Axial elongation in nonpathologic high myopia: Ocular structural changes and glaucoma diagnostic challenges

Axial elongation continues in highly myopic adult eyes, even in the absence of pathologic changes such as posterior staphyloma or chorioretinal atrophy. This ongoing axial elongation leads to structural changes in the macular and peripapillary regions, including chorioretinal thinning, reduced vascular perfusion and optic disc tilting and rotation, among others. These alterations can affect the acquisition and interpretation of optical coherence tomography, optical coherence tomography angiography and fundus photographs, potentially introducing artifacts and diminishing the accuracy of glaucoma diagnosis in highly myopic eyes. In this review, we compared the progression patterns of axial elongation across populations with varying demographic characteristics, genetic and environmental backgrounds and ocular features. We also discussed the implications of axial elongation-induced ocular structural changes for diagnosing glaucoma in nonpathologic high myopia. Finally, we highlighted the prospects for enhancing the diagnostic efficacy of glaucoma in nonpathologic highly myopic populations.