Dominique Bremond-Gignac

Response to Letter in regards to The Blooming Effect: A Potential Source of Variability in OCT-Derived Choroidal Vascularity Measurements [Letter]

This systematic review evaluates current evidence on choroidal structural and vascular changes in myopia development and progression and assesses how these parameters are influenced by different myopia control interventions. A literature search was conducted in PubMed and Scopus for studies published between January 2000 and January 2026, following PRISMA 2020 guidelines. Eligible studies included human observational and interventional research investigating choroidal parameters, primarily choroidal thickness (CT) and choroidal vascularity index (CVI), in relation to myopia progression or treatment response, including pharmacological (atropine), optical (orthokeratology and defocus-incorporated lenses), and light-based interventions. Due to heterogeneity in study designs and outcomes, a qualitative synthesis was performed. Forty-one studies were included. Evidence from cross-sectional and longitudinal studies consistently showed reduced CT in myopic eyes, with choroidal thinning associated with axial elongation and refractive progression. Multiple interventions were associated with measurable choroidal changes, most commonly transient or sustained thickening. Optical and light-based therapies demonstrated more consistent and pronounced choroidal responses, often driven by vascular expansion, whereas atropine showed dose-dependent and variable effects. Early choroidal thickening correlated with slower axial elongation and reduced myopia progression, suggesting a predictive role. However, variability in imaging techniques, study populations, and follow-up durations limited comparability across studies. Overall, the choroid emerges as a dynamic, treatment-responsive tissue involved in myopia pathophysiology, and choroidal parameters (particularly early changes in CT and vascularity) show promise as functional and prognostic biomarkers for myopia control. Further standardized, longitudinal studies are needed to clarify underlying mechanisms and to establish the choroid’s role in personalized myopia management.

Aims: Stickler syndrome is a genetically inherited vitreoretinopathy that can lead to retinal detachment from early childhood. There is currently no consensus preventive treatment. We aimed at determining whether sex influences the age of onset of rhegmatogenous retinal detachment (RRD) in COL2A1 and COL11A1 Stickler patients. Methods: This is a retrospective study including genotyped Stickler patients from two tertiary centres with at least one RRD. We analysed differences in the age of occurrence of RRD according to sex and genetic mutation. A multivariate analysis was used to analyse risk factors for RRD including sex, presence of preventive treatment, congenital myopia or extra-ophthalmologic conditions. Results: 58 patients with at least one RRD were included. In girls with COL2A1 variants (n=30), the average age of RRD onset was later (21.3 (±14.5) years; range: 5.4–66.0), and the age distribution was broader than in boys with COL2A1 variants (n=19, 10.07 (±5.7) years; range: 0.5–19.7; pCOL11A1 patients, there was no significant difference in age of RRD between boys and girls. Preventive treatment (360° laser or scleral buckling) was the only independent protective factor for RRD (RR=−0.49 (±0.002); pCOL2A1 -Stickler syndrome, males tend to experience RRD at an earlier age. In COL11A1 -Stickler patients, RRD occurs earlier in life but no sex difference was found. Based on these findings, if preventive treatment is considered, it should be performed before puberty, particularly earlier in boys with COL2A1-related Stickler syndrome and in both male and female patients with COL11A1 variants.

The increasing global prevalence of myopia represents a major public health concern. This perspective article aligns with the research theme of the special issue on Interventional Modalities for the Prevention and Management of Childhood Myopia. In progressive myopia, the goal is to implement reliable early-life strategies to control myopia and reduce the risk of high myopia. We propose the PREC framework (Prevent, Recognize, Evaluate, and Control) for childhood myopia. Each component is detailed to support individualized myopia management. However, further evidence is required to establish robust guidelines and optimize management strategies, particularly for non-isolated myopia.