The Role of Scleral Changes in the Progression of Myopia: A Review and Future Directions

This review article comprehensively examines the alterations in scleral collagen fibers and the extracellular matrix (ECM) during myopia progression, with a particular focus on the scleral hypoxia theory and inflammatory mechanisms. It delves into key signaling pathways, including the matrix metalloproteinase - 2 (MMP-2) pathway, hypoxia - inducible factors (HIF-1α and HIF-2α) pathways, and the Wnt signaling pathway. By elucidating the intricate relationships between these signaling pathways, this article highlights the latest advancements in myopia prevention and control strategies that target the sclera. Moreover, it provides novel insights into the molecular mechanisms underlying scleral remodeling and explores their potential therapeutic applications for effectively managing myopia progression.