Comment on: Effect of axial elongation on anterior scleral thickness in myopia

Dear Editor, I acknowledge the work of the authors, Yan et al.,[1] for their exploration of the correlation between axial elongation and anterior scleral thickness (AST) in the context of myopia. This research provides important findings regarding the structural alterations linked to the progression of myopia. Nonetheless, certain constraints and opportunities for enhancement necessitate consideration to strengthen the study’s rigor and applicability in clinical settings. Study Design Limitations:The cross-sectional design limits the ability to draw causal conclusions. Although correlations provide valuable insights, longitudinal studies are more effective in elucidating the dynamic progression of alterations in axial elongation associated with AST changes.[1,2]Technical Limitations of AS-OCT:The authors indicate that anterior segment optical coherence tomography (AS-OCT) encountered challenges related to penetration and exhibited variability in measurements among different devices.[1] The integration of advanced imaging technologies, including swept-source OCT, has the potential to enhance the depth and accuracy of scleral imaging.[2,3]Lack of Dynamic Functional Analysis:The research is centered solely on static morphological measurements. Incorporating evaluations of biomechanical characteristics, including scleral elasticity and stiffness, would enhance overall comprehension, as demonstrated by research on scleral biomechanics.[3,4]Age and Gender Associations:No notable differences between genders were observed in AST, which is inconsistent with other research indicating hormonal and structural variations across genders.[1,4] Further studies may categorize outcomes to examine these discrepancies.Measurement Variability:The research does not investigate additional potential factors influencing AST variations, including genetic predispositions, environmental influences, or habitual practices. Incorporating these variables may yield comprehensive insights into the remodeling of the anterior segment tissues in myopia.[1,2]Exclusion of Key Variables:The research does not investigate additional potential factors influencing AST variations, including genetic predispositions, environmental influences, or habitual practices. Incorporating these variables may yield comprehensive insights into the remodeling of the anterior segment tissues in myopia.[1,5]Overlooked Posterior Scleral Changes:The study primarily examines AST; however, it neglects to address concurrent alterations in the posterior sclera, which are essential in the context of high myopia. Including posterior scleral evaluations would provide more clinically pertinent insights.[1,4] Conclusion The research conducted by Yan et al.[1] represents a significant advancement in the comprehension of scleral biomechanics associated with myopia. Rectifying the identified methodological and conceptual deficiencies will enhance the study’s applicability and inform subsequent research endeavors. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.