Artificial intelligence assisted quantitative analysis of fundus structural and vascular alterations reveals fundus tessellation as a robust biomarker of myopia severity.

Fundus structural and vascular parameters showed significant differences across myopia severity groups.

Fundus tessellation-related parameters increased progressively with increasing myopia severity (all P < 0.001), with macular fundus tessellation area demonstrating the strongest association.

Retinal vascular complexity and vessel density decreased with increasing myopia severity, reflected by reduced fractal dimensions and vessel density (all P < 0.001).

ROC analysis showed that macular fundus tessellation area achieved the highest discriminative performance (AUC = 0.819), and a combined model yielded an AUC of 0.869.