Retinal and Choroidal Microvasculature at Different Myopia Severities: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Topic This study systematically evaluates changes in retinal and choroidal microvasculature with increasing myopia severity. Clinical relevance Conflicting results in reported studies on the changes in retinal and choroidal microvasculature with increasing myopia severity require comprehensive analysis to guide patient management. Methods The PubMed, Embase, and Web of Science databases were thoroughly searched for studies published before 8 th May 2025 on retinal and/or choroidal changes across different myopia severities. Included were the cross-sectional or prospective case-control and cohort designs that reported outcomes of foveal avascular zone (FAZ) area and vessel densities (VD) in the retina and choroid. The risk of bias was assessed by the Newcastle-Ottawa Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) tools. Funnel plot with Egger's test assessed potential publication bias. Meta-regressions were conducted to identify potential moderators in subgroup meta-analyses with high heterogeneity. The protocol was registered with PROSPERO (CRD42023402550). Results A total of 47 studies comprising 7293 eyes were included. Highly myopic eyes demonstrated significantly enlarged FAZ area in both the superficial capillary plexus (SCP) (P = 0.049, SMD: 0.37, 95% CI: [0.00, 0.74], I2=82%) and deep capillary plexus (DCP) (P = 0.001, SMD: 0.61, 95% CI: [0.24, 0.98], I2=83%). Macular VD was significantly reduced in the SCP for moderate and high myopia subgroups (P = 0.003 and P < 0.001, respectively), and in the SCP for the high myopia subgroup (P < 0.001). Significant VD reductions were also observed in parafoveal (SCP: P <0.001, DCP: P=0.012) and perifoveal (SCP: P=0.006; DCP: P < 0.001) regions in the high myopia subgroup in both plexuses. Peripapillary VD showed consistently reductions across mild, moderate, and high myopia subgroups (all P ≤ 0.033). No significant differences were observed in choriocapillaris VD or flow area. Conclusion This meta-analysis revealed significantly enlarged FAZ areas and reduced VD in the macular and peripapillary regions with increasing myopia, especially in high myopia. These findings enhance understanding of myopia-related fundus microvascular changes, guiding clinical management and screening of highly myopic patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.027 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.030 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".