High myopia is a leading cause of blindness worldwide. Myopia progression may lead to pathological changes of lens and affect the outcome of lens surgery, but the underlying mechanism remains unclear. Here, we find an increased lens size in highly myopic eyes associated with up-regulation of β/γ-crystallin expressions. Similar findings are replicated in two independent mouse models of high myopia. Mechanistic studies show that the transcription factor MAF plays an essential role in up-regulating β/γ-crystallins in high myopia, by direct activation of the crystallin gene promoters and by activation of TGF-β1-Smad signaling. Our results establish lens morphological and molecular changes as a characteristic feature of high myopia, and point to the dysregulation of the MAF-TGF-β1-crystallin axis as an underlying mechanism, providing an insight for therapeutic interventions.

To compare the accuracy of the Barrett Universal II, Haigis, and Olsen formulas in calculating intraocular lens (IOL) power in eyes with extreme myopia. Eye and Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China. Prospective case series. Eyes were divided into 3 axial length (AL) groups as follows: 26.0 to 28.0 mm (control), 28.0 to 30.0 mm (extreme myopia 1), and 30.0 mm or more (extreme myopia 2). The mean error (ME) 1 month postoperatively was adjusted to zero by optimizing the lens factor; then, the median absolute errors (MedAEs) were compared between formulas. Factors associated with postoperative refractive errors were analyzed. After optimization, the MEs of the Barrett Universal II, Haigis, and Olsen formulas were 0.04 diopter (D) ± 0.48 (SD), 0.04 ± 0.66 D, and 0.04 ± 0.52 D, respectively, and the MedAEs were 0.37 D, 0.46 D, and 0.39 D, respectively (P = .044; Haigis versus Barrett: P = .038). In the extreme myopia 1 group, all 3 formulas produced small MedAEs (P = .662). In the extreme myopia 2 group, the Haigis formula produced a significantly greater MedAE than the Barrett Universal II formula (P = .007; Haigis versus Olsen: P = .055). The accuracy of the Haigis formula in myopic eyes was affected by the AL and keratometry value, whereas the accuracy of the Barrett Universal II and Olsen formulas was affected by the AL only. In eyes with an AL of 28.0 to 30.0 mm, all 3 formulas were accurate. In eyes with AL of 30.0 mm or more, the Barrett Universal II formula was better than the Haigis formula, possibly because there were fewer influencing factors.