Intraocular pressure-lowering therapy slows down axial elongation in progressive high myopia with enhanced choroidal perfusion

Purpose: To evaluate the efficacy of intraocular pressure (IOP)-lowering medications in slowing down axial elongation among adults with progressive high myopia (PHM).Design: Retrospective longitudinal cohort study.Participants: Fifty eyes from 50 adults with PHM (axial elongation 0.1 mm/year prior to using IOP-lowering medications) who initiated IOP-lowering medications at Zhongshan Ophthalmic Center between December 2019 and May 2025. Methods:A comprehensive set of variables, including demographic data, ocular characteristics, and optical coherence tomography angiography (OCTA) imaging were collected and analyzed.Main Outcome Measures: Change in the axial elongation rate before and after at least 12 months of IOP-lowering medication use. Results:Of the 1628 participants, 50 eyes from 50 eligible participants were finally analyzed.These participants had a mean age of 40.4 10.7 years, with 72% being female; the mean number of IOP-lowering medications they used was 2.0 0.3.After 12 months of follow-up, IOP decreased from 13.49 (2.50) to 12.03 (2.28) mmHg (P < .001).The axial elongation rate decreased from 0.14 (0.04) to 0.03 (0.07) mm/y (P < .001).OCTA showed increased perfusion density in the deep capillary plexus (49.70% to 50.27%; P = .03)and choriocapillaris (55.47% to 55.66%; P = .04). Conclusions:In this cohort, IOP-lowering therapy was associated with reduced axial elongation in adults with PHM, with concurrent modest enhancement of perfusion in deep capillary plexus and choriocapillaris.These findings support IOP-lowering therapy as a potential strategy to slow myopia progression in adults with PHM.