Anterior Sclera Undergoes Thinning with Increasing Degree of Myopia

Purpose: Considering that ocular expansion is associated with scleral thinning, this study investigated variation in scleral thickness (anterior scleral thickness [AST] and posterior scleral thickness [PST]) in different meridians across emmetropes and a wide range of myopes.

Methods: A total of 95 participants (mean age, 24 ± 4 years) including emmetropes (spherical equivalent refractive error, ±0.75 diopters [D]; n = 20) and myopes (-1.00 to -27.25 D; n = 75) underwent ocular imaging with swept-source optical coherence tomography. All the images were analyzed using semiautomated custom-designed software to determine scleral thickness in 1-mm intervals. AST was estimated from limbus to 5 mm (n = 95), and PST from fovea to 5 mm (n = 25; high myopes only) along the horizontal and vertical meridian.

Results: The median spherical equivalent refractive error and axial length were -4.25 D (IQR, -12.50 to -1.00 D) and 25 mm (IQR, 23.72-28.35 mm), respectively. The anterior sclera was thinnest in the superior and thickest in the inferior region (475.3 ± 19.0 vs. 605.9 ± 18.6 µm; P < 0.001). The inferior AST alone decreased significantly with increasing magnitude of myopia (r = 0.27; P = 0.008). There were no differences in AST between nasal and temporal meridians (583.24 ± 15.00 vs. 587.09 ± 27.00 µm; P > 0.05). The mean subfoveal PST for the subset of high myopes was 251.7 ± 12.0 µm which was thinner than mean AST along all the meridians by more than 45%. The averaged scleral thickness peripheral to fovea (1-5 mm) was similar along different meridians (P > 0.05).

Conclusions: The relative significant thinning of the anterior sclera along the inferior meridian with increasing degree of myopia compared with the other three meridians indicates the potential role of AST, especially in the inferior meridian, to act as a marker for myopia progression.