Intraocular Pressure-Lowering Therapy Slows Down Axial Elongation in Progressive High Myopia with Enhanced Choroidal Perfusion.

PURPOSE: To evaluate the efficacy of intraocular pressure (IOP)-lowering medications in slowing down axial elongation among adults with progressive high myopia (PHM).

DESIGN

A retrospective longitudinal cohort study.

PARTICIPANTS

Fifty eyes from 50 adults with PHM (axial elongation ≥0.1 mm/year prior to using IOP-lowering medications) who initiated IOP-lowering medications at Zhongshan Ophthalmic Center between December 2019 and May 2025.

METHODS

A comprehensive set of variables, including demographic data, ocular characteristics, and OCT angiography imaging were collected and analyzed.

MAIN OUTCOME MEASURES: Change in the axial elongation rate before and after ≥12 months of IOP-lowering medication use.

RESULTS

Of the 1628 participants, 50 eyes from 50 eligible participants were finally analyzed. These participants had a mean age of 40.4 ± 10.7 years, with 72% being female; the mean number of IOP-lowering medications they used was 2.0 ± 0.3. After 12 months of follow-up, IOP decreased from 13.49 (2.50) to 12.03 (2.28) mmHg (P < 0.001). The axial elongation rate decreased from 0.14 (0.04) to 0.03 (0.07) mm/y (P < 0.001). OCT angiography showed increased perfusion density in the deep capillary plexus (DCP; 49.70% to 50.27%; P = 0.03) and choriocapillaris (CC; 55.47% to 55.66%; P = 0.04).

CONCLUSIONS

In this cohort, IOP-lowering therapy was associated with reduced axial elongation in adults with PHM, with concurrent modest enhancement of perfusion in DCP and CC. These findings support IOP-lowering therapy as a potential strategy to slow myopia progression in adults with PHM.

FINANCIAL DISCLOSURES: The authors have no proprietary or commercial interest in any materials discussed in this article.