Fig. 6: Scleral birefringence in patients with high and pathologic myopia.

a–d, Representative TRIPS-OCT images of a patient (61-yr-old female, OD, AL: 27.8 mm, Asian) with pathologic myopia, diagnosed by the presence of staphyloma, shown in contrasts of en face intensity (a), en face birefringence (a’), cross-sectional intensity (b,c), cross-sectional birefringence (b’,c’) and three-dimensional reconstruction of the eyeball shape (d). The dashed lines in a and a’ indicate the locations of the cross-sectional images (b,b’,c,c’). White arrowheads (a’,b,b’,c,c’) indicate the edges of staphyloma. Yellow arrowheads (b’,c’) indicate regions of scleral birefringence increase. e, Representative images of eyes with high myopia and pathologic myopia at various stages (from left to right: 32-yr-old male, OD, AL: 28.8 mm; 32-yr-old female, OS, AL: 26.9 mm; 49-yr-old female, OS, AL: 26.9 mm; 62-yr-old male, OS, AL: 30.2 mm, all Asian). Images are shown in contrasts of cross-sectional intensity (upper panel), en face intensity (middle panel) and en face birefringence (lower panel). Black arrows indicate PPA. f, Correlation of PPSB and AL in all eyes (non-pathologic n = 85, pathologic n = 15). The scatterplot shows 100 eyes from 59 individuals, regression (line) and 95% confidence intervals (shaded area). The r value was calculated using Pearson correlation. The P value was calculated using F-test against a constant model. Inter-eye correlation was addressed by cluster bootstrapping. g, Performance of using PPSB and AL as classifiers to differentiate eyes with pathologic myopia from eyes with high myopia. h, PPSB values in eyes with high myopia without PPA (n = 10), high myopia with PPA (n = 6) and pathologic myopia (n = 15). Dots represent eyes, central line indicates median, box shows interquartile range and whiskers show range. The P value was calculated using two-sided Wilcoxon rank-sum test with cluster bootstrapping to correct inter-eye correlation. Histogram equalization was applied to b, c and e (upper panels). Scale bars: a, 1 mm; b,e, vertical: 300 µm, horizontal: 1 mm.