomarkers and Their Role in Clinical Practice

Polarization‑sensitive OCT (PS‑OCT) reveals reproducible scleral and retinal collagen signatures in progressive myopia that alter risk stratification and referral thresholds for sight‑threatening complications.

Prior clinical practice relied on spectral‑domain OCT and fundus photography to define maculopathy patterns and choroidal thinning, but these modalities capture little scleral detail. PS‑OCT extends both depth and contrast, allowing visualization of collagen orientation and localized disruptions beneath the choroid.

Mapping these deeper layers identifies focal areas of structural weakness that correspond to sites of mechanical deformation and subsequent retinal compromise. That correlation shifts surveillance strategies toward earlier targeted imaging in eyes at higher risk of progression.

Recent research reported core structural features associated with progression to pathological myopia—choroidal thinning, posterior staphyloma, dome‑shaped macula, altered scleral fiber orientation and localized collagen architecture disruptions.

Spectral‑domain and swept‑source OCT remain the foundation for measuring choroidal thickness and defining macular morphology. PS‑OCT may increase contrast for visualizing scleral fiber orientation and collagen polarization changes.

Integrated imaging findings support refining screening criteria, monitoring intervals and thresholds for specialist referral based on axial length, rapid refractive or structural change, and the presence of the described biomarkers.

Looking ahead, these imaging biomarkers create a more granular framework for targeted interventions and prospective trials aimed at preventing myopia‑related vision loss.