Clinical spectrum and prevalence associations of chorioretinal damage in high myopia: a retrospective cross-sectional analysis

Background: High myopia is a growing public-health challenge linked to irreversible chorioretinal damage and vision loss. Understanding its clinical spectrum and identifying predictors of early structural injury are essential for risk-stratified surveillance. Despite progress in imaging and diagnostic classification, population-level evidence describing lesion patterns and predictive factors in high-burden clinical settings remains limited. Methods: The cross-sectional retrospective study evaluated 1,420 patients (2,610 eyes) with high myopia examined between 2015 and 2024 at Lanzhou Aier Eye Hospital. Eligibility was based on refractive or biometric criteria and availability of multimodal imaging. Chorioretinal changes were graded using the ATN classification. Descriptive statistics summarized demographics and imaging findings. Prevalence of each lesion type was estimated with confidence intervals. Univariable comparisons and multivariable logistic regression with clustered variance identified independent predictors. Model calibration and discrimination were assessed, with prespecified sensitivity analyses based on axial length, age strata, and exclusion of treated choroidal neovascularization. Missing data were imputed using chained equations. Results: Chorioretinal damage was documented in 40.0% of eyes. Diffuse atrophy (16.1%), foveoschisis (11.9%), and patchy atrophy (8.2%) were the most frequent lesions. Older age, greater axial length, more negative spherical equivalent, and thinner choroid were independently associated with the presence of pathology. The final model demonstrated stable calibration and high discrimination across sensitivity analyses. Projected estimates indicated considerable population-level burden, particularly in individuals with axial length ≥32 mm. Conclusion: High-myopia eyes show substantial structural vulnerability, and key biometric parameters can support targeted early surveillance. The findings contribute new epidemiological evidence from a large clinical cohort and highlight practical risk-stratification markers suitable for public-health planning in regions facing rapid growth in myopia prevalence.