BACKGROUND: Abnormalities in cone photoreceptor topography are closely associated with the development of various ocular diseases, including axial myopia. Adaptive Optics Scanning Laser Ophthalmoscopy (AOSLO) enables high-resolution, single-cell imaging of the living human retina. METHODS: This study aimed to investigate the potential relationship between cone topography and axial myopia using a commercial AOSLO system. A total of 74 participants (148 eyes
30 men, 40.5%) with a mean age of 31.8 ± 10.4 years were included. Cone mosaics were imaged at 3° and 5° eccentricities of the fovea centralis. The relationships between cone parameters (linear cone density, cone spacing, cone dispersion, and cone regularity) and axial length were analyzed. RESULTS: Linear cone density significantly decreased with increasing axial length at both 3° and 5° eccentricities (all P <
0.001). Cone spacing significantly increased with greater axial length and reduced cone density. After adjusting for axial length, cone spacing was significantly associated only with linear cone density at both 3° and 5° eccentricities (all P <
0.001). Cone dispersion significantly increased with longer axial length and lower cone density. After adjusting for axial length, cone dispersion remained significantly associated with linear cone density only at the inferior 3° (β = -0.43, P = 0.014) and inferior 5° eccentricities (β=-0.4, P=0.003). Cone regularity significantly increased with higher linear cone density at certain 3° eccentricities (nasal: β=0.34, P<
0.001
temporal: β=0.25, P=0.006
inferior: β = 0.2, P = 0.04) and significantly decreased with longer axial length at temporal 5° eccentricity (β = -0.57, P <
0.001). CONCLUSIONS: Linear cone density was significantly reduced in axial myopia. The uniformity of cone distribution was disrupted as a result of the reduction in cone density. Additionally, cone regularity was significantly diminished in axial myopia, potentially due to the direct effects of axial elongation at 5° eccentricity or reductions in cone density at 3° eccentricity.