Abstract: The evolution of myopia is intricately linked to the progressive elongation of the ocular axis. Throughout this process, there is a notable thinning of the choroid and sclera, yet their volumes remain remarkably stable. Intriguingly, the thickness of Bruch's membrane (BM) appears to be decoupled from variations in the axial length of the eye. Given that the spatial separation between the ora serrata and the posterior pole escalates in tandem with axial elongation, this phenomenon suggests a concomitant expansion of the BM surface area. Consequently, the observed independence of BM thickness from changes in axial length provides compelling evidence for a compensatory increase in BM volume as the ocular axis extends. In highly myopia, a robust correlation has been observed between increased axial length and the incidence of BM openings, BM defects, and peripapillary atrophy. These findings indicate that the morphological modifications of BM within myopia may significantly contribute to the pathophysiological mechanisms governing axial elongation, hinting at novel therapeutic targets for myopia management.(Int Rev Ophthalmol, 2024, 48:  272-277)

Key words: myopia, Bruch's membrane