Aim This study aimed to identify the loci of gene mutations associated with high myopia, analyse the genetic mutation spectrum characteristics for early onset high myopia (eo-HM) and explore the application of polygenic risk scores (PRSs) in predicting eo-HM.Methods Whole-exome sequencing (WES) and ophthalmic measurements were performed on participants with high myopia, and the mutation results were further verified by copy number variation sequencing, long range PCR and Sanger sequencing. Participants were classified into eo-HM (onset age<7 years and binocular spherical equivalent refraction <-6.0 dioptres (D)) and late-onset high myopia (lo-HM). PRS was calculated and assessed for eo-HM prediction accuracy through receiver operating characteristic (ROC) curve metrics.Results The participants comprised 100 patients with high myopia. WES identified 36 variants across 35 of 100 patients (35.00%), with the eo-HM group exhibiting a significantly higher detection rate (56.52%) than the lo-HM group (16.67%) (p<0.001). COL2A1 c.1221+1G>A, ARR3 c.41T>C, GLRA2 c.1006G>A, ZEB1 c.1672C>T and HDAC8 c.466A>G were recognised as de novo mutation loci in eo-HM. TCF7L2, AIPL1, INPP5E and the promoter mutation of SALL4 were identified as novel potential pathogenic mutations for high myopia (HM). Genetic mutations related to retinal diseases were more frequently observed in the eo-HM group than in the lo-HM group (p<0.01). ROC curve analysis signified that PRS had acceptable predicting ability for eo-HM (area under the curve=0.70).Conclusion This study expands the eo-HM mutational spectrum and proposes novel HM pathogenic genes. PRS demonstrates a certain ability to predict eo-HM.

Background:This study investigated the correlation between quantitative contrast sensitivity function (qCSF) and spherical equivalent (SE) under uncorrected and corrected conditions in children with ametropia. Methods:All participants completed comprehensive ophthalmic evaluations, including manifest refraction and qCSF testing performed under uncorrected and corrected visual acuity conditions. The qCSF parameters included the area under the log contrast sensitivity function (AULCSF), contrast sensitivity function acuity, and contrast sensitivity at spatial frequencies of 1.0-18.0 cycles per degree (cpd). The analysis was stratified by age and SE. Results:A total of 114 eyes from 57 children (29 boys and 28 girls; mean age: 8.56 ± 2.09 years) were included. The mean SE was -0.60 ± 1.04 D (range: -3.125 to +3 D). In children with myopia, the qCSF results were significantly better after refraction correction than those under uncorrected visual acuity and increased linearly with the degree of myopia, whereas in children with hyperopia, the qCSF parameters before and after refraction correction did not differ significantly. Generalized linear modeling identified SE was the strongest independent predictor of uncorrected qCSF performance, whereas age showed minimal influence. The differences in qCSF parameters before and after refractive correction were correlated with the SE. Conclusions:In children without myopia, uncorrected qCSF closely matched the corrected results supporting its use for screening, whereas in children with myopia, the difference between uncorrected and corrected qCSF increased linearly with the degree of myopia. These findings demonstrate the importance of early optical correction and integrating contrast sensitivity assessment into pediatric eye-health evaluations.

PURPOSE:To compare the effective optical zone (EOZ), extent of lenticule decentration, and corneal higher order aberrations (HOAs) after keratorefractive lenticule extraction (KLEx) using the VisuMax 800 and 500 (Carl Zeiss Meditec AG). METHODS:This was a prospective, matched case-control study controlled for programmed sphere (PS: ±0.25 diopters [D]), cylinder (PC: ±0.25 D), and optical zone (±0.1 mm). The EOZ and decentration values were obtained from the tangential topography difference map. The refractive outcomes and corneal HOAs were compared between the two platforms at the 3-month postoperative visit. RESULTS:A total of 95 right eyes of 95 patients who underwent KLEx using the VisuMax 800 and 95 patients using the VisuMax 500 were included. Both platforms are effective and safe for the treatment of myopia and astigmatism. No significant difference was found in the percentage reduction of EOZ between the two platforms (16.52 ± 4.53% vs 16.42 ± 4.60%, P = .637). Multiple linear regression revealed that, for both platforms, PS and mean keratometry were negatively correlated with the percentage reduction in EOZ, whereas PC was positively correlated with the percentage reduction in EOZ. The absolute values of the vertical decentration were significantly lower for the VisuMax 800 (0.14 ± 0.10 vs 0.21 ± 0.14 mm, P < .001). No significant differences in postoperative total HOAs, horizontal and vertical coma, or spherical aberration were found between the two platforms (P > .05). CONCLUSIONS:Both platforms achieved good and comparable refractive, EOZ, and HOAs outcomes. The VisuMax 800 demonstrated higher centration accuracy.

Pathological remodeling of the sclera, characterized by extracellular matrix (ECM) degradation and biomechanical weakening, is a central feature of axial elongation in high myopia. Scleral fibroblasts are the major cell type responsible for ECM homeostasis, and mechanotransduction pathways such as YAP signaling have been implicated in regulating fibroblast behavior and matrix turnover. However, the upstream regulators that control fibroblast function and ECM remodeling in the myopic sclera remain incompletely understood. Long noncoding RNAs (lncRNAs) have emerged as important modulators of gene regulation, but their contribution to scleral fibroblast dysfunction and ECM remodeling in high myopia is largely unexplored. Integrated transcriptomic analyses were performed on scleral tissues from lens-induced myopic (LIM) mice and adults with high myopia to identify conserved dysregulated lncRNAs and mRNAs. Functional roles were examined using primary scleral fibroblasts through gain- and loss-of-function approaches, combined with assays of proliferation, migration, apoptosis, and ECM protein expression. RNA-protein interaction, chromatin immunoprecipitation, luciferase reporter, and competing endogenous RNA (ceRNA) analyses were conducted to interrogate molecular mechanisms. In vivo relevance was evaluated by sub-Tenon’s AAV-mediated modulation of lncRNA expression in LIM mice. Cross-species transcriptomic profiling identified lncRNA Carmn as a consistently downregulated lncRNA in myopic sclera. Reduced Carmn expression was associated with scleral thinning, collagen disorganization, and fibroblast dysfunction in both mice and humans. In vitro, modulation of Carmn levels was associated with changes in scleral fibroblast proliferation, migration, apoptosis, and expression of ECM-related proteins. Mechanistically, Carmn physically interacted with the transcription factor Myrf and was associated with altered YAP transcriptional activity. In parallel, Carmn functioned as a ceRNA by sequestering miR-1224-5p, thereby modulating Myrf expression at the post-transcriptional level. In vivo, AAV-mediated Carmn overexpression attenuated axial elongation and preserved scleral structure in LIM mice, whereas Carmn knockdown exacerbated myopic progression, accompanied by coordinated changes in the miR-1224-5p/Myrf/YAP axis. LncRNA Carmn as a conserved regulatory factor associated with scleral remodeling in high myopia. Through combined RNA-protein interaction and ceRNA-mediated mechanisms, Carmn is linked to Myrf-YAP signaling and ECM homeostasis in scleral fibroblasts. This study provides mechanistic insight into lncRNA-mediated regulation of scleral biomechanics and highlights Carmn as a potential molecular target for modulating pathological axial elongation. Not applicable.

3D printing is reshaping ophthalmic biomaterials, tissue models, implants, biosensors, and drug-delivery systems, but its clinical value depends on matching each printing strategy to ocular-specific requirements rather than on printing capability alone. This review classifies ophthalmic 3D printing into extrusion-based, inkjet-based, electric field-assisted, and light-assisted approaches, while clarifying the boundary between acellular material inks and cell-laden bioinks. We summarize how ink formulation, spatial resolution, optical transparency, mechanical stiffness, degradation, sterilization, immune response, and regulatory classification influence applications in corneal, conjunctival, lens, retinal, orbital, sensing, and drug-delivery contexts. We further discuss hybrid printing and artificial intelligence (AI)-assisted process control as emerging strategies that may improve patient-specific design, reproducibility, and quality assurance. By emphasizing current limitations, clinical translation barriers, and actionable priorities, this review aims to provide a balanced roadmap from basic ophthalmic 3D-printing research toward clinically meaningful transformation. STATEMENT OF SIGNIFICANCE: Ophthalmic diseases affect millions worldwide, yet traditional treatments like eye drops suffer from poor efficacy due to the eye's complex biological barriers. Three-dimensional (3D) printing offers a revolutionary solution by enabling the creation of customized, structurally precise biomaterials. This review provides a comprehensive overview of how advanced 3D printing technologies are being used to engineer delicate eye tissues (cornea, conjunctiva, and retina) and develop novel drug delivery systems (microneedles and smart contact lenses). Furthermore, we introduce the concept of 'dynamic bioprinting,' highlighting how smart materials can adapt to the ocular microenvironment over time. This work bridges the gap between biomaterial structure-function design and clinical ophthalmology, providing a roadmap for future personalized vision therapies.

PURPOSE:To compare lenticular scanning quality and visual outcomes between keratorefractive lenticule extraction performed with VisuMax 800 and VisuMax 500 systems. SETTING:Single ophthalmic surgical center. DESIGN:Comparative, nonrandomized prospective study. METHODS:Consecutive patients aged 18 to 46 years were recruited between November 2024 and March 2025. Opaque bubble layer (OBL) and lenticular surface regularity were measured using intraoperative imaging and scanning electron microscopy. Visual acuity and refractive error were assessed at 1 month, 3 months, and 6 months postoperatively. RESULTS:A total of 140 participants (140 eyes) were included (70 per group). The VisuMax 800 group had significantly lower OBL proportions (3.97% ± 2.58% vs 2.44% ± 0.52%, P = .013) and better lenticular surface regularity scores (11.85 ± 2.56 vs 14.98 ± 4.05, P = .048). In the VisuMax 800 group, higher flat K and steep K correlated with larger OBL areas (β = 0.412, P < .001; β = 0.358, P = .002) and larger optical zones were associated with better lenticular surface regularity (β = 0.535, P = .038). No statistically significant difference was observed in the visual and refractive outcomes between the 2 groups at the 6-month postoperative follow-up ( P > .05). In the VisuMax 800 group, smaller OBL proportions were associated with better visual acuity at 1 and 3 months postoperatively (β < 0, P < .05), while better lenticular surface regularity was correlated with lower astigmatism at 3 months postoperatively (β = -0.574, P = .002). CONCLUSIONS:Although technical advancements of the VisuMax 800 may optimize intraoperative lenticular scanning quality, the VisuMax 800 and 500 systems yield comparable visual outcomes.

To evaluate the impact of various factors, including sex, retinal thickness, and axial length (AL), on pupillary light reflex (PLR) in young individuals with axial myopia. Sixty-two patients (50

BACKGROUND:The rising prevalence of mild myopia among kids needs very effective methods for preventing its progression. Recent research suggests that a combination of acupuncture and a small dose of atropine eye drops might be more effectively combined for myopia control. The trial will evaluate myopia control among kids aged 6-14 years old using buried needle acupuncture with low-dose atropine 0.01%. OBJECTIVES:To evaluate if there is a synergistic effect from periocular acupuncture and low doses of atropine on mild myopia in children 6-14 years old. METHODS:A total of 80 children with mild myopia and 160 eyes were included in the randomized controlled trial from March 2020 to June 2021. All participants were then randomly assigned equally into both the treatment group, which included acupuncture and low doses of atropine and routine eye care, and the control group, which included sham acupuncture and routine eye care. The main outcomes were uncorrected visual acuity, best-corrected visual acuity, spherical equivalent refraction, amplitude and facility of accommodation, and axial length. All these were measured at 0, 2, 6, and 12 months. Treatment compliance and attendance were monitored. RESULTS:The treatment group showed marked improvement in UCVA and BCVA, accommodation function, and rate of SER and axial length progression compared with the control group (P < 0.05). There were no serious side effects; two patients complained of mild transient pain. The combination regimen was generally tolerated without serious ocular or systemic side effects. CONCLUSION:Periocular acupuncture with low dose atropine solution (.01%) seems to be a safe and more effective method as compared with conventional treatment alone for controlling mild myopia in children. Large scale trials should be conducted for validating these findings.

PURPOSE:To investigate the long-term decentration changes and associated factors after SMILE surgery for high and low-to-moderate myopia. METHODS:47 eyes of 30 patients undergoing SMILE surgery at the Eye & ENT Hospital of Fudan University were included in this prospective study (age at surgery: 28.23 ± 7.38 years old, male:female = 13:17). 20 eyes of 15 patients were divided into low-to-moderate myopia (LMM) group, and 27 eyes of 20 patients to high myopia (HM) group by preoperative refraction. Main outcome measures included visual acuity, preoperative refraction, intraocular pressure, axial length, optical zone diameter, decentration, and ablation depth. Follow-up time was 11.50 ± 1.52 years (10 to 13 years). RESULTS:All surgeries were successful without complications. The safety index was 1.18 ± 0.17 in HM group and 1.19 ± 0.17 in LMM group. The decentration was 0.38 ± 0.20 mm in HM group and 0.48 ± 0.19 mm in LMM group, with no statistically significant difference between groups (p = 0.130). In LMM group, decentration was negatively correlated with spherical refraction (r = -0.46, p = 0.016*) and spherical equivalent (r = -0.41, p = 0.032*), and positively correlated with corneal thickness (r = 0.50, p = 0.008*) and axial length (r = 0.51, p = 0.006*). In HM group, no significant correlation was found between decentration and evaluated factors (p > 0.05). CONCLUSION:SMILE surgery demonstrates long-term safety, efficacy, and predictability. Long-term decentration after SMILE is unaffected by the degree of myopia.

Purpose:To investigate changes in contrast sensitivity (CS) and their association with Lenticule surface regularity after keratorefractive lenticule extraction (KLEx) performed with the VisuMax 800. Patients and Methods:In total, 92 patients (184 eyes) with myopia were recruited between November and December 2024. CS was measured using the quantitative contrast sensitivity function at 1, 3 and 6 months postoperatively. The lenticules were examined using scanning electron microscopy (SEM), and the SEM images were scored using the large language model Doubao-vision-pro 32k. Correlation analysis between Lenticule surface regularity and CS was performed based on the Generalized Estimating Equations model. Results:At 6 months postoperatively, the uncorrected distance visual acuity of all operated eyes was 20/25 or better; none of the eyes lost 1-2 lines of corrected distance visual acuity. Area under the log CS function, cutoff spatial frequency acuity and CS (3.0-18.0 cpd) significantly improved from 1 to 6 months and correlated with visual acuity and refraction (P < 0.05). Lenticule surface regularity, mainly influenced by age (β=0.204, P < 0.001) and cap thickness (β=-0.325, P < 0.001), was significantly associated with CS (3.0 cpd) at 1 and 3 months postoperatively (β=0.027, P=0.005; β=0.028, P=0.006), and with CS (6.0 cpd) at 6 months postoperatively (β=0.035, P=0.001). Conclusion:KLEx performed with the VisuMax 800 yields excellent and stable visual outcomes at six months postoperatively and postoperative CS improved over time. Lenticule surface regularity could contribute to postoperative visual quality to a certain extent.

PURPOSE:To compare the contrast sensitivity (CS) after keratorefractive lenticule extraction (KLEx) between the VisuMax 800 and VisuMax 500 systems (Carl Zeiss Meditec AG). METHODS:Participants aged 18 to 46 years were recruited between November 2024 and April 2025. Visual and refractive outcomes were assessed and CS function (CSF) was measured using the quantitative CSF (qCSF) test at 1, 3, and 6 months postoperatively. The differential analysis and influencing factor analysis of qCSF parameters between the two systems were conducted. RESULTS:In the VisuMax 800 group, qCSF parameters at 1 month postoperatively were better than those in the VisuMax 500 group (P < .05). There were no statistically significant differences in qCSF parameters between the two groups at 3 and 6 months postoperatively (P > .05). In the VisuMax 500 group, preoperative and postoperative cylindrical refraction were significantly correlated with CS (6 cycles per degree [cpd]) and CS (12 cpd) (P < .05). In the VisuMax 800 group, preoperative and postoperative spherical refraction (SR) and postoperative SR was were significantly correlated with CS (6 cpd) and CS (12 cpd) (P < .05). CS (12 cpd) in the VisuMax 500 group and CS (6 cpd) in the VisuMax 800 group were correlated with the optical zone (P < .05). CONCLUSIONS:The VisuMax 800 system demonstrates a slight advantage in the early recovery of visual function following KLEx, particularly excelling in CS at medium and high spatial frequencies, and its outcomes converge with those of the VisuMax 500 system at postoperative 3 and 6 months.

BACKGROUND AND AIMS:Since DNA sequencing alone faces challenges in variant interpretation during genetic diagnosis, RNA sequencing has recently gained attention in resolving these diagnostic gaps. This study aimed to evaluate the advantages of liver tissue RNA sequencing in the diagnosis of genetic liver diseases. APPROACH AND RESULTS:Liver tissue RNA sequencing was performed on 147 patients with prior DNA sequencing. We evaluated the role of RNA sequencing by analyzing aberrant gene expression, splicing, allele-specific expression, transcript-level similarity, and mosaic variants. Liver RNA-seq supported the molecular diagnoses in 56 patients diagnosed by DNA sequencing alone. Among 91 previously undiagnosed patients, incorporating RNA sequencing established a diagnosis in 17 (18.68%) patients. Among the 33 patients with indicative clinical phenotypes or prioritized variants, diagnosis was established in 15 (45.45%) patients with the help of RNA sequencing. This improvement was primarily (16/17) driven by the detection of aberrant splicing and allele-specific expression, instead of aberrant expression. RNA sequencing revealed ±50 bp of cryptic splicing sites as hotspot regions, characterized allele-specific expression at both the gene and variant levels, and revealed shared transcriptomic features in low-GGT cholestasis. CONCLUSIONS:While DNA sequencing demonstrates superior sensitivity in detecting clinically relevant variants, liver RNA sequencing significantly enhances genetic diagnosis, mainly by revealing aberrant splicing and allele-specific expression. These findings suggest that RNA sequencing is an essential complement to DNA sequencing.

Purpose:To determine the contrast sensitivity (CS) and vision quality of patients with high and extreme high myopia following long-term evolution implantable collamer lens (EVO ICL) implantation. Patients and Methods:Thirty-five patients (60 eyes) with a myopia range of -7.25 D to -18.50 D were enrolled. Participants were categorized into the high myopia (HM) (spherical equivalent>-12.0 D) and extreme high myopia (EHM) (spherical equivalent≤-12.0 D) groups. Routine examinations, including measurements of endothelial cell density and anterior chamber parameters, were performed. CS and vision quality were assessed over a long-term follow-up period, with an average final follow-up time of 7.29±0.82 years. Results:All surgical procedures were completed without any significant complications. No statistical differences for the CS parameters at the six different spatial frequencies in the corrected and uncorrected conditions were identified between the two groups (P>0.05). The vision quality questionnaire results indicated both groups reported concerns regarding the frequency of halos (HM group 57.6%, EHM group 63%). Driving was identified as the most distressing postoperative daily life activity. Further analysis revealed a negative correlation between driving distress and CS (B=-0.40, P<0.01). The preoperative axial length was found to be correlated with CS (B=-0.39, P<0.01). Conclusion:Patients with HM and EHM maintained good long-term CS and vision quality after EVO ICL implantation. Halos and driving distress were the most common complaints.

ABSTRACT Hydrogels represent a transformative solution for corneal pathologies, offering the advantages of transparency, biocompatibility, and structural tunability to address the global donor tissue shortage. This review establishes a comprehensive framework for material design by delineating critical requirements, including optical clarity, mechanical anisotropy, and stable wet adhesion within dynamic ocular environments. The performances of natural, synthetic, and decellularized‐matrix hydrogels are systematically compared to elucidate the structure–property relationships essential for recapitulating native corneal physiology. Beyond passive substitution, the transition toward bioactive regeneration is examined through analyses of scarless wound healing, sustained drug delivery, and stimuli‐responsive implants. Furthermore, the integration of advanced technologies is evaluated with a focus on three‐/four‐dimensional bioprinting for hierarchical architectural reconstruction and hydrogel‐based wearable bioelectronics for real‐time sensing. Finally, pivotal clinical translation bottlenecks, ranging from sterilization to long‐term immunocompatibility, are identified to guide the development of next‐generation personalized and intelligent corneal devices.

Purpose:To evaluate multi-distance binocular visual function in children using a tablet-based dichoptic platform and compare performance between single-vision and highly aspherical lenslet (HAL) spectacle lenses. Methods:This cross-sectional study included 300 children aged 4 to 17 years wearing single-vision spectacle lenses (n = 154) or HAL spectacle lenses (n = 146). Outcomes included foveal simultaneous-perception non-composite responses, peripheral simultaneous-perception non-normal responses, and fine, dynamic, and gross stereopsis from 0.4 to 3.0 m. Generalized estimating equations clustered by participant evaluated lens type and testing distance, with adjustment for age, sex, myopia magnitude, interocular spherical-equivalent difference, and mean absolute cylinder. Results:Fine stereopsis declined significantly as testing distance increased and was rarely measurable at 2.0 m. Compared with 0.4 m, the adjusted odds of measurable fine stereopsis were lower at 1.5 m (adjusted odds ratio [aOR] = 0.81; P = 0.003) and 2.0 m (aOR = 0.08; P < 0.001). In adjusted observational analyses, HAL lens wear was associated with higher odds of measurable dynamic (aOR = 1.68; P = 0.024) and gross stereopsis (aOR = 2.51; P = 0.006) than single-vision lens wear. Fine stereopsis remained comparable between the two groups (aOR = 0.99; P = 0.960). Foveal non-composite responses were uncommon at 0.4 m but highly prevalent at 3.0 m (>87%) regardless of lens type, while peripheral simultaneous perception remained mostly normal. Conclusions:Tablet-based binocular visual performance declined as the testing distance increased. In this cross-sectional observational analysis, children wearing HAL spectacle lenses showed higher adjusted odds of measurable dynamic and gross stereopsis than those wearing single-vision lenses, while fine stereopsis remained comparable. These findings provide preliminary clinical evidence regarding binocular visual performance with HAL lens wear and warrant confirmation in longitudinal studies across different myopia levels.

Purpose:To investigate the impact of myopia on the Brillouin biomechanics and morphology of crystalline lenses in Chinese adults. Methods:Patients with myopia were enrolled and divided into low-medium (spherical equivalent [SE] ≥ -5.75 D, N = 66) and high (SE ≤ -6.0 D, N = 72) myopia groups. All patients underwent routine ophthalmic examinations, including SE, axial length, and anterior chamber metrics (Pentacam) measurements. The Brillouin-related metrics of the crystalline lenses were measured using a Brillouin microscopy. The morphological parameters included the Width of Top Plateau (WTP), Width of Bottom Plateau (WBP), Bottom-Top (B-T), Slope of Anterior Cortex (SAC), and Slope of Posterior Cortex (SPC). The height of Plateau was a biomechanical parameter. Results:The study included 138 eyes (138 patients); the mean age was 28.43 ± 8.31 years. WBP, B-T, SAC, and SPC significantly differed between the high and low-medium myopia groups (all P<0.05). WBP, B-T, and SPC significantly correlated with SE in the high myopia group (Pearson's r = 0.365, 0.287, and 0.294, respectively; all P<0.05) but not in the low-medium group. The SPC significantly decreased for all participants based on the SE values (P<0.05). The biomechanics and thickness of the nucleus displayed no discrepancies with SE in all participants (all P >0.05). Conclusion:An increase in the degree of myopia could be associated with posterior cortex thickening while maintaining stable biomechanics and morphology of the crystalline lens nucleus. Brillouin microscopy can serve as an effective technique for multidisciplinary lens biomechanical and morphological imaging.

Myopia is an urgent public health concern. However, its pathogenesis remains unclear. Sleep disturbance is a potential environmental risk factor for myopia; however, the underlying mechanisms linking sleep and myopia remain largely unexplored. This review outlines three pathways through which sleep disturbance may contribute to the onset and progression of myopia. First, disruption of the circadian rhythm associated with sleep disturbance alters retinal dopamine dynamics and the balance between dopamine receptor subtypes, ultimately promoting myopia, with melatonin and intrinsically photosensitive retinal ganglion cells likely mediating this effect. Second, reduced choroidal blood flow caused by increased sympathetic tone during sleep disturbance may induce scleral hypoxia and myopic changes. Third, ocular inflammation triggered by sleep disturbance may further accelerate myopia progression. Elucidating these mechanisms could guide the development of targeted preventive and therapeutic strategies. Future studies should use well-designed animal models with sleep interventions to elucidate these mechanisms.

PURPOSE:To assess the long-term stability of the posterior corneal surface in myopic patients with thin corneas after Small Incision Lenticule Extraction (SMILE). METHODS:This study involved 60 eyes from 60 patients (mean spherical equivalent (SE): -5.81 ± 1.79 D), divided into two groups based on preoperative central corneal thickness (CCT): Group A (CCT < 510 μm, thin cornea) and Group B (CCT ≥ 510 μm, normal cornea), with 30 eyes per group. Data collected preoperatively and 7 years postoperatively included visual acuity, SE, efficacy and safety indices, intraocular pressure, axial length, and posterior corneal surface elevation measured by Pentacam. RESULTS:No significant long-term complications were observed. Efficacy and safety indices were similar: 0.94 ± 0.16 and 1.07 ± 0.11 in Group A, and 0.94 ± 0.17 and 1.07 ± 0.16 in Group B. In Group A, posterior central elevation (PCE) increased significantly from baseline, while posterior thinnest elevation (PTE) decreased. Group B showed a significant increase in mid-peripheral elevation at 4 mm (MPE-4 mm). Subgroup analysis revealed increased PTE and MPE-6 mm in low-to-moderate myopia in Group A, and increased peripheral elevations in similar myopia levels in Group B. High myopia patients showed no significant changes. Correlation analysis in Group A showed that changes in 7-year PTE were negatively correlated with residual bed thickness (RBT) and positively correlated with the ablation ratio (AR). Similarly, changes in PCE and PTE correlated with RBT and AR. CONCLUSION:SMILE effectively corrects myopia long-term but increases posterior surface elevation in thin corneas. Patients with high myopia and thin corneas should monitor RBT and AR to ensure long-term corneal stability and safety.

Hundreds of millions of people suffer from blindness and severe vision impairment due to pathologic myopia and other ocular illnesses, posing substantial worldwide public health issues. Accurate diagnosis and timely treatment of these conditions heavily rely on the precise segmentation of key anatomical structures in fundus images, such as the optic disc, which is essential for identifying disease types for timely and effective clinical interventions. Although medical image analysis has made significant progress, existing methods often address segmentation and classification as separate tasks, resulting in limited performance and poor clinical applicability. In this work, we present an innovative end-to-end framework named Fusion-Attention Diagnosis Network (FADNet), which unifies ocular disease classification and optic disc segmentation tasks. The core innovation of FADNet lies in the Dynamic Weighted Feature Fusion strategy, which seamlessly integrates the segmentation mask into the original fundus image using a context-aware weighting mechanism. This approach amplifies the contribution of pathological regions, enhancing feature relevance for subsequent classification. The framework first employs an Attention U-Net to achieve accurate optic disc segmentation, followed by a ResNet-based classification network to diagnose ocular diseases from the fused image. Experiments on the iChallenge-PM and Retina datasets indicate that FADNet attains state-of-the-art performance, achieving accuracies of 97.1% in binary classification and 90.4% in multi-class classification, surpassing current methodologies. FADNet outperforms previous methods by its joint optimization strategy, which improves the synergy between segmentation and classification tasks, resulting in notable improvements in diagnostic accuracy and robustness. FADNet showcases its effectiveness and adaptability across multiple datasets, offering a comprehensive and practical solution for the automated diagnosis of ocular diseases, with significant potential for future deployment in clinical settings.