Characteristics of the fundus and optical coherence tomography angiography metrics in patients with myelinated retinal nerve fibers

Characteristics of the fundus and optical coherence tomography angiography metrics in patients with myelinated retinal nerve fibers | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Characteristics of the fundus and optical coherence tomography angiography metrics in patients with myelinated retinal nerve fibers Weiming Yang, Ruoyan Wei, Chi Zhang, Chen Huang, Feng Lin, Yang Shen, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4636865/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Oct, 2024 Read the published version in BMC Ophthalmology → Version 1 posted 4 You are reading this latest preprint version Abstract AIMS To investigate the fundus characteristics and macular OCTA metrics in patients with MRNFs and to identify the associations among myopic parameters, fundus metrics, and OCTA metrics METHODS The single-center case-control study included 15 patients with monocular MRNFs and 15 patients without MRNFs, matched for age, affected eyes’ spherical equivalent error (SER), and axial length (AL) between May 2021 and December 2021. Fundus features, including the entire MRNF area (Area1), the denser MRNF area (Area2), and the shortest distance from the fovea to the MRNF border (D f−m ), along with ocular parameters, including SER, AL, corrected distance visual acuity (CDVA), and OCTA metrics at the fovea, including choroidal (ChT) and retinal (ReT) thicknesses at the fovea, the foveal avascular zone area (FAZ), foveal avascular zone perimeter (FAZP), FAZ-circularity index (FAZ-CI), and foveal vessel density in a 300-µm wide region (FD-300), were assessed. RESULTS The SER, AL, and CDVA were significantly worse and the ChT was thinner in the affected eyes than in the contralateral eyes. Compared with matched eyes, affected eyes had worse CDVA and thinner ReT. In the affected eyes, both Area1 and Area2 were negatively correlated with SER ( r 1 = -0.84, r 2 = -0.65), △SER ( r 1 = -0.86, r 2 = -0.61), ReT at the vertical superior 3 mm (VS) ( r 1 = -0.78, r 2 = -0.67), and ChT_VS ( r 1 = -0.64, r 2 = -0.62), and positively correlated with AL ( r 1 = 0.82, r 2 = 0.52) and CDVA ( r 1 = 0.54, r 2 = 0.59). D f−m was negatively correlated with CDVA ( r = -0.57). CONCLUSION The presence of MRNFs affects CDVA and ReT at the fovea. The area of the MRNFs, as well as the distance from the MRNFs to the fovea, are closely associated with the affected eyes’ CDVA, SER, AL, and the degree of anisometropia. myopia myelinated retinal nerve fiber fundus Figures Figure 1 INTRODUCTION Myelinated retinal nerve fibers (MRNFs) were first described in 1856 by Virchow.[ 1 ] They are congenital retinal lesions that present as gray or white patches with feathery edges in the inner retinal layer. Their prevalence has been reported as 0.02%,[ 2 ] 0.4%,[ 3 ] 0.57%,[ 4 ] and 0.98%[ 5 ] in the general population. Patients with MRNFs and myopia often present with axial myopia.[ 6 ] Affected eyes tend to have a longer axial length (AL) and more severe myopia than eyes without MRNFs.[ 6 ] MRNFs have been postulated to affect visual development and stimulate axial elongation.[ 7 ] In addition, eyes with widespread MRNFs may show higher degrees of myopia and poorer corrected distance visual acuity (CDVA).[ 1 , 8 ] However, the associations between the area of MRNFs and myopic parameters such as spherical equivalent error (SER), AL, and CDVA have not been adequately evaluated. One proposed mechanism of myopia development involves the potential role of altered choroidal microvasculature and reduced choroidal blood flow in the development of myopia.[ 9 ] Myopia-related visual signals can reduce choroidal capillary patency and blood flow, reduce the supply of oxygen and nutrients to the neighboring avascular sclera, and cause scleral extracellular matrix remodeling.[ 9 ] The dense and widespread MRNFs may compress the retinal and choroidal vasculature, resulting in the development of myopia. Optical coherence tomography angiography (OCTA) is an advanced, non-invasive imaging technology capable of providing detailed information on the microvascular metrics of the retina and choroid. Little is known about OCTA metrics in patients with MRNFs. Herein, we performed this study to investigate fundus and OCTA metrics and the associations among fundus metrics, OCTA metrics, and myopic parameters in patients with MRNFs. METHODS Study design This was a single-center study. Written informed consent was obtained from all recruited participants or their guardians before their participation in the study. All patients were treated in accordance with the tenets of the Declaration of Helsinki. This study was conducted in accordance with the guidelines of the Ethics Committee of the Eye and ENT Hospital of Fudan University, Shanghai, China. Participant selection Fifteen consecutive patients with MRNFs presenting between May 2021 and December 2021 at the Department of Ophthalmology of Fudan University Eye & ENT Hospital were included in this study. Fifteen participants without MRNFs were matched based on age, SER, and AL of affected eyes. The exclusion criteria were as follows: participants with a history of ocular surgery/trauma, smoking, or systemic diseases (hypertension, diabetes, etc.) that may affect retinal or choroidal blood flow. Clinical examinations Each patient underwent a comprehensive ophthalmic examination, which included slit-lamp evaluation, measurement of intraocular pressure (IOP), evaluation of uncorrected distance visual acuity (UDVA) and CDVA using standard logarithmic visual acuity charts, and manifest refraction. AL, corneal curvature, and anterior chamber depth (ACD) were measured in each eye using swept-source optical coherence tomography (IOL Master 700, Carl Zeiss Meditec AG, Jena, Germany). A cover test and alternating cover test were used to detect the presence of strabismus. Each patient underwent an interview, which included assessments of demographic data and medical history, when available. Acquisition of fundus images An ultra-wide-field fundus camera, Zeiss Clarus 500 (Carl Zeiss Meditec, Jena, Germany), which utilizes true colors, was used to acquire fundus images. The single wide-field mode, which achieves a 133-degree field, as well as the montage mode with four images that achieve an approximately 220-degree field, were used to obtain a full view of the MRNFs. For eyes with MRNFs, the border of MRNFs on fundus images was delineated, and the area covered by MRNFs was measured using the ImageJ Pro software (version 6.0.0.260, Media Cybernetics, Inc., Bethesda, USA) (Supplemental Fig. 1). The entire area of the MRNFs was defined as Area1. Considering that MRNF thickness may affect myopic parameters and OCTA metrics, we further defined the area covering the denser MRNFs as Area2. The shortest distance from the fovea to the border of the MRNFs was defined as the D f−m . The MRNF measurements were performed by two experienced doctors (WMY and RYW), and the average of the measurements was calculated. Image acquisition of OCTA The SS-OCT/OCTA system (VG100; SVision Imaging, Henan, China) was used; it functions near 1050 nm and features the following specifications: scan speed, 100,000 A-scans per second; wide-field, 56°; and imaging depth, 2.7 mm (in tissue). The axial and lateral resolutions were 5 µm and 13 µm, respectively. An eye-tracking system based on an integrated confocal scanning laser ophthalmoscope was used to eliminate eye-motion artifacts. Structural OCT of the macular region was performed using 18 radial scan lines centered on the fovea. Each scan line, which was generated by 2048 A-scans, was 12 mm long. Sixteen B-scans were obtained on each scan line and automatically averaged to improve the signal-to-noise ratio.[ 10 ] Vertical scans were used to analyze the choroidal thickness. The choroid in the SS-OCT images was defined as the zone from the retinal pigment epithelium–Bruch’s membrane complex to the choroid-sclera interface. Each OCTA image was corrected for image magnification based on AL with Bennett’s formula using integral manufacturer-developed software. After segmentation, the choroidal and retinal thicknesses at the fovea were defined as the ChT and ReT, respectively. Choroidal and retinal thicknesses at the vertical superior 3 mm centered on the fovea were defined as ChT_VS and ReT_VS, respectively. Similarly, choroidal and retinal thicknesses at the vertical inferior 3 mm were defined as ChT_VI and ReT_VI, respectively. For angiography, a raster scan mode of 512 horizontal B-scans covering an area of 3 × 3 mm centered on the fovea was used. Each B-scan contained 512 A-scans, which were repeated four times and averaged. The foveal avascular zone (FAZ) area, foveal avascular zone perimeter (FAZP), FAZ-circularity index (FAZ-CI), and foveal vessel density in a 300-µm wide region (FD-300) were automatically analyzed. Statistical analysis Data were analyzed with Stata13.0 (StataCorp, Texas, USA) and reported as mean ± standard deviation (SD) or medians with interquartile ranges. The distribution was examined using the Shapiro–Wilk test. Paired t -tests or Wilcoxon signed-rank tests were used to evaluate the interocular differences between fellow eyes for ocular biometrics and OCTA parameters. Correlations among myopic variables (CDVA, SER, △SER [defined as the difference in SER between affected and contralateral eyes], and AL), fundus parameters, and OCTA parameters were examined using the Pearson correlation test and expressed as the Pearson correlation coefficient. Furthermore, we carried out univariate linear regression analysis, with the fundus metrics (Area1, Area2, and D f−m ) as independent variables and those myopic parameters and OCTA metrics that were significantly correlated with the fundus metrics in Pearson correlation analysis as dependent variables. The regression analysis results were expressed as the regression coefficient beta (β) and the 95% confidence interval (CI) of β. The statistical significance level was set at P < 0.05. RESULTS Patient characteristics Demographic characteristics are presented in Table 1 . Fifteen participants with MRNFs (male/female, 4/11) and 15 participants without MRNFs (male/female, 7/8) were included in the study ( P = 0.45). The mean age was 24.3 ± 13.1 years (range, 7 to 51 years) and 24.7 ± 12.5 years (range, 8 to 50 years), respectively ( P = 0.17). Table 1 Characteristics of the study participants Eyes with MRNFs (n = 15) Contralateral eyes without MRNFs (n = 15) Control eyes (n = 15) P # P* Spherical error -9.17 ± 6.13 -3.33 ± 3.70 -9.37 ± 5.94 0.003 0.45 range -20.75, 0 -12.00, 1.50 -21.00, 0 Cylindrical error -2 (-2.25, -1) † -1.13 ± 0.75 -1.55 ± 1.10 0.04 0.53 range -5.50, 0 -2.50, 0 -4.25, -0.25 SER -10.10 ± 6.36 -3.90 ± 3.94 -10.14 ± 6.11 0.002 0.80 range -21.25, 0 -13.25, 0.75 -21.5, -0.125 CDVA, logMAR 0.4 (0, 0.7) † -0.02 ± 0.05 0.04 ± 0.09 0.002 0.01 range -0.08, 1.30 -0.18, 0 0, 0.3 IOP, mmHg 13.20 ± 2.80 13.36 ± 3.08 15.27 ± 2.79 0.74 0.05 range 10.0, 19.9 9.0, 19.0 12, 20.5 Axial length, mm 27.65 ± 2.64 25.22 ± 1.51 27.47 ± 2.42 0.003 0.58 range 23.39, 32.91 23.14, 28.33 24.38, 33.1 Corneal K readings, D 42.78 ± 1.76 42.87 ± 1.87 43.85 ± 1.53 0.46 0.11 range 39.68, 45.10 39.38, 45.55 41.45, 46.1 CCT, µm 560.5(517.0,566.0) † 545.5(511.8,564.5) † 530.5 ± 37.9 0.04 0.36 range 433, 584 430, 574 466, 588 ACD, mm 3.46 ± 0.26 3.49 ± 0.27 3.41 ± 0.26 0.11 0.69 range 2.88, 3.77 2.93, 3.84 2.99, 3.94 Area1, (pixel)×10 4 137.15 ± 152.04 - Range 4.60, 441.22 Area2, (pixel)×10 4 43.86 ± 38.09 - range 4.29, 142.83 D f−m , µm 399.77 ± 219.06 - range 0, 728.87 #Comparison between eyes with MRNFs and contralateral eyes without MRNFs. *Comparison between eyes with MRNFs and control eyes. †Median (P25–P75). MRNF = Myelinated Retinal Nerve Fiber; CDVA = Corrected Distance Visual Acuity; IOP = Intraocular Pressure; CCT = Central Corneal Thickness; ACD = Anterior Chamber Depth; SER = spherical equivalent error Each patient with MRNF had one affected eye and a contralateral unaffected eye. Four of the 15 affected eyes were right eyes. None of the patients had any other accompanying congenital systemic abnormalities. Among the 15 affected eyes, nine had amblyopia. All unaffected eyes had a CDVA of ≤ 0 logMAR. None of the patients had any concomitant strabismus. Differences in manifest refraction and biometric parameters Compared with the contralateral eyes, spherical error, cylindrical error, SER, and CDVA (logMAR) were worse in the affected eyes (all P < 0.05), while the AL was significantly greater ( P = 0.003) and the CCT was significantly lower ( P = 0.04). No statistically significant differences were found in anterior corneal K readings or ACD ( P = 0.46, P = 0.11, respectively). (Table 1 ) Compared with the matched eyes of control participants, eyes with MRNFs had poorer CDVA (logMAR) ( P = 0.01) and no statistically significant differences were detected in other parameters (all P > 0.05). (Table 1 ) Characteristics of MRNFs in fundus Images Data for Area1, Area2, and D f−m are presented in Table 2 . The MRNFs in all eyes were directly connected to the optic disc (15/15 eyes, 100%). The MRNFs involved four, three, two, and one quadrant in nine (60%), two (13.3%), three (20%), and one (6.7%) eye, respectively. In twelve eyes (80%), MRNFs exhibited a greater area in two superior quadrants than in two inferior quadrants. Eight eyes (53.3%) had MRNFs surrounding the optic disc. (Fig. 1 ) Table 2 OCTA metrics of the study participants. Eye with MRNFs (n = 15) Contralateral eyes without MRNFs (n = 15) Control eyes (n = 15) P # P* FAZ, mm 2 0.31 ± 0.14 0.35 ± 0.13 0.37 ± 0.19 0.21 0.19 FAZP, mm 2.36 ± 0.59 2.54 ± 0.44 2.51 ± 0.69 0.17 0.11 FAZ-CI 0.68 ± 0.09 0.68 ± 0.09 0.68 ± 0.11 0.98 0.84 FD-300 42.74 ± 5.39 44.01 ± 5.28 39.81 ± 4.41 0.42 0.06 ReT, µm 206.27 ± 26.93 216 ± 15.49 227.21 ± 27.50 0.08 0.04 ChT, µm 176 (149, 213) † 299.73 ± 84.18 221.64 ± 92.38 0.001 0.07 ReT_VI, µm 208 (162, 232) † 260.2 ± 12.59 242.86 ± 37.60 0.1 0.85 ChT_VI, µm 216.67 ± 79.24 281.87 ± 75.96 226.14 ± 95.51 0.008 0.23 ReT_VS, µm 161 (125, 264) † 287(275, 293) † 269.14 ± 15.08 0.01 0.04 ChT_VS, µm 203.87 ± 113.90 280(243, 331) † 252.21 ± 102.21 0.003 0.07 #Comparison between eyes with MRNFs and contralateral eyes without MRNFs. *Comparison between eyes with MRNFs and control eyes. †Median (P25–P75). FAZ = Foveal Avascular Zone; FAZP = Foveal Avascular Zone Perimeter; FAZ-CI = FAZ-circularity index; FD-300 = Foveal vessel density in a 300µm wide region around FAZ; ReT = Foveal Retinal Thickness; ChT = Foveal Choroidal Thickness; ReT_VI = Retinal Thickness at Vertical Inferior 3 mm around Fovea; ChT_VI = Choroidal Thickness at Vertical Inferior 3 mm around Fovea; ReT_VS = Retinal Thickness at Vertical Superior 3 mm around Fovea; ChT_VS = Choroidal Thickness at Vertical Superior 3 mm around Fovea. Differences in OCTA metrics The ChT, ChT_VS, ChT_VI, and ReT_VS were thinner in the affected eyes than in the unaffected eyes. No significant differences were found in the FAZ, FAZP, FAZ-CI, FD-300, ReT, or ReT_VI between the affected and unaffected eyes. (Table 2 ) The ReT and ReT_VS were thinner in the eyes with MRNFs than in the matched eyes in control participants. No significant differences were found in other parameters. (Table 2 ) Correlations among myopic parameters, MRNFs, and OCTA in eyes with MRNFs In the affected eyes, both Area1 and Area2 were negatively correlated with SER (r area1 = -0.84, r area2 = -0.65), △SER (r area1 = -0.86, r area2 = -0.61), ReT_VS (r area1 = -0.78, r area2 = -0.67), and ChT_VS (r area1 = -0.64, r area2 = -0.62), and positively correlated with AL (r area1 = 0.82, r area2 = 0.52) and CDVA (r area1 = 0.54, r area2 = 0.59). D f−m was negatively correlated with CDVA ( r = -0.57). (Table 3 ) Table 3 Pearson’s correlations among the fundus metrics, myopic parameters, and OCTA metrics in the affected eyes. Area1, (pixel)×10 3 Area2, (pixel)×10 3 D f−m SER -0.84 ‡ -0.65 † 0.38 △SER -0.86 ‡ -0.61* 0.10 AL 0.82 ‡ 0.56 * -0.18 CDVA 0.54 * 0.59 * -0.57 * FAZ, mm 2 -0.03 -0.36 0.48 FAZP, mm -0.31 -0.57 0.47 FAZ-CI 0.31 0.19 0.19 FD-300 -0.49 -0.34 0.01 ReT, µm -0.09 0.06 -0.18 ChT, µm -0.49 -0.45 0.39 ReT_VI, µm -0.22 -0.25 -0.04 ChT_VI, µm -0.37 -0.36 0.31 ReT_VS, µm -0.78 ‡ -0.67 † 0.41 ChT_VS, µm -0.64 * -0.62 * 0.50 *P < 0.05; † P < 0.01; ‡ P < 0.001 SER = Spherical Equivalent Error; AL = Axial Length; CDVA = Corrected Distance Visual Acuity; FAZ = Foveal Avascular Zone; FAZP = Foveal Avascular Zone Perimeter; FAZ-CI = FAZ-circularity index; FD-300 = Foveal vessel density in a 300µm wide region around FAZ; ReT = Foveal Retinal Thickness; ChT = Foveal Choroidal Thickness; ReT_VI = Retinal Thickness at Vertical Inferior 3 mm around Fovea; ChT_VI = Choroidal Thickness at Vertical Inferior 3 mm around Fovea; ReT_VS = Retinal Thickness at Vertical Superior 3 mm around Fovea; ChT_VS = Choroidal Thickness at Vertical Superior 3 mm around Fovea. Linear regression showed that larger Area1 and Area2 were significantly associated with worse SER (β area1 = -0.035, 95% CI: -0.049, -0.022, P < 0.001; β area2 = -0.109, 95% CI: -0.185, -0.033, P = 0.009), AL (β area1 = 0.014, 95% CI: 0.008, 0.020, P < 0.001; β area2 = 0.039, 95% CI: 0.005, 0.073, P = 0.029), and CDVA (β area1 = 0.0016, 95% CI: 0.0001, 0.0031, P = 0.036; β area2 = 0.0071, 95% CI: 0.0013, 0.0128, P = 0.020). (Table 4 ) Table 4 Univariate regression analysis of myopic parameters and fundus metrics in the affected eyes SER AL CDVA ReT_VS ChT_VS Correlation Coefficient (95%CI) P Value Correlation Coefficient (95% CI) P Value Correlation Coefficient (95% CI) P Value Correlation Coefficient (95% CI) P Value Correlation Coefficient (95% CI) P Value Area1 -0.035 (-0.049,-0.022) < 0.001 0.014 (0.008, 0.020) < 0.001 0.0016 (0.0001,0.0031) 0.036 -0.381 (-0.566, -0.195) 0.001 -0.477 (-0.823, -0.131) 0.011 Area2 -0.109 (-0.185,-0.033) 0.009 0.039 (0.005,0.073) 0.029 0.0071 (0.0013,0.0128) 0.020 -1.306 (-2.181, -0.430) 0.007 -1.858 (-3.262, -0.454) 0.013 SER = Spherical Equivalent Error; AL = Axial Length; CDVA = Corrected Distance Visual Acuity; CI = Confidence Interval; ReT_VS = Retinal Thickness at Vertical Superior 3 mm around Fovea; ChT_VS = Choroidal Thickness at Vertical Superior 3 mm around Fovea; CI = Confidence Interval Table 5 Univariate regression analysis of OCTA and fundus metrics in the affected eyes ReT_VS ChT_VS Correlation Coefficient (95% Confidence Interval) P Value Correlation Coefficient (95% Confidence Interval) P Value Area1 -0.381 (-0.566, -0.195) 0.001 -0.477 (-0.823, -0.131) 0.011 Area2 -1.306 (-2.181, -0.430) 0.007 -1.858 (-3.262, -0.454) 0.013 ReT_VS = Retinal Thickness at Vertical Superior 3 mm around Fovea; ChT_VS = Choroidal Thickness at Vertical Superior 3 mm around Fovea. Regarding the relationship between fundus metrics and OCTA, larger Area1 and Area2 were significantly associated with thinner ReT_VS (β area1 =-0.381, 95% CI: -0.566, -0.195, P = 0.001; β area2 =-1.306, 95% CI: -2.181, -0.430, P = 0.007) and ChT_VS (β area1 = -0.477, 95% CI: -0.823, -0.131, P = 0.011; β area2 = -1.858, 95%CI: -3.262, -0.454, P = 0.013). (Table 4 ) Additionally, shorter D f−m was significantly associated with worse CDVA (β = -0.0012, 95% CI: -0.0022, -0.0002, P = 0.026). Correlations among myopic parameters and OCTA metrics In the affected eyes, SER was positively correlated with ChT (r = 0.64), ReT_VS (r = 0.75), and ChT_VS (r = 0.73). AL was negatively correlated with ChT (r = -0.67), ReT_VS (r = -0.72), and ChT_VS (r = -0.76). CDVA was negatively correlated with ChT (r = -0.54), ReT_VS (r = -0.64), and ChT_VS (r = -0.71). In the unaffected eyes, SER was positively correlated with ChT (r = 0.55) and ChT_VS (r = 0.64). AL was negatively correlated with ChT (r = -0.59) and ChT_VS (r = -0.69). (Supplemental table 1 ) DISCUSSION Myelination typically progresses from the chiasm to the optic nerve from the eighth month of gestation until birth and then stops at the lamina cribrosa.[ 1 ] The pathophysiology of MRNFs remains unclear. Several factors, such as the structure of the lamina cribrosa and plasma proteins, have been proposed to inhibit myelination in the normal human retina.[ 11 , 12 ] MRNFs are usually present unilaterally in most cases.[ 5 ] Previous studies have reported the potential progression of these lesions[ 3 , 13 ]; their findings on autofluorescence, fluorescein angiographic images,[ 12 ] or OCT[ 13 ]; and their natural history.[ 13 ] With the advent of new examination equipment, doctors have more means of gaining a deeper understanding of such diseases. The present study is the first to investigate the fundus using true-color, ultra-wide-field fundus images and OCTA metrics, and to identify the associations among the area and location of MRNFs with myopic parameters and OCTA metrics. In this study, eyes with MRNFs exhibited poorer CDVA compared to control eyes matched for age, SER, and AL. MRNFs are often associated with high myopia, anisometropia, and amblyopia. Vision loss may occur due to anisometropia and amblyopia, or secondary to structural abnormalities of the retina and/or optic nerve.[ 1 ] In accordance with our study, Kee et al.[ 14 ] investigated the visual prognosis of amblyopia associated with anisometropia and MRNFs in 12 children (mean age: 4.2 years, range: 2.1–8.6). They found that the amount of anisometropia and the area of myelination differed between groups with different CDVA. In addition, our study found that CDVA was strongly positively correlated with the area of MRNFs and negatively correlated with D f−m , indicating that the area of MRNFs and the distance of the MRNFs to the macula affect patients’ visual prognosis. This explains why, in some cases, although aggressive treatments were applied, many patients did not respond well to treatment.[ 1 ] These results suggest that doctors should set realistic expectations among patients for the final recovery of vision. In addition to the new insights into the associations between MRNFs and CDVA, our study also investigated the correlations between MRNFs and △SER, SER, and AL. In the present study, the area and location of MRNFs were also correlated with patients’ SER, AL, and △SER. The larger the area of the MRNFs, the worse the SE, AL, and △SER. Regarding △SER, in contrast to our findings, Kee et al.[ 14 ] found no statistical correlation between the extent of myelination and the amount of anisometropia. The underlying reason contributing to these discrepancies may be that we used ultra-wide-field images to calculate the full area of MRNFs, while Kee et al. used clock hours of retinal involvement. Clarus is an ultra-wide-field fundus camera that obtains approximately 133° in a single capture and 220° in a montage mode, which makes it possible to obtain a full view of MRNFs in comparison with traditional fundus cameras. The area of MRNFs was also found to be associated with patients’ ReT_VS and ChT_VS, but not with foveal ReT, ChT, ReT_VI, or ChT_VI. The underlying reason may be that MRNFs were more often distributed at the superior and inferotemporal areas of the optic disc rather than other areas. Consistent with our results, Straatsma et al.[ 5 ] reported a similar result of MRNF distribution in 42 patients with MRNFs. The MRNF-involved retina tends to be thicker,[ 12 ] which results in compression of the choroid and causes a reduction in choroid thickness. Knowledge of the microvascular metrics of the retina and choroid can help differentiate it from other intraretinal lesions or elucidate the mechanism underlying the association of axial myopia with MRNFs. Previous studies reported that there was no significant difference in FAZ between the myopia and the non-myopia groups in patients without MRNFs.[ 15 , 16 ] In the present study, we did not find any statistical difference in FAZ parameters, including FAZ, FAZP, FAZ-CI, and FD-300, between the eyes with and without MRNFs. However, we did not evaluate microvessel density metrics other than FAZ parameters because thick MRNFs could result in intense posterior shadowing with loss of structural and vascular information of the retina and choroid. As for choroidal thickness, the foveal ChT, ChT_VI, and ChT_VS were significantly thinner in the affected eyes. Two reasons may have contributed to this finding. First, the thickened MRNF-involved retina compressed the choroid, resulting in a decrease in choroid thickness. Second, affected eyes tend to show axial high myopia, and the progression of myopia has been suggested to be associated with elongation of the eyeball, mechanically stretching the retina and causing a reduction in the retinal nerve fiber layer thickness, retinal microvascular density, and choroid thickness.[ 15 , 17 ] Consistent with these findings, the SER and AL were closely correlated with ChT in the unaffected eyes in our study (mean SER: -3.90 ± 3.94 D; range, -13.25 to 0.75 D).(Table 3 ) Therefore, to distinguish the factor causing thinning of the choroid, the ideal study design would include other age-, sex-, and SER-matched controls. However, age- and sex-matched children with super-high myopia are rare in clinics, making them very difficult to recruit. Thus, further studies with better designs are necessary. This study had two limitations. First, the sample size was small, which may have limited the precision of the results. However, the prevalence of patients with MRNFs is very low; therefore, it is difficult to include a large number of patients. Second, MRNFs could be isolated, or associated with myopia, anisometropia, amblyopia syndrome, optic nerve diseases,[ 18 , 19 ] and systemic diseases. 1 None of the patients in the present study had systemic diseases, so the findings of the present study could not be extrapolated to other situations. In summary, the findings of the present study suggest that the presence of MRNFs impacts CDVA and ReT at the fovea, especially ReT_VS. The area of MRNFs, as well as the distance from the MRNFs to the fovea, are closely associated with the affected eyes’ CDVA, SER, AL, the amount of anisometropia, ReT_VS, and ChT_VS. These findings could help doctors judge the visual prognosis of patients and elucidate the mechanism underlying axial myopia associated with MRNFs in the future. Declarations Commercial relationships disclosures: None Contributorship: Weiming Yang and Xingtao Zhou had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis Concept and design: Xingtao Zhou, Meiyan Li Acquisition, analysis, or interpretation of data: All authors Drafting of the manuscript: Weiming Yang, Meiyan Li, Ruoyan Wei Critical revision of the manuscript for important intellectual content: All authors Statistical analysis: Meiyan Li, Chen Huang, Ruoyan Wei Obtained funding: Xingtao Zhou, Meiyan Li, Ruoyan Wei Administrative, technical, or material support: Xingtao Zhou and Meiyan Li Supervision: Xingtao Zhou and Meiyan Li Funding Statement: 1) Shanghai Rising-Star Program (21QA1401500); 2) National Natural Science Foundation of China (82371091, 82301251); 3) Construction of a 3D digital intelligent prevention and control platform for the whole life cycle of highly myopic patients in the Yangtze River Delta (21002411600); 4) Natural Science Foundation of Shanghai (23ZR1409200); 5) Project of Shanghai Xuhui District Science and Technology (2020-015, XHLHGG202104); 6) Shanghai Yangfan Project (23YF1445300) Competing of Interests: None declared. Ethics statement: The study adhered to the Declaration of Helsinki and was approved by the Institutional Review Board of Kunming Medical University (2013014). Availability of data and materials: The data that support the findings of this study are available from the corresponding author upon reasonable request at [email protected] . References Tarabishy AB, Alexandrou TJ, Traboulsi EI: Syndrome of myelinated retinal nerve fibers, myopia, and amblyopia: a review . SURV OPHTHALMOL 2007, 52 (6):588-596. Kaimbo DK, Mwilambwe AM, Leys A, Missotten L: [Myelin fibers in Zairian patients] . Bull Soc Belge Ophtalmol 1995, 259 :127-131. Pan Z, Wei CC, Peng X, Zhang Q, Xu L, Yang H, Wei WB, Wang YX, Jonas JB: Myelinated Retinal Nerve Fiber Progression in a 10-Year Follow-Up. The Beijing Eye Study 2001/2011 . AM J OPHTHALMOL 2021, 230 :68-74. Kodama T, Hayasaka S, Setogawa T: Myelinated retinal nerve fibers: prevalence, location and effect on visual acuity . OPHTHALMOLOGICA 1990, 200 (2):77-83. Straatsma BR, Foos RY, Heckenlively JR, Taylor GN: Myelinated retinal nerve fibers . AM J OPHTHALMOL 1981, 91 (1):25-38. Shen Y, Zhao J, Sun L, Zeng L, Chen Z, Tian M, Zhou X: The long-term observation in Chinese children with monocular myelinated retinal nerve fibers, myopia and amblyopia . TRANSL PEDIATR 2021, 10 (4):860-869. Ellis GJ, Frey T, Gouterman RZ: Myelinated nerve fibers, axial myopia, and refractory amblyopia: an organic disease . J PEDIAT OPHTH STRAB 1987, 24 (3):111-119. Straatsma BR, Heckenlively JR, Foos RY, Shahinian JK: Myelinated retinal nerve fibers associated with ipsilateral myopia, amblyopia, and strabismus . AM J OPHTHALMOL 1979, 88 (3 Pt 1):506-510. Wu H, Chen W, Zhao F, Zhou Q, Reinach PS, Deng L, Ma L, Luo S, Srinivasalu N, Pan M et al : Scleral hypoxia is a target for myopia control . P NATL ACAD SCI USA 2018, 115 (30):E7091-E7100. Wu H, Zhang G, Shen M, Xu R, Wang P, Guan Z, Xie Z, Jin Z, Chen S, Mao X et al : Assessment of Choroidal Vascularity and Choriocapillaris Blood Perfusion in Anisomyopic Adults by SS-OCT/OCTA . INVEST OPHTH VIS SCI 2021, 62 (1):8. FitzGibbon T, Nestorovski Z: Morphological consequences of myelination in the human retina . EXP EYE RES 1997, 65 (6):809-819. Shelton JB, Digre KB, Gilman J, Warner JE, Katz BJ: Characteristics of myelinated retinal nerve fiber layer in ophthalmic imaging: findings on autofluorescence, fluorescein angiographic, infrared, optical coherence tomographic, and red-free images . JAMA OPHTHALMOL 2013, 131 (1):107-109. Rao R, Turkoglu EB, Say EAT, Shields CL: CLINICAL FEATURES, IMAGING, AND NATURAL HISTORY OF MYELINATED RETINAL NERVE FIBER LAYER . RETINA-J RET VIT DIS 2019, 39 (6):1125-1132. Kee C, Hwang JM: Visual prognosis of amblyopia associated with myelinated retinal nerve fibers . AM J OPHTHALMOL 2005, 139 (2):259-265. Ucak T, Icel E, Yilmaz H, Karakurt Y, Tasli G, Ugurlu A, Bozkurt E: Alterations in optical coherence tomography angiography findings in patients with high myopia . EYE 2020, 34 (6):1129-1135. Milani P, Montesano G, Rossetti L, Bergamini F, Pece A: Vessel density, retinal thickness, and choriocapillaris vascular flow in myopic eyes on OCT angiography . GRAEF ARCH CLIN EXP 2018, 256 (8):1419-1427. Li M, Yang Y, Jiang H, Gregori G, Roisman L, Zheng F, Ke B, Qu D, Wang J: Retinal Microvascular Network and Microcirculation Assessments in High Myopia . AM J OPHTHALMOL 2017, 174 :56-67. Duval R, Hammamji K, Aroichane M, Michaud JL, Ospina LH: Acquired myelinated nerve fibers in association with optic disk drusen . J AAPOS 2010, 14 (6):544-547. Ali BH, Logani S, Kozlov KL, Arnold AC, Bateman B: Progression of retinal nerve fiber myelination in childhood . AM J OPHTHALMOL 1994, 118 (4):515-517. Additional Declarations No competing interests reported. Supplementary Files supFigure1.jpg Supplemental Figure 1. Diagram showing how the area of myelinated retinal nerve fibers was calculated. The area marked by the blue line was defined as Area1. The area marked by the red line was defined as Area2. The shortest distance from the fovea to the border of the MRNFs was defined as the D f-m . supTable.docx Cite Share Download PDF Status: Published Journal Publication published 24 Oct, 2024 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 26 Jun, 2024 Editor assigned by journal 26 Jun, 2024 Submission checks completed at journal 25 Jun, 2024 First submitted to journal 25 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4636865","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":319248530,"identity":"e42b716c-0b40-4a47-9b4c-b83a3825f5cc","order_by":0,"name":"Weiming Yang","email":"","orcid":"","institution":"Children’s Hospital of Fudan University, National Children's Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Weiming","middleName":"","lastName":"Yang","suffix":""},{"id":319248531,"identity":"aeb4e8c9-c067-41ee-9941-129a8c8d9ede","order_by":1,"name":"Ruoyan Wei","email":"","orcid":"","institution":"EYE \u0026 ENT Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Ruoyan","middleName":"","lastName":"Wei","suffix":""},{"id":319248532,"identity":"7d024755-6195-40ca-8a25-923cf8a4a42f","order_by":2,"name":"Chi Zhang","email":"","orcid":"","institution":"EYE \u0026 ENT Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Chi","middleName":"","lastName":"Zhang","suffix":""},{"id":319248534,"identity":"fc112664-e2d8-4c79-becc-29333824c09c","order_by":3,"name":"Chen Huang","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Chen","middleName":"","lastName":"Huang","suffix":""},{"id":319248535,"identity":"debea407-b2ea-420a-ada0-7fe4566e8180","order_by":4,"name":"Feng Lin","email":"","orcid":"","institution":"EYE \u0026 ENT Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Feng","middleName":"","lastName":"Lin","suffix":""},{"id":319248536,"identity":"61502d8a-9d3a-4503-9feb-1e2c2fe7237b","order_by":5,"name":"Yang Shen","email":"","orcid":"","institution":"EYE \u0026 ENT Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Shen","suffix":""},{"id":319248537,"identity":"e70ab2bd-d0b5-470d-9517-6b9eef6d3f3b","order_by":6,"name":"Chenhao Yang","email":"","orcid":"","institution":"Children’s Hospital of Fudan University, National Children's Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Chenhao","middleName":"","lastName":"Yang","suffix":""},{"id":319248538,"identity":"2c02765b-2bea-41e0-a689-2c1dadf5f573","order_by":7,"name":"Xingtao Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYDCCA0DM2AAkmCF8OTb29gOEtDA2wLUA1Rrz8ZxJIFIL1MrEeRIOBnh18B1vfv7w5w6bxA3HeQ+//lBjk94mwZDA8KNiG04tkmeOGTZInklLnNnMl2Zx4Fhabpt04wHGnjO3cWoxuJHD2GDYdjixn5nHzOAA2+HcNpkDCcyMbQS0JAK1tIG1/DucziaRYEBYy0GILcYPgIwEglpAfpnZ2JZmPLOZx4zhbF+aYRswkA/i8wswxB58/NlmI7vh/BnjDxXfbOTl29sPPvhRgVsLMmCTgLEOEKUeCJg/EKtyFIyCUTAKRhYAAHhnYH4bq984AAAAAElFTkSuQmCC","orcid":"","institution":"Shanghai Medical College","correspondingAuthor":true,"prefix":"","firstName":"Xingtao","middleName":"","lastName":"Zhou","suffix":""},{"id":319248539,"identity":"ecd23133-cfac-4757-af24-387f84e01541","order_by":8,"name":"Meiyan Li","email":"","orcid":"","institution":"Shanghai Medical College","correspondingAuthor":false,"prefix":"","firstName":"Meiyan","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2024-06-25 13:38:47","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4636865/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4636865/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-024-03733-x","type":"published","date":"2024-10-24T15:58:11+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60630788,"identity":"eeaa0651-75ba-4d13-bb1a-9e32590b335f","added_by":"auto","created_at":"2024-07-19 00:48:18","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1396568,"visible":true,"origin":"","legend":"\u003cp\u003eFundus images of the 15 eyes with myelinated retinal nerve fibers.\u003c/p\u003e","description":"","filename":"fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4636865/v1/03ea9360d2180692d847896a.jpg"},{"id":67681992,"identity":"82ed0a49-a372-4081-b7e2-c3d7b1281d0f","added_by":"auto","created_at":"2024-10-28 16:12:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2608121,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4636865/v1/f10c1271-3292-4eb2-96e0-b5361640e166.pdf"},{"id":60630787,"identity":"f188b6db-11a1-4807-878e-48ade6975ab0","added_by":"auto","created_at":"2024-07-19 00:48:18","extension":"jpg","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1019043,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplemental Figure 1\u003c/strong\u003e. Diagram showing how the area of myelinated retinal nerve fibers was calculated. The area marked by the blue line was defined as Area1. The area marked by the red line was defined as Area2. The shortest distance from the fovea to the border of the MRNFs was defined as the D\u003csub\u003ef-m\u003c/sub\u003e.\u003c/p\u003e","description":"","filename":"supFigure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4636865/v1/bda76a2160b0757b24c0f03a.jpg"},{"id":60630786,"identity":"7c9127e0-9975-4d4f-95af-d5654562550e","added_by":"auto","created_at":"2024-07-19 00:48:18","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":39941,"visible":true,"origin":"","legend":"","description":"","filename":"supTable.docx","url":"https://assets-eu.researchsquare.com/files/rs-4636865/v1/c2e229efe1fe4bb1412b5e8f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Characteristics of the fundus and optical coherence tomography angiography metrics in patients with myelinated retinal nerve fibers","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMyelinated retinal nerve fibers (MRNFs) were first described in 1856 by Virchow.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] They are congenital retinal lesions that present as gray or white patches with feathery edges in the inner retinal layer. Their prevalence has been reported as 0.02%,[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] 0.4%,[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] 0.57%,[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and 0.98%[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] in the general population.\u003c/p\u003e \u003cp\u003ePatients with MRNFs and myopia often present with axial myopia.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Affected eyes tend to have a longer axial length (AL) and more severe myopia than eyes without MRNFs.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] MRNFs have been postulated to affect visual development and stimulate axial elongation.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] In addition, eyes with widespread MRNFs may show higher degrees of myopia and poorer corrected distance visual acuity (CDVA).[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] However, the associations between the area of MRNFs and myopic parameters such as spherical equivalent error (SER), AL, and CDVA have not been adequately evaluated.\u003c/p\u003e \u003cp\u003eOne proposed mechanism of myopia development involves the potential role of altered choroidal microvasculature and reduced choroidal blood flow in the development of myopia.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Myopia-related visual signals can reduce choroidal capillary patency and blood flow, reduce the supply of oxygen and nutrients to the neighboring avascular sclera, and cause scleral extracellular matrix remodeling.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] The dense and widespread MRNFs may compress the retinal and choroidal vasculature, resulting in the development of myopia. Optical coherence tomography angiography (OCTA) is an advanced, non-invasive imaging technology capable of providing detailed information on the microvascular metrics of the retina and choroid. Little is known about OCTA metrics in patients with MRNFs.\u003c/p\u003e \u003cp\u003eHerein, we performed this study to investigate fundus and OCTA metrics and the associations among fundus metrics, OCTA metrics, and myopic parameters in patients with MRNFs.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis was a single-center study. Written informed consent was obtained from all recruited participants or their guardians before their participation in the study. All patients were treated in accordance with the tenets of the Declaration of Helsinki. This study was conducted in accordance with the guidelines of the Ethics Committee of the Eye and ENT Hospital of Fudan University, Shanghai, China.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipant selection\u003c/h2\u003e \u003cp\u003eFifteen consecutive patients with MRNFs presenting between May 2021 and December 2021 at the Department of Ophthalmology of Fudan University Eye \u0026amp; ENT Hospital were included in this study. Fifteen participants without MRNFs were matched based on age, SER, and AL of affected eyes.\u003c/p\u003e \u003cp\u003eThe exclusion criteria were as follows: participants with a history of ocular surgery/trauma, smoking, or systemic diseases (hypertension, diabetes, etc.) that may affect retinal or choroidal blood flow.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eClinical examinations\u003c/h2\u003e \u003cp\u003eEach patient underwent a comprehensive ophthalmic examination, which included slit-lamp evaluation, measurement of intraocular pressure (IOP), evaluation of uncorrected distance visual acuity (UDVA) and CDVA using standard logarithmic visual acuity charts, and manifest refraction. AL, corneal curvature, and anterior chamber depth (ACD) were measured in each eye using swept-source optical coherence tomography (IOL Master 700, Carl Zeiss Meditec AG, Jena, Germany). A cover test and alternating cover test were used to detect the presence of strabismus. Each patient underwent an interview, which included assessments of demographic data and medical history, when available.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAcquisition of fundus images\u003c/h2\u003e \u003cp\u003eAn ultra-wide-field fundus camera, Zeiss Clarus 500 (Carl Zeiss Meditec, Jena, Germany), which utilizes true colors, was used to acquire fundus images. The single wide-field mode, which achieves a 133-degree field, as well as the montage mode with four images that achieve an approximately 220-degree field, were used to obtain a full view of the MRNFs. For eyes with MRNFs, the border of MRNFs on fundus images was delineated, and the area covered by MRNFs was measured using the ImageJ Pro software (version 6.0.0.260, Media Cybernetics, Inc., Bethesda, USA) (Supplemental Fig.\u0026nbsp;1). The entire area of the MRNFs was defined as Area1. Considering that MRNF thickness may affect myopic parameters and OCTA metrics, we further defined the area covering the denser MRNFs as Area2. The shortest distance from the fovea to the border of the MRNFs was defined as the D\u003csub\u003ef\u0026minus;m\u003c/sub\u003e. The MRNF measurements were performed by two experienced doctors (WMY and RYW), and the average of the measurements was calculated.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eImage acquisition of OCTA\u003c/h2\u003e \u003cp\u003eThe SS-OCT/OCTA system (VG100; SVision Imaging, Henan, China) was used; it functions near 1050 nm and features the following specifications: scan speed, 100,000 A-scans per second; wide-field, 56\u0026deg;; and imaging depth, 2.7 mm (in tissue). The axial and lateral resolutions were 5 \u0026micro;m and 13 \u0026micro;m, respectively. An eye-tracking system based on an integrated confocal scanning laser ophthalmoscope was used to eliminate eye-motion artifacts.\u003c/p\u003e \u003cp\u003eStructural OCT of the macular region was performed using 18 radial scan lines centered on the fovea. Each scan line, which was generated by 2048 A-scans, was 12 mm long. Sixteen B-scans were obtained on each scan line and automatically averaged to improve the signal-to-noise ratio.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Vertical scans were used to analyze the choroidal thickness. The choroid in the SS-OCT images was defined as the zone from the retinal pigment epithelium\u0026ndash;Bruch\u0026rsquo;s membrane complex to the choroid-sclera interface. Each OCTA image was corrected for image magnification based on AL with Bennett\u0026rsquo;s formula using integral manufacturer-developed software.\u003c/p\u003e \u003cp\u003eAfter segmentation, the choroidal and retinal thicknesses at the fovea were defined as the ChT and ReT, respectively. Choroidal and retinal thicknesses at the vertical superior 3 mm centered on the fovea were defined as ChT_VS and ReT_VS, respectively. Similarly, choroidal and retinal thicknesses at the vertical inferior 3 mm were defined as ChT_VI and ReT_VI, respectively.\u003c/p\u003e \u003cp\u003eFor angiography, a raster scan mode of 512 horizontal B-scans covering an area of 3 \u0026times; 3 mm centered on the fovea was used. Each B-scan contained 512 A-scans, which were repeated four times and averaged. The foveal avascular zone (FAZ) area, foveal avascular zone perimeter (FAZP), FAZ-circularity index (FAZ-CI), and foveal vessel density in a 300-\u0026micro;m wide region (FD-300) were automatically analyzed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were analyzed with Stata13.0 (StataCorp, Texas, USA) and reported as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or medians with interquartile ranges. The distribution was examined using the Shapiro\u0026ndash;Wilk test. Paired \u003cem\u003et\u003c/em\u003e-tests or Wilcoxon signed-rank tests were used to evaluate the interocular differences between fellow eyes for ocular biometrics and OCTA parameters. Correlations among myopic variables (CDVA, SER, △SER [defined as the difference in SER between affected and contralateral eyes], and AL), fundus parameters, and OCTA parameters were examined using the Pearson correlation test and expressed as the Pearson correlation coefficient. Furthermore, we carried out univariate linear regression analysis, with the fundus metrics (Area1, Area2, and D\u003csub\u003ef\u0026minus;m\u003c/sub\u003e) as independent variables and those myopic parameters and OCTA metrics that were significantly correlated with the fundus metrics in Pearson correlation analysis as dependent variables. The regression analysis results were expressed as the regression coefficient beta (β) and the 95% confidence interval (CI) of β. The statistical significance level was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics\u003c/h2\u003e \u003cp\u003eDemographic characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Fifteen participants with MRNFs (male/female, 4/11) and 15 participants without MRNFs (male/female, 7/8) were included in the study (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.45). The mean age was 24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1 years (range, 7 to 51 years) and 24.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5 years (range, 8 to 50 years), respectively (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.17).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEyes with MRNFs\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eContralateral eyes without MRNFs (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl eyes\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003csup\u003e\u003cem\u003e#\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP*\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpherical error\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-9.17\u0026thinsp;\u0026plusmn;\u0026thinsp;6.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-9.37\u0026thinsp;\u0026plusmn;\u0026thinsp;5.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-20.75, 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-12.00, 1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-21.00, 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCylindrical error\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2 (-2.25, -1) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-5.50, 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.50, 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4.25, -0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-10.10\u0026thinsp;\u0026plusmn;\u0026thinsp;6.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.90\u0026thinsp;\u0026plusmn;\u0026thinsp;3.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-10.14\u0026thinsp;\u0026plusmn;\u0026thinsp;6.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-21.25, 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-13.25, 0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-21.5, -0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCDVA, logMAR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4 (0, 0.7) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.08, 1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.18, 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0, 0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIOP, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.0, 19.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.0, 19.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12, 20.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAxial length, mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.39, 32.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.14, 28.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.38, 33.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorneal K readings, D\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.68, 45.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.38, 45.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.45, 46.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCT, \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e560.5(517.0,566.0)\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e545.5(511.8,564.5) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e530.5\u0026thinsp;\u0026plusmn;\u0026thinsp;37.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e433, 584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e430, 574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e466, 588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACD, mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.88, 3.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.93, 3.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.99, 3.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArea1, (pixel)\u0026times;10\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137.15\u0026thinsp;\u0026plusmn;\u0026thinsp;152.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.60, 441.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArea2, (pixel)\u0026times;10\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.86\u0026thinsp;\u0026plusmn;\u0026thinsp;38.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.29, 142.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD\u003csub\u003ef\u0026minus;m\u003c/sub\u003e, \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e399.77\u0026thinsp;\u0026plusmn;\u0026thinsp;219.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0, 728.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e#Comparison between eyes with MRNFs and contralateral eyes without MRNFs.\u003c/p\u003e \u003cp\u003e*Comparison between eyes with MRNFs and control eyes.\u003c/p\u003e \u003cp\u003e\u0026dagger;Median (P25\u0026ndash;P75).\u003c/p\u003e \u003cp\u003eMRNF\u0026thinsp;=\u0026thinsp;Myelinated Retinal Nerve Fiber; CDVA\u0026thinsp;=\u0026thinsp;Corrected Distance Visual Acuity; IOP\u0026thinsp;=\u0026thinsp;Intraocular Pressure; CCT\u0026thinsp;=\u0026thinsp;Central Corneal Thickness; ACD\u0026thinsp;=\u0026thinsp;Anterior Chamber Depth; SER\u0026thinsp;=\u0026thinsp;spherical equivalent error\u003c/p\u003e \u003cp\u003eEach patient with MRNF had one affected eye and a contralateral unaffected eye. Four of the 15 affected eyes were right eyes. None of the patients had any other accompanying congenital systemic abnormalities. Among the 15 affected eyes, nine had amblyopia. All unaffected eyes had a CDVA of \u0026le;\u0026thinsp;0 logMAR. None of the patients had any concomitant strabismus.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDifferences in manifest refraction and biometric parameters\u003c/h2\u003e \u003cp\u003eCompared with the contralateral eyes, spherical error, cylindrical error, SER, and CDVA (logMAR) were worse in the affected eyes (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while the AL was significantly greater (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) and the CCT was significantly lower (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04). No statistically significant differences were found in anterior corneal K readings or ACD (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.46, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.11, respectively). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eCompared with the matched eyes of control participants, eyes with MRNFs had poorer CDVA (logMAR) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01) and no statistically significant differences were detected in other parameters (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of MRNFs in fundus Images\u003c/h2\u003e \u003cp\u003eData for Area1, Area2, and D\u003csub\u003ef\u0026minus;m\u003c/sub\u003e are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The MRNFs in all eyes were directly connected to the optic disc (15/15 eyes, 100%). The MRNFs involved four, three, two, and one quadrant in nine (60%), two (13.3%), three (20%), and one (6.7%) eye, respectively. In twelve eyes (80%), MRNFs exhibited a greater area in two superior quadrants than in two inferior quadrants. Eight eyes (53.3%) had MRNFs surrounding the optic disc. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOCTA metrics of the study participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEye with MRNFs\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eContralateral eyes without MRNFs (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl eyes (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003csup\u003e\u003cem\u003e#\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP*\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAZ, mm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAZP, mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAZ-CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFD-300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.74\u0026thinsp;\u0026plusmn;\u0026thinsp;5.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.01\u0026thinsp;\u0026plusmn;\u0026thinsp;5.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e39.81\u0026thinsp;\u0026plusmn;\u0026thinsp;4.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReT, \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e206.27\u0026thinsp;\u0026plusmn;\u0026thinsp;26.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e216\u0026thinsp;\u0026plusmn;\u0026thinsp;15.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e227.21\u0026thinsp;\u0026plusmn;\u0026thinsp;27.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChT, \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e176 (149, 213)\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e299.73\u0026thinsp;\u0026plusmn;\u0026thinsp;84.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e221.64\u0026thinsp;\u0026plusmn;\u0026thinsp;92.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReT_VI, \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e208 (162, 232) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e260.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e242.86\u0026thinsp;\u0026plusmn;\u0026thinsp;37.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChT_VI, \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e216.67\u0026thinsp;\u0026plusmn;\u0026thinsp;79.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e281.87\u0026thinsp;\u0026plusmn;\u0026thinsp;75.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e226.14\u0026thinsp;\u0026plusmn;\u0026thinsp;95.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReT_VS, \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e161 (125, 264) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e287(275, 293) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e269.14\u0026thinsp;\u0026plusmn;\u0026thinsp;15.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChT_VS, \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e203.87\u0026thinsp;\u0026plusmn;\u0026thinsp;113.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e280(243, 331) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e252.21\u0026thinsp;\u0026plusmn;\u0026thinsp;102.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e#Comparison between eyes with MRNFs and contralateral eyes without MRNFs.\u003c/p\u003e \u003cp\u003e*Comparison between eyes with MRNFs and control eyes.\u003c/p\u003e \u003cp\u003e\u0026dagger;Median (P25\u0026ndash;P75).\u003c/p\u003e \u003cp\u003eFAZ\u0026thinsp;=\u0026thinsp;Foveal Avascular Zone; FAZP\u0026thinsp;=\u0026thinsp;Foveal Avascular Zone Perimeter;\u003c/p\u003e \u003cp\u003eFAZ-CI\u0026thinsp;=\u0026thinsp;FAZ-circularity index; FD-300\u0026thinsp;=\u0026thinsp;Foveal vessel density in a 300\u0026micro;m wide region around FAZ; ReT\u0026thinsp;=\u0026thinsp;Foveal Retinal Thickness; ChT\u0026thinsp;=\u0026thinsp;Foveal Choroidal Thickness; ReT_VI\u0026thinsp;=\u0026thinsp;Retinal Thickness at Vertical Inferior 3 mm around Fovea; ChT_VI\u0026thinsp;=\u0026thinsp;Choroidal Thickness at Vertical Inferior 3 mm around Fovea; ReT_VS\u0026thinsp;=\u0026thinsp;Retinal Thickness at Vertical Superior 3 mm around Fovea; ChT_VS\u0026thinsp;=\u0026thinsp;Choroidal Thickness at Vertical Superior 3 mm around Fovea.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDifferences in OCTA metrics\u003c/h2\u003e \u003cp\u003eThe ChT, ChT_VS, ChT_VI, and ReT_VS were thinner in the affected eyes than in the unaffected eyes. No significant differences were found in the FAZ, FAZP, FAZ-CI, FD-300, ReT, or ReT_VI between the affected and unaffected eyes. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe ReT and ReT_VS were thinner in the eyes with MRNFs than in the matched eyes in control participants. No significant differences were found in other parameters. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eCorrelations among myopic parameters, MRNFs, and OCTA in eyes with MRNFs\u003c/h2\u003e \u003cp\u003eIn the affected eyes, both Area1 and Area2 were negatively correlated with SER (r\u003csub\u003earea1\u003c/sub\u003e = -0.84, r\u003csub\u003earea2\u003c/sub\u003e = -0.65), △SER (r\u003csub\u003earea1\u003c/sub\u003e = -0.86, r\u003csub\u003earea2\u003c/sub\u003e = -0.61), ReT_VS (r\u003csub\u003earea1\u003c/sub\u003e = -0.78, r\u003csub\u003earea2\u003c/sub\u003e = -0.67), and ChT_VS (r\u003csub\u003earea1\u003c/sub\u003e = -0.64, r\u003csub\u003earea2\u003c/sub\u003e = -0.62), and positively correlated with AL (r\u003csub\u003earea1\u003c/sub\u003e = 0.82, r\u003csub\u003earea2\u003c/sub\u003e = 0.52) and CDVA (r\u003csub\u003earea1\u003c/sub\u003e= 0.54, r\u003csub\u003earea2\u003c/sub\u003e = 0.59). D\u003csub\u003ef\u0026minus;m\u003c/sub\u003e was negatively correlated with CDVA (\u003cem\u003er\u003c/em\u003e = -0.57). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePearson\u0026rsquo;s correlations among the fundus metrics, myopic parameters, and OCTA metrics in the affected eyes.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArea1, (pixel)\u0026times;10\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eArea2, (pixel)\u0026times;10\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eD\u003csub\u003ef\u0026minus;m\u003c/sub\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.84\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.65\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e△SER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.86\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.61*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.82\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.56\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCDVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.54\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.59\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.57\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAZ, mm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAZP, mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAZ-CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFD-300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReT, \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChT, \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReT_VI, \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChT_VI, \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReT_VS, \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.78\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.67\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChT_VS, \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.64\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.62\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; \u003csup\u003e\u0026dagger;\u003c/sup\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.01; \u003csup\u003e\u0026Dagger;\u003c/sup\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/h2\u003e \u003cp\u003eSER\u0026thinsp;=\u0026thinsp;Spherical Equivalent Error; AL\u0026thinsp;=\u0026thinsp;Axial Length; CDVA\u0026thinsp;=\u0026thinsp;Corrected Distance Visual Acuity; FAZ\u0026thinsp;=\u0026thinsp;Foveal Avascular Zone; FAZP\u0026thinsp;=\u0026thinsp;Foveal Avascular Zone Perimeter; FAZ-CI\u0026thinsp;=\u0026thinsp;FAZ-circularity index; FD-300\u0026thinsp;=\u0026thinsp;Foveal vessel density in a 300\u0026micro;m wide region around FAZ; ReT\u0026thinsp;=\u0026thinsp;Foveal Retinal Thickness; ChT\u0026thinsp;=\u0026thinsp;Foveal Choroidal Thickness; ReT_VI\u0026thinsp;=\u0026thinsp;Retinal Thickness at Vertical Inferior 3 mm around Fovea; ChT_VI\u0026thinsp;=\u0026thinsp;Choroidal Thickness at Vertical Inferior 3 mm around Fovea; ReT_VS\u0026thinsp;=\u0026thinsp;Retinal Thickness at Vertical Superior 3 mm around Fovea; ChT_VS\u0026thinsp;=\u0026thinsp;Choroidal Thickness at Vertical Superior 3 mm around Fovea.\u003c/p\u003e \u003cp\u003eLinear regression showed that larger Area1 and Area2 were significantly associated with worse SER (β\u003csub\u003earea1\u003c/sub\u003e = -0.035, 95% CI: -0.049, -0.022, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; β\u003csub\u003earea2\u003c/sub\u003e = -0.109, 95% CI: -0.185, -0.033, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009), AL (β\u003csub\u003earea1\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.014, 95% CI: 0.008, 0.020, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; β\u003csub\u003earea2\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.039, 95% CI: 0.005, 0.073, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.029), and CDVA (β\u003csub\u003earea1\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.0016, 95% CI: 0.0001, 0.0031, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036; β\u003csub\u003earea2\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.0071, 95% CI: 0.0013, 0.0128, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020). (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate regression analysis of myopic parameters and fundus metrics in the affected eyes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSER\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eCDVA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eReT_VS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eChT_VS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrelation Coefficient\u003c/p\u003e \u003cp\u003e(95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCorrelation Coefficient\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCorrelation Coefficient\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCorrelation Coefficient\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCorrelation Coefficient\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArea1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.035\u003c/p\u003e \u003cp\u003e(-0.049,-0.022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.014 (0.008, 0.020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0016 (0.0001,0.0031)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.381\u003c/p\u003e \u003cp\u003e(-0.566, -0.195)\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-0.477\u003c/p\u003e \u003cp\u003e(-0.823, -0.131)\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArea2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.109\u003c/p\u003e \u003cp\u003e(-0.185,-0.033)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.039 (0.005,0.073)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0071 (0.0013,0.0128)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.306\u003c/p\u003e \u003cp\u003e(-2.181, -0.430)\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-1.858\u003c/p\u003e \u003cp\u003e(-3.262, -0.454)\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eSER\u0026thinsp;=\u0026thinsp;Spherical Equivalent Error; AL\u0026thinsp;=\u0026thinsp;Axial Length; CDVA\u0026thinsp;=\u0026thinsp;Corrected Distance Visual Acuity; CI\u0026thinsp;=\u0026thinsp;Confidence Interval; ReT_VS\u0026thinsp;=\u0026thinsp;Retinal Thickness at Vertical Superior 3 mm around Fovea; ChT_VS\u0026thinsp;=\u0026thinsp;Choroidal Thickness at Vertical Superior 3 mm around Fovea; CI\u0026thinsp;=\u0026thinsp;Confidence Interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate regression analysis of OCTA and fundus metrics in the affected eyes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eReT_VS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eChT_VS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrelation Coefficient\u003c/p\u003e \u003cp\u003e(95% Confidence Interval)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCorrelation Coefficient\u003c/p\u003e \u003cp\u003e(95% Confidence Interval)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArea1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.381 (-0.566, -0.195)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.477 (-0.823, -0.131)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArea2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.306 (-2.181, -0.430)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.858 (-3.262, -0.454)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eReT_VS\u0026thinsp;=\u0026thinsp;Retinal Thickness at Vertical Superior 3 mm around Fovea; ChT_VS\u0026thinsp;=\u0026thinsp;Choroidal Thickness at Vertical Superior 3 mm around Fovea.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding the relationship between fundus metrics and OCTA, larger Area1 and Area2 were significantly associated with thinner ReT_VS (β\u003csub\u003earea1\u003c/sub\u003e =-0.381, 95% CI: -0.566, -0.195, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001; β\u003csub\u003earea2\u003c/sub\u003e =-1.306, 95% CI: -2.181, -0.430, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007) and ChT_VS (β\u003csub\u003earea1\u003c/sub\u003e = -0.477, 95% CI: -0.823, -0.131, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011; β\u003csub\u003earea2\u003c/sub\u003e = -1.858, 95%CI: -3.262, -0.454, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.013). (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) Additionally, shorter D\u003csub\u003ef\u0026minus;m\u003c/sub\u003e was significantly associated with worse CDVA (β = -0.0012, 95% CI: -0.0022, -0.0002, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eCorrelations among myopic parameters and OCTA metrics\u003c/h2\u003e \u003cp\u003eIn the affected eyes, SER was positively correlated with ChT (r\u0026thinsp;=\u0026thinsp;0.64), ReT_VS (r\u0026thinsp;=\u0026thinsp;0.75), and ChT_VS (r\u0026thinsp;=\u0026thinsp;0.73). AL was negatively correlated with ChT (r = -0.67), ReT_VS (r = -0.72), and ChT_VS (r = -0.76). CDVA was negatively correlated with ChT (r = -0.54), ReT_VS (r = -0.64), and ChT_VS (r = -0.71). In the unaffected eyes, SER was positively correlated with ChT (r\u0026thinsp;=\u0026thinsp;0.55) and ChT_VS (r\u0026thinsp;=\u0026thinsp;0.64). AL was negatively correlated with ChT (r = -0.59) and ChT_VS (r = -0.69). (Supplemental table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eMyelination typically progresses from the chiasm to the optic nerve from the eighth month of gestation until birth and then stops at the lamina cribrosa.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] The pathophysiology of MRNFs remains unclear. Several factors, such as the structure of the lamina cribrosa and plasma proteins, have been proposed to inhibit myelination in the normal human retina.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] MRNFs are usually present unilaterally in most cases.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Previous studies have reported the potential progression of these lesions[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]; their findings on autofluorescence, fluorescein angiographic images,[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] or OCT[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]; and their natural history.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] With the advent of new examination equipment, doctors have more means of gaining a deeper understanding of such diseases. The present study is the first to investigate the fundus using true-color, ultra-wide-field fundus images and OCTA metrics, and to identify the associations among the area and location of MRNFs with myopic parameters and OCTA metrics.\u003c/p\u003e \u003cp\u003eIn this study, eyes with MRNFs exhibited poorer CDVA compared to control eyes matched for age, SER, and AL. MRNFs are often associated with high myopia, anisometropia, and amblyopia. Vision loss may occur due to anisometropia and amblyopia, or secondary to structural abnormalities of the retina and/or optic nerve.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] In accordance with our study, Kee et al.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] investigated the visual prognosis of amblyopia associated with anisometropia and MRNFs in 12 children (mean age: 4.2 years, range: 2.1\u0026ndash;8.6). They found that the amount of anisometropia and the area of myelination differed between groups with different CDVA. In addition, our study found that CDVA was strongly positively correlated with the area of MRNFs and negatively correlated with D\u003csub\u003ef\u0026minus;m\u003c/sub\u003e, indicating that the area of MRNFs and the distance of the MRNFs to the macula affect patients\u0026rsquo; visual prognosis. This explains why, in some cases, although aggressive treatments were applied, many patients did not respond well to treatment.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] These results suggest that doctors should set realistic expectations among patients for the final recovery of vision.\u003c/p\u003e \u003cp\u003eIn addition to the new insights into the associations between MRNFs and CDVA, our study also investigated the correlations between MRNFs and △SER, SER, and AL. In the present study, the area and location of MRNFs were also correlated with patients\u0026rsquo; SER, AL, and △SER. The larger the area of the MRNFs, the worse the SE, AL, and △SER. Regarding △SER, in contrast to our findings, Kee et al.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] found no statistical correlation between the extent of myelination and the amount of anisometropia. The underlying reason contributing to these discrepancies may be that we used ultra-wide-field images to calculate the full area of MRNFs, while Kee et al. used clock hours of retinal involvement. Clarus is an ultra-wide-field fundus camera that obtains approximately 133\u0026deg; in a single capture and 220\u0026deg; in a montage mode, which makes it possible to obtain a full view of MRNFs in comparison with traditional fundus cameras.\u003c/p\u003e \u003cp\u003eThe area of MRNFs was also found to be associated with patients\u0026rsquo; ReT_VS and ChT_VS, but not with foveal ReT, ChT, ReT_VI, or ChT_VI. The underlying reason may be that MRNFs were more often distributed at the superior and inferotemporal areas of the optic disc rather than other areas. Consistent with our results, Straatsma et al.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] reported a similar result of MRNF distribution in 42 patients with MRNFs. The MRNF-involved retina tends to be thicker,[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] which results in compression of the choroid and causes a reduction in choroid thickness.\u003c/p\u003e \u003cp\u003eKnowledge of the microvascular metrics of the retina and choroid can help differentiate it from other intraretinal lesions or elucidate the mechanism underlying the association of axial myopia with MRNFs. Previous studies reported that there was no significant difference in FAZ between the myopia and the non-myopia groups in patients without MRNFs.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] In the present study, we did not find any statistical difference in FAZ parameters, including FAZ, FAZP, FAZ-CI, and FD-300, between the eyes with and without MRNFs. However, we did not evaluate microvessel density metrics other than FAZ parameters because thick MRNFs could result in intense posterior shadowing with loss of structural and vascular information of the retina and choroid.\u003c/p\u003e \u003cp\u003eAs for choroidal thickness, the foveal ChT, ChT_VI, and ChT_VS were significantly thinner in the affected eyes. Two reasons may have contributed to this finding. First, the thickened MRNF-involved retina compressed the choroid, resulting in a decrease in choroid thickness. Second, affected eyes tend to show axial high myopia, and the progression of myopia has been suggested to be associated with elongation of the eyeball, mechanically stretching the retina and causing a reduction in the retinal nerve fiber layer thickness, retinal microvascular density, and choroid thickness.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Consistent with these findings, the SER and AL were closely correlated with ChT in the unaffected eyes in our study (mean SER: -3.90\u0026thinsp;\u0026plusmn;\u0026thinsp;3.94 D; range, -13.25 to 0.75 D).(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) Therefore, to distinguish the factor causing thinning of the choroid, the ideal study design would include other age-, sex-, and SER-matched controls. However, age- and sex-matched children with super-high myopia are rare in clinics, making them very difficult to recruit. Thus, further studies with better designs are necessary.\u003c/p\u003e \u003cp\u003eThis study had two limitations. First, the sample size was small, which may have limited the precision of the results. However, the prevalence of patients with MRNFs is very low; therefore, it is difficult to include a large number of patients. Second, MRNFs could be isolated, or associated with myopia, anisometropia, amblyopia syndrome, optic nerve diseases,[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and systemic diseases.\u003csup\u003e1\u003c/sup\u003e None of the patients in the present study had systemic diseases, so the findings of the present study could not be extrapolated to other situations.\u003c/p\u003e \u003cp\u003eIn summary, the findings of the present study suggest that the presence of MRNFs impacts CDVA and ReT at the fovea, especially ReT_VS. The area of MRNFs, as well as the distance from the MRNFs to the fovea, are closely associated with the affected eyes\u0026rsquo; CDVA, SER, AL, the amount of anisometropia, ReT_VS, and ChT_VS. These findings could help doctors judge the visual prognosis of patients and elucidate the mechanism underlying axial myopia associated with MRNFs in the future.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCommercial relationships disclosures:\u0026nbsp;\u003c/strong\u003eNone\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eContributorship:\u003c/strong\u003e Weiming Yang and Xingtao Zhou had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConcept and design:\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eXingtao Zhou, Meiyan Li\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcquisition, analysis, or interpretation of data:\u0026nbsp;\u003c/strong\u003eAll authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDrafting of the manuscript:\u0026nbsp;\u003c/strong\u003eWeiming Yang, Meiyan Li, Ruoyan Wei\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCritical revision of the manuscript for important intellectual content:\u0026nbsp;\u003c/strong\u003eAll authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis:\u003c/strong\u003e Meiyan Li, Chen Huang, Ruoyan Wei\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObtained funding:\u0026nbsp;\u003c/strong\u003eXingtao Zhou, Meiyan Li, Ruoyan Wei\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdministrative, technical, or material support:\u0026nbsp;\u003c/strong\u003eXingtao Zhou and Meiyan Li\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupervision:\u003c/strong\u003e Xingtao Zhou and Meiyan Li\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e1) Shanghai Rising-Star Program (21QA1401500); 2) National Natural Science Foundation of China (82371091, 82301251); 3) Construction of a 3D digital intelligent prevention and control platform for the whole life cycle of highly myopic patients in the Yangtze River Delta (21002411600); 4) Natural Science Foundation of Shanghai (23ZR1409200); 5) Project of Shanghai Xuhui District Science and Technology (2020-015, XHLHGG202104); 6) Shanghai Yangfan Project (23YF1445300)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting of Interests:\u0026nbsp;\u003c/strong\u003eNone declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement:\u0026nbsp;\u003c/strong\u003eThe study adhered to the Declaration of Helsinki and was approved by the Institutional Review Board of Kunming Medical University (2013014).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The data that support the findings of this study are available from the corresponding author upon reasonable request at [email protected].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTarabishy AB, Alexandrou TJ, Traboulsi EI: \u003cstrong\u003eSyndrome of myelinated retinal nerve fibers, myopia, and amblyopia: a review\u003c/strong\u003e. \u003cem\u003eSURV OPHTHALMOL\u003c/em\u003e 2007, \u003cstrong\u003e52\u003c/strong\u003e(6):588-596.\u003c/li\u003e\n\u003cli\u003eKaimbo DK, Mwilambwe AM, Leys A, Missotten L: \u003cstrong\u003e[Myelin fibers in Zairian patients]\u003c/strong\u003e. \u003cem\u003eBull Soc Belge Ophtalmol\u003c/em\u003e 1995, \u003cstrong\u003e259\u003c/strong\u003e:127-131.\u003c/li\u003e\n\u003cli\u003ePan Z, Wei CC, Peng X, Zhang Q, Xu L, Yang H, Wei WB, Wang YX, Jonas JB: \u003cstrong\u003eMyelinated Retinal Nerve Fiber Progression in a 10-Year Follow-Up. 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images\u003c/strong\u003e. \u003cem\u003eJAMA OPHTHALMOL\u003c/em\u003e 2013, \u003cstrong\u003e131\u003c/strong\u003e(1):107-109.\u003c/li\u003e\n\u003cli\u003eRao R, Turkoglu EB, Say EAT, Shields CL: \u003cstrong\u003eCLINICAL FEATURES, IMAGING, AND NATURAL HISTORY OF MYELINATED RETINAL NERVE FIBER LAYER\u003c/strong\u003e. \u003cem\u003eRETINA-J RET VIT DIS\u003c/em\u003e 2019, \u003cstrong\u003e39\u003c/strong\u003e(6):1125-1132.\u003c/li\u003e\n\u003cli\u003eKee C, Hwang JM: \u003cstrong\u003eVisual prognosis of amblyopia associated with myelinated retinal nerve fibers\u003c/strong\u003e. \u003cem\u003eAM J OPHTHALMOL\u003c/em\u003e 2005, \u003cstrong\u003e139\u003c/strong\u003e(2):259-265.\u003c/li\u003e\n\u003cli\u003eUcak T, Icel E, Yilmaz H, Karakurt Y, Tasli G, Ugurlu A, Bozkurt E: \u003cstrong\u003eAlterations in optical coherence tomography angiography findings in patients with high myopia\u003c/strong\u003e. \u003cem\u003eEYE\u003c/em\u003e 2020, \u003cstrong\u003e34\u003c/strong\u003e(6):1129-1135.\u003c/li\u003e\n\u003cli\u003eMilani P, Montesano G, Rossetti L, Bergamini F, Pece A: \u003cstrong\u003eVessel density, retinal thickness, and choriocapillaris vascular flow in myopic eyes on OCT angiography\u003c/strong\u003e. \u003cem\u003eGRAEF ARCH CLIN EXP\u003c/em\u003e 2018, \u003cstrong\u003e256\u003c/strong\u003e(8):1419-1427.\u003c/li\u003e\n\u003cli\u003eLi M, Yang Y, Jiang H, Gregori G, Roisman L, Zheng F, Ke B, Qu D, Wang J: \u003cstrong\u003eRetinal Microvascular Network and Microcirculation Assessments in High Myopia\u003c/strong\u003e. \u003cem\u003eAM J OPHTHALMOL\u003c/em\u003e 2017, \u003cstrong\u003e174\u003c/strong\u003e:56-67.\u003c/li\u003e\n\u003cli\u003eDuval R, Hammamji K, Aroichane M, Michaud JL, Ospina LH: \u003cstrong\u003eAcquired myelinated nerve fibers in association with optic disk drusen\u003c/strong\u003e. \u003cem\u003eJ AAPOS\u003c/em\u003e 2010, \u003cstrong\u003e14\u003c/strong\u003e(6):544-547.\u003c/li\u003e\n\u003cli\u003eAli BH, Logani S, Kozlov KL, Arnold AC, Bateman B: \u003cstrong\u003eProgression of retinal nerve fiber myelination in childhood\u003c/strong\u003e. \u003cem\u003eAM J OPHTHALMOL\u003c/em\u003e 1994, \u003cstrong\u003e118\u003c/strong\u003e(4):515-517.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"myopia, myelinated retinal nerve fiber, fundus","lastPublishedDoi":"10.21203/rs.3.rs-4636865/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4636865/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAIMS\u003c/h2\u003e \u003cp\u003eTo investigate the fundus characteristics and macular OCTA metrics in patients with MRNFs and to identify the associations among myopic parameters, fundus metrics, and OCTA metrics\u003c/p\u003e\u003ch2\u003eMETHODS\u003c/h2\u003e \u003cp\u003eThe single-center case-control study included 15 patients with monocular MRNFs and 15 patients without MRNFs, matched for age, affected eyes\u0026rsquo; spherical equivalent error (SER), and axial length (AL) between May 2021 and December 2021. Fundus features, including the entire MRNF area (Area1), the denser MRNF area (Area2), and the shortest distance from the fovea to the MRNF border (D\u003csub\u003ef\u0026minus;m\u003c/sub\u003e), along with ocular parameters, including SER, AL, corrected distance visual acuity (CDVA), and OCTA metrics at the fovea, including choroidal (ChT) and retinal (ReT) thicknesses at the fovea, the foveal avascular zone area (FAZ), foveal avascular zone perimeter (FAZP), FAZ-circularity index (FAZ-CI), and foveal vessel density in a 300-\u0026micro;m wide region (FD-300), were assessed.\u003c/p\u003e\u003ch2\u003eRESULTS\u003c/h2\u003e \u003cp\u003eThe SER, AL, and CDVA were significantly worse and the ChT was thinner in the affected eyes than in the contralateral eyes. Compared with matched eyes, affected eyes had worse CDVA and thinner ReT. In the affected eyes, both Area1 and Area2 were negatively correlated with SER (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e = -0.84, \u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sub\u003e = -0.65), △SER (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e = -0.86, \u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sub\u003e = -0.61), ReT at the vertical superior 3 mm (VS) (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e = -0.78, \u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sub\u003e = -0.67), and ChT_VS (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e = -0.64, \u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sub\u003e = -0.62), and positively correlated with AL (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.82, \u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.52) and CDVA (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.54, \u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.59). D\u003csub\u003ef\u0026minus;m\u003c/sub\u003e was negatively correlated with CDVA (\u003cem\u003er\u003c/em\u003e = -0.57).\u003c/p\u003e\u003ch2\u003eCONCLUSION\u003c/h2\u003e \u003cp\u003eThe presence of MRNFs affects CDVA and ReT at the fovea. The area of the MRNFs, as well as the distance from the MRNFs to the fovea, are closely associated with the affected eyes\u0026rsquo; CDVA, SER, AL, and the degree of anisometropia.\u003c/p\u003e","manuscriptTitle":"Characteristics of the fundus and optical coherence tomography angiography metrics in patients with myelinated retinal nerve fibers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-19 00:48:13","doi":"10.21203/rs.3.rs-4636865/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-26T09:57:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-26T04:20:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-25T23:30:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2024-06-25T13:37:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8cdd57f6-10ea-4fa1-9cfd-34eaa2349cb1","owner":[],"postedDate":"July 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-28T16:05:05+00:00","versionOfRecord":{"articleIdentity":"rs-4636865","link":"https://doi.org/10.1186/s12886-024-03733-x","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2024-10-24 15:58:11","publishedOnDateReadable":"October 24th, 2024"},"versionCreatedAt":"2024-07-19 00:48:13","video":"","vorDoi":"10.1186/s12886-024-03733-x","vorDoiUrl":"https://doi.org/10.1186/s12886-024-03733-x","workflowStages":[]},"version":"v1","identity":"rs-4636865","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4636865","identity":"rs-4636865","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}