The dynamic sclera: Extracellular matrix remodeling in normal ocular growth and myopia development

- The sclera is a dense connective tissue that defines ocular size and shape.
- The biomechanical properties of the sclera are determined by its ECM.
- Myopia is characterized by scleral thinning and ocular elongation.
- Defects in scleral ECM remodeling lead to myopia in humans and animal models.
- Scleral remodeling is regulated in part by a retina-to-sclera chemical cascade.

Myopia is a common ocular condition, characterized by excessive elongation of the ocular globe. The prevalence of myopia continues to increase, particularly among highly educated groups, now exceeding 80% in some groups. In parallel with the increased prevalence of myopia, are increases in associated blinding ocular conditions including glaucoma, retinal detachment and macular degeneration, making myopia a significant global health concern. The elongation of the eye is closely related to the biomechanical properties of the sclera, which in turn are largely dependent on the composition of the scleral extracellular matrix. Therefore an understanding of the cellular and extracellular events involved in the regulation of scleral growth and remodeling during childhood and young adulthood will provide future avenues for the treatment of myopia and its associated ocular complications.