Understanding the link between ocular shape and myopia: a systematic review.

PURPOSE: To present an up-to-date summary of the association between ocular shape and myopia. METHODS: We systematically searched PubMed, Embase, Web of Science, the Cochrane Library, CNKI and Wanfang from June 2009 to September 2025 for cross-sectional and cohort studies examining the association between ocular shape and myopia (PROSPERO: CRD42024558271). The Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality were used to evaluate the quality of included studies. RESULTS: Thirty-four studies were included. Ocular growth appears relatively uniform in non-myopic eyes whereas myopic eyes tend to show non-uniform expansion. Greater myopia is associated with asymmetric changes in both anterior and posterior ocular shape. Highly myopic eyes frequently display spheroid shapes with equatorial pyriform contours and macular staphylomas, with more pronounced posterior deformities linked to a higher risk of myopic complications. Longitudinal evidence suggests that baseline ocular shape may be associated with subsequent ocular morphological changes and myopia progression. CONCLUSIONS: Ocular shape is closely associated with myopia and myopic retinopathy. Existing studies remain mostly observational and heterogeneous, with small sample sizes in some studies limiting causal inference and precluding meta-analysis. Future studies are needed to better understand the potential value of ocular shape in myopia control. PROSPERO REGISTRATION NUMBER: CRD 42024558271.