High-frequency quantitative ultrasound of the anterior sclera in vivo to predict myopia progression

High myopia increases the risk of irreversible vision loss and is associated with changes in scleral collagen microstructure. While refractive error (RE) measurements assess current myopia severity, they cannot predict progression. We developed a high-frequency (80 MHz) point-of-care (POC) ultrasound instrument to collect radiofrequency (RF) echo data of the anterior sclera in vivo and applied quantitative ultrasound (QUS) techniques to compute parameters related to tissue microstructure. In this study, we investigated the feasibility of QUS to predict myopia progression. Longitudinal RE and POC measurements from 59 subjects were collected at baseline and annually for 2 years. QUS parameters based on backscatter coefficient (BSC) and shear wave speed were computed from years 0 and 1. Eyes with change in RE (ΔRE) ≥0.5D from baseline were classified as progressors. After 1 year, the 18 progressor eyes exhibited statistically significant changes in QUS parameters (ΔQUS, p ≤ 0.01), whereas non-progressor eyes showed no significant ΔQUS. Multilinear regression showed strong correlation between ΔQUS and 1-year ΔRE (R = 0.82, p < 0.001). Combining ΔQUS with baseline ophthalmic measurements, a logistic regression classifier predicted 2-year progressor eyes with AUC = 0.75. These findings support high-frequency QUS as a tool to detect myopia-induced changes in anterior sclera microstructure and predict myopia progression. [Work supported by NIH grant R21EB028084 (JM).]