Abstract / Summary
Myopia is a growing global public health burden. Progressive axial elongation causes optic nerve head (ONH) deformation that cannot be fully explained by axial length alone. However, whether peripapillary choroidal perfusion is associated with ONH deformation in myopia remains unclear. This study aimed to investigate ONH and choroidal changes in myopia and factors associated with ONH deformation. A total of 387 young myopic patients aged 18 to 40 years were recruited and divided into groups based on axial length (AL): AL1 (≤ 26 mm), AL2 (26 < AL < 27 mm), and AL3 (≥ 27 mm). We measured structural parameters of the ONH, including peripapillary atrophy (PPA), optic disc tilt and rotation, Bruch’s membrane opening distance (BMOD), border length (BL), and border tissue angle (BTA), as well as choroidal parameters including subfoveal choroidal thickness (SFCT), macular choroidal vascularity index (mCVI), peripapillary choroidal thickness (pChT), and peripapillary choroidal vascularity index (pCVI). Receiver operating characteristic (ROC) analysis was used to evaluate the discriminative performance for ONH deformation. Linear regression and mediation analysis assessed the relationships between AL, choroidal perfusion, and ONH deformation. The area of β-PPA and γ-PPA, ovality index, BMOD, and BL increased, while BTA, SFCT, mCVI, pChT, and pCVI decreased with increasing AL. ROC curve analysis demonstrated that combining AL with choroidal parameters improved the discriminative performance for significant ONH deformation. Multiple linear regression analysis identified AL and choroidal parameters as factors significantly associated with ONH deformation severity. Mediation analysis showed that pCVI statistically accounted for a portion of the association between AL and ONH deformation. Decreased choroidal perfusion is significantly associated with ONH deformation in young myopic adults across the axial length range studied. Peripapillary choroidal parameters are valuable indicators of ONH health.