Glymphatic Dysfunction Coupled with Altered Neural Activity in High Myopia: Multimodal Study of Brain−Eye Interactions

High myopia is a serious global health issue, with particularly significant impacts on the central nervous system. However, the role of glymphatic system dysfunction and associated neural alterations in high myopia remains largely unexplored, and the underlying brain-eye pathological interactions are poorly understood. Our multimodal magnetic resonance imaging (MRI) study integrates diffusion tensor image analysis along the perivascular space (DTI-ALPS), choroid plexus volumetry, and regional homogeneity (ReHo) analyses to evaluate glymphatic function and neural activity changes in high myopia. Compared to controls, patients exhibited significantly reduced DTI-ALPS indices, enlarged choroid plexus volumes, and distinct ReHo alterations, including increased activity in the superior frontal gyrus, but decreased activity in the calcarine fissure and surrounding cortex, as well as the superior temporal gyrus. Notably, the DTI-ALPS index correlated positively with refractive error but negatively with axial length, whereas choroid plexus volume showed the opposite pattern. Furthermore, glymphatic dysfunction correlated with abnormal ReHo in key brain regions. These findings indicate a pathological cascade linking axial elongation, impaired glymphatic clearance, and disrupted neural synchronization-a pathophysiological state that may underlie the broader neurological risks associated with high myopia. This framework integrates multimodal evidence to elucidate brain-eye interactions, incorporating complementary insights derived from structural, diffusion, and functional MRI methodologies.