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Unravelling the role of scleral events on a novel treatment for Myopia using microscopy techniques

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A glimpse into the structure of the myopic eye

With myopia becoming a global epidemic, investigation of the underlying mechanisms can lead to cutting-edge treatments and improved vision solutions.

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Myopia – commonly known as near-sightedness – is on the rise globally, with nearly 1 billion people expected to be affected by 2050. This surge not only makes myopia the leading cause of permanent blindness worldwide but also presents significant challenges in planning comprehensive eye care services. Despite its prevalence, the causes behind the escalating risk of blindness and the underlying structural and physiological mechanisms of myopia remain elusive.

Investigating the structure of the myopic eye

Undertaken with the support of the Marie Skłodowska-Curie Actions (MSCA) programme, the MYOMICRO project aims to characterise myopic eyes with unprecedented detail to gain novel insight, and to assess treatment effects objectively and comprehensively beyond conventional vision tests. To unravel the mysteries of myopia, the project has developed innovative imaging methods to assess the sclera, the outer layer of the eye crucial in determining eye size and refractive status. “One of the critical challenges in myopia research was the absence of quantitative techniques to characterise the optical and morphological properties of the myopic eye,” explains MSCA research fellow María Viñas Peña.

A multidisciplinary technological approach

Experimental and clinical evidence underscore the important role of scleral collagen fibers in the development of myopia. It also suggests that intervention of the abnormal development of the sclera may be providing ways to prevent or halt the development of myopia. MYOMICRO investigated the collagen structures and biomechanical properties of the sclera by developing new methods that combine technologies such as optical coherence elastography (OCE) and fluorescence lifetime imaging (FLIM). Moreover, for the first time in myopia research, researchers used a technology inherited from astronomy known as adaptive optics which allowed more quantifiable structural images of the sclera. “Undoubtedly, following a multidisciplinary technological approach to tackle myopia has proven to be the right strategy towards understanding eye growth mechanisms and its disruptions,” highlights Viñas Peña.

The impact of scleral collagen crosslinking treatment

OCE is a novel imaging technology recently applied for the first time to ophthalmology. It has enabled the investigation of the biomechanical changes of the sclera following scleral collagen crosslinking (SCXL) treatment – one of the most promising novel techniques under investigation to treat myopia. SCXL is built on the success of corneal crosslinking –currently a clinical treatment – and is inspired by the fact that myopia leads to progressive scleral thinning. OCE showed the effects of SCXL with unprecedented detail and paved the way for enhanced methods to increase scleral strength. Building on the success of OCE, scientists explored the possibility of combining fluorescence and lifetime imaging, with metallic nanoparticles, to understand the structural, mechanical, and molecular changes after SCXL. This multi-imaging approach opened new avenues for myopia research and treatment and provided a more holistic understanding of the complexities involved.

Future directions

Considering the multifactorial trigger signals that induce myopic eye growth, treatment requires a more multidisciplinary approach. Looking ahead, Viñas Peña plans to extend MYOMICRO’s success from the sclera to the retina. By developing nanoimaging technologies, Viñas Peña aims to investigate retinoscleral signalling pathways during normal eye development. This ambitious step will explore the intricate relationship between retinal activity, visual function and the molecular and structural changes in the retinal circuitry leading to scleral remodeling.

Keywords

MYOMICRO, myopia, sclera, near-sightedness, collagen, scleral collagen crosslinking optical coherence elastography, fluorescence lifetime imaging

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