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Purpose: This study aimed to establish and validate optical coherence tomography (OCT) based diagnostic criteria of highmyopia. Methods: This was a cross-sectional study including 100 eyes of high myopia with axial length larger than 26.5 mm and 100control eyes, which were examined by spectral-domain OCT. Vertical and horizontal OCT of 9 mm scanning across fovea wereanalyzed. OCT characteristics including mirror artifact, scleral sink due to steep inclination of posterior sclera, scleral visibility,abnormality of outer retinal layer, foveoschisis, and dome-shaped macula were assessed in each group. Results: The mean axial length was 28.65 ± 2.07 mm (range, 26.51–34.59 mm) in high myopia group and 23.79 ± 0.99 mm(range, 21.26–25.94 mm) in control group. Among the OCT characteristics noted at high frequency in the eyes with high myopia,three criteria achieving high sensitivity and specificity were determined: scleral sink over 500 μm, scleral visibility over100 μm, and dome-shaped macula. Under conditions of presence of any of three criteria in either horizontal or vertical OCTscanning, the diagnostic sensitivity, specificity, positive predictive value, and negative predictive value for high myopia werefound to be 95.0%, 98.0%, 98.0%, and 95.1%, respectively. In a new set of OCT images from 50 eyes with high myopia and 50eyes of nonhigh myopia cases, the OCT-based criteria also proved similar level of diagnostic validity. Conclusions: The OCT-based criteria, which directly addressed posterior scleral contour changes, may lead to an intuitive andaccurate diagnosis of high myopia. Also, the criteria may contribute to early detection and monitoring of eyes that cannot bedefined as high myopia but can progress. OCT may be useful for monitoring high myopia patients as OCT can detect myopia-associated retinal pathologies as well as scleral contour changes.
