Ocular Dominance at Near versus Distance: Links to Axial Elongation and Refractive Progression

Ocular Dominance at Near versus Distance: Links to Axial Elongation and Refractive Progression | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ocular Dominance at Near versus Distance: Links to Axial Elongation and Refractive Progression Wenfang Ye, Huan Ding, Zhujiang Bai, Shuyuan Zhang, Dehai Zheng, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8684859/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To investigate the associations between ocular dominance under near and distance viewing conditions and subsequent axial elongation as well as refractive progression. Methods: A total of 105 children and adolescents aged 6–16 years who attended the Ophthalmology Outpatient Clinic of Hainan General Hospital between September 2024 and September 2025 were enrolled. Ocular dominance was determined using two approaches: near dominance was identified with a modified near-hole-in-the-card test (Group A), while distance dominance was assessed using the conventional hole-in-the-card test (Group B). Consistency between dominance classifications obtained by the two methods was evaluated. Furthermore, axial length elongation and refractive change were compared between dominant and non-dominant eyes as defined by each method. Results: Ocular dominance differed between near and distance testing (McNemar test, P = 0.024). During near viewing, dominant eyes showed greater axial elongation ( P = 0.001) and faster refractive progression ( P = 0.009) than non-dominant eyes; these associations were not observed for distance dominance. Across both testing distances, dominant eyes had lower cylindrical power than nondominant eyes ( P < 0.001). Conclusion: Near and distance ocular dominance are not interchangeable. Near dominant eyes are more prone to accelerated axial growth and myopic progression, and dominance at either distance was associated with lower astigmatism than the non-dominant eye. Ocular dominance Axial elongation Refractive progression Astigmatism Figures Figure 1 Figure 2 Key message Current research indicates that ocular dominance varies with testing distance. Individuals may utilize different dominant eyes depending on the viewing distance. Near ocular dominance is the primary predictor of accelerated axial elongation and myopic progression. Introduction Myopia has increased rapidly worldwide, especially in East Asia, and childhood-onset myopia often progresses during the school years. Axial elongation is the key structural change, and excessive elongation can lead to high myopia with sight-threatening complications such as myopic macular degeneration, retinal detachment, and glaucoma [ 1 ]. Myopia arises from interactions between genetic susceptibility, environmental, and lifestyle factors [ 2 ]. Among modifiable factors, prolonged near work and limited time outdoors are consistently associated with incident myopia and faster progression [ 3 – 5 ]. Clinical and experimental evidence supports sustained near visual demand as a major environmental driver [ 6 , 7 ]. Mechanistically, near tasks may promote accommodative lag and hyperopic defocus: when accommodation is insufficient, the focal plane falls behind the retina, providing a stimulus for axial elongation [ 7 , 8 ]. Moreover, prolonged near work often introduces peripheral blur from printed text or digital screens, degrading the retinal image in a way reminiscent of form deprivation, which can promote abnormal ocular growth [ 9 ]. In this setting, the choroid may thin and its perfusion decline, reducing blood supply and creating relative hypoxia in the adjacent outer sclera [ 10 , 11 ]. Hypoxia-driven scleral remodeling can then weaken the tissue, facilitating excessive axial elongation [ 12 ]. Ocular dominance (ocular preference) refers to the eye that is more often selected for binocular fixation and that tends to contribute more strongly to perception and afferent signaling [ 13 , 14 ]. Ocular laterality has been linked to interocular differences in retinal architecture, including photoreceptor, ganglion-cell, and bipolar-cell densities. Correspondingly, processing of input from the dominant eye is often faster and more accurate, supporting a sharper and more stable internal visual representation. Evidence on whether ocular dominance relates to axial length is still sparse and mixed. Several reports describe a longer axial length in the dominant eye than in the fellow eye [ 15 – 18 ], whereas other studies have found the opposite or no clear association [ 19 – 21 ]. Notably, ocular dominance has been shown to be task- and distance dependent, with potential shifts between near and distance viewing conditions [ 22 , 23 ]. Current literature shows that most investigations have leaned on aperture-sighting assessments at a distance of 6 m as the primary metric for eye dominance. which predominantly captures distance-related dominance rather than dominance during near visual tasks. Given the well-established role of sustained near work in axial elongation, a mismatch between near and distance ocular dominance may contribute to the heterogeneity of reported findings. A clearer delineation of distance-specific ocular dominance and its relationship with axial length may therefore provide further insight into myopiarelated mechanisms and support the development of more individualized preventive or therapeutic approaches, including vision-based interventions. Subjects and Methods Subjects Children and adolescents were recruited for this prospective study. Based on a two-sided α of 0.05 and 80% power, the estimated minimum sample size was 118; this was inflated by 20% to allow for potential loss to follow-up [ 24 ]. Between September 2024 and September 2025, participants were consecutively recruited from the Ophthalmology Outpatient Clinic of Hainan General Hospital. Inclusion criteria were an age of 6–16 years and best-corrected visual acuity of 20/20 or better at both near and distance. Exclusion criteria included: abnormal axial length (AL 27 mm), anisometropia exceeding 1.75 D, manifest strabismus, amblyopia, significant heterophoria, coexisting anterior or posterior segment disease, or a history of ocular surgery. By September 2025, 8 of them had been missed the interview, and another 5 had been excluded due to two examinations and found that the superiority of distant eyes was different, considering poor compliance. In the end, there were 105 subjects. Methods Ocular Dominance Measurement Method A adopted the improved near-hole method [ 22 ], using a 25 x 150mm polyethylene transparent culture dish. A 30 x 30mm black square sticker with a square opening in the center of 1.5 x 1.5 mm was pasted to the surface of the culture dish. The black letters (height and width were 1 mm) were pasted in the center of the white background at the bottom of the culture dish, and the distance between the hole and the observation letter was 25mm, Fig. 1 . The culture dish was fixed on the bookshelf. The subject adjusted the height of the seat so that he could use the reading distance (40cm) to see the letters through the opening. The eye that continued to see the target was recorded as the Near Ocular Dominance (NOD).We employed the validated hole-in-the-card (Miles Test) approach (Method B) as a benchmark for measuring Distance Ocular Dominance (DOD) [ 25 ]. Participants were instructed to hold the test card with both hands and to view a target optotype on a Snellen chart at a distance of 6 meters through a central opening of 3 centimeters. After binocular localization, each eye was alternately occluded, and the eye maintaining stable fixation on the target was identified as the distance-dominant eye. Each assessment was performed three times to ensure reliability. In addition, all dominance measurements were repeated after a 6-month interval to evaluate longitudinal stability. Refraction and AL Measurement To standardize the examination procedure and improve participant compliance, a uniform cycloplegic protocol was applied to all subjects. Cycloplegia was induced using a combined eyedrop of 0.5% Tropicamide and 0.5% Phenylephrine Hydrochloride (Jinyao, China), administered four times at 10-minute intervals. Refractive measurements began at least 30 minutes after the final instillation of the cycloplegic eyedrops and only after confirming the absence of the pupillary light reflex [ 26 ]. Refractions were measured using an automated refractor (Digital Ref-Ractor DR-900, Japan). All measurements were conducted by a single experienced optometrist, with a minimum of three reliable readings obtained and averaged for each eye. Spherical equivalent (SE) was subsequently defined as sphere power plus half of the cylinder power SE = Sphere + 1/2Cylinder. Axial length was measured using an IOLMaster 500 (Carl Zeiss Meditec, Jena, Germany). Both refractive status and axial length were reassessed at the 6-month follow-up. Statistical Analysis All statistical analyses were performed using IBM SPSS Statistics (version 27.0; IBM Corp., Armonk, NY, USA). Figures were generated using GraphPad Prism (version 10.6; GraphPad Software, San Diego, CA, USA). Statistical normality was determined using the Shapiro-Wilk test, after which paired t-tests were applied to compare conditions for variables meeting the normal distribution (reported as mean ± SD). For non-parametric datasets, values were reported as medians (P25, P75), with the Wilcoxon signed-rank test applied to evaluate longitudinal changes in axial elongation and refractive progression between eyes. Categorical data are summarized as frequencies (%). Differences in sex distribution were examined using Fisher’s exact test, while the McNemar test was applied to evaluate agreement and distribution shifts between near- and distance-ocular dominance. Statistical significance was defined by a two-tailed P-value of less than 0.05. Results Difference between Distance and Near Ocular Dominance The study included 105 participants aged 6–16 years (mean age 10.04 ± 2.41 years), of whom 46 (43.81%) were female and 59 (56.19%) were male. Right-eye dominance was predominant in this cohort, observed in 64 participants (60.95%) for near vision and 78 participants (74.29%) for distance vision. The distribution of ocular dominance by gender is presented in Fig. 2 . No statistically significant sex-based difference was found in near or distance ocular dominance (Fisher's Exact Test, near P = 0.546; distant P = 1.0) (Fig. 2 and Table 1 ). A kappa coefficient of 0.275 and an agreement rate of 67.6% point toward weak concordance between dominance patterns at different ranges. Significant binocular distribution differences surfaced during McNemar testing ( P = 0.024), confirming that viewing distance exerts a substantial influence on the determination of the dominant eye (Table 2 ). ocular dominance (NOD) was determined using the modified hole-in-the-card test; in Group B, distance ocular dominance (DOD) was assessed via the standard version. Table 1 The relationship between the types of dominant eye and gender Gender No. (%) Near hole-in-the-card Hole-in-the-card Right eye Left eye P Right eye Left eye P Male 59 (56.48%) 34 25 0.546 44 15 1.0 Female 46 (43.81%) 30 16 34 12 a : Fisher’s exact test Table 2 The relationship between the near and distance-dominant eye Hole-in- the-card Near hole-in-the-card No. (%) b Right eye Left eye Right eye 54 24 78 (74.29%) Left eye 10 17 27 (25.71%) total 64 (60.95%) 41 (39.05%) 105 (100.00%) b : McNemar test, P = 0.024, (κ = 0.275) Near and Distance Ocular Dominance and Axial Elongation Axial elongation was defined as the longitudinal change in AL from baseline to the 6-month follow-up. A statistically significant difference in axial elongation was observed based on near ocular dominance (dominant: 0.19mm (0.11, 0.35) vs non-dominant eye: 0.17mm (0.09, 0.34); P = 0.001). In contrast, no significant difference was found based on distance ocular dominance (dominant eye: 0.18 mm (0.11, 0.35) vs non-dominant eye: 0.17 mm (0.10, 0.35); P = 0.766). The results indicate that axial elongation was significantly faster in the near-dominant eye compared to its fellow non-dominant eye. However, no such difference existed between the distance-dominant and non-dominant eyes (Table 3 ). Table 3 Interocular comparison of AL and SE changes by ocular dominance Parameter Dominant Eye M (P25, P75) Non-dominant Eye M (P25, P75) P Group A AL elongation(mm) 0.19 (0.11, 0.35) 0.17 (0.09, 0.34) 0.001 C Change in SE (D) -0.25 (-0.50, 0) -0.13 (-0.50, 0) 0.009 C Group B AL elongation (mm) 0.18 (0.11, 0.35) 0.17 (0.10, 0.35) 0.766 C Change in SE(D) -0.25 (-0.50, 0) -0.25 (-0.50, 0) 0.104 C SE: spherical equivalent; D: diopters; c : Wilcoxon signed-rank test Near and Distance Ocular Dominance and Refractive Progression Refractive progression was defined as the change in spherical equivalent (SE) from baseline to the 6-month follow-up. A significant inter-eye difference in refractive progression was observed based on near ocular dominance (dominant eye: -0.25D (-0.50, 0) vs nondominant eye: -0.13D (-0.50, 0); P = 0.009). In contrast, no significant difference was found based on distance ocular dominance (dominant eye: -0.25D (-0.50, 0) vs non-dominant eye: -0.25D (-0.50, 0); P = 0.104). These results indicate that myopic progression was significantly greater in the near-dominant eye than in the contralateral non-dominant eye. No such difference was observed between the distance-dominant eye and its non-dominant fellow (Table 3 ). Near and Distance Ocular Dominance and Astigmatism (Cylinder Power) Although the change in cylinder power over the follow-up period was not statistically significant, a cross-sectional analysis of astigmatism at both baseline and final visits was conducted to evaluate inter-eye asymmetry between the dominant and non-dominant eyes. For consistency, all cylinder values were uniformly converted to negative notation. The analysis revealed that the dominant eye consistently exhibited a significantly lower degree of astigmatism than the non-dominant eye under both near and distance viewing conditions (Table 4 , P < 0.001). Table 4 Cross-sectional analysis of cylindrical power astigmatism Dominant Eye M (P25, P75) Non-dominant Eye M (P25, P75) P Group A Initial Cylinder Power (D) -0.50 (-1.50, 0) -0.75 (-2.00, -0.25) <0.001 C The second Cylinder Power (D) -0.50 (-1.50, 0) -0.75 (-1.88, -0.25) <0.001 C Group B Initial Cylinder Power (D) -0.50 (-1.50, 0) -0.75 (2.00, -0.50) <0.001 C The second Cylinder Power (D) -0.50 (-1.50, 0) -0.75 (2.00, -0.50) <0.001 C D: diopters; c : Wilcoxon signed-rank test Discussion Ocular dominance was first described by Rosenbach in 1903 and is currently classified into three principal types: motor (or aiming) dominance, sensory dominance, and fixational dominance. Aiming dominance refers to the eye preferentially used for pointing/aiming tasks, reflecting neural preference for motor coordination and spatial localization, and is typically assessed by tests such as hole-in-thecard, pointing, near-convergence, and near hole-in-the-card procedures. Sensory dominance reflects cortical prioritization of one eye’s input during binocular stimulation, supporting clearer and more stable perception, and is often quantified using binocular rivalry or fusion-based measures. Fixation dominance is frequently evaluated in clinical contexts involving binocular dysfunction (e.g., strabismus, amblyopia) and denotes the eye that can promptly and stably refixate on a target after visual interruption, commonly assessed via alternating cover tests or Worth four-dot testing [ 27 , 28 ]. Because the conventional hole-in-the-card test primarily captures distance sighting dominance, we incorporated both standard distance testing and a near-task variant to better reflect dominance relevant to sustained near work [ 25 ]. Five participants were excluded due to inconsistent distance dominance shifts between baseline and the 6-month follow-up. This discordance could reflect subjective variation in the test procedure or a genuine change in dominance over time; the underlying reason cannot be determined from our data. Dellatolas (1998) reported that about two-thirds of children show completely stable ocular dominance, with stability improving with age [ 29 ], but long-term evidence remains limited. Although we excluded these five participants from the main analysis, we will continue to follow them longitudinally for further evaluation. Current evidence does not clearly indicate whether an interocular AL difference is a cause or a consequence of ocular dominance. Cheng et al. and others have noted that when anisometropia exceeds 1.75 D, the dominant eye is almost always the more myopic eye [ 18 , 30 ]. Because the inclusion of individuals with extremely long or short axial lengths would substantially increase the overall variability (σ) of the study population [ 31 ], participants with axial lengths 27 mm, as well as those with interocular refractive differences exceeding 1.75 D, were therefore excluded from the analysis [ 32 ]. This study demonstrates that ocular dominance may differ between near and distance visual tasks, and such task-dependent dominance has important implications for investigations of ocular biometric parameters, particularly axial elongation and refractive progression. The eye preferentially engaged during sustained, high-intensity near work may be subjected to greater visual load or functional demand. The eyes that are selected for continuous high-intensity close-up work may be under greater visual pressure or functional needs. This increase in demand may trigger some biological mechanisms (such as retinal defocus, ciliary muscle tone or growth factor release), thus accelerating eyeball elongation. Due to the different advantages of near-sighted and far-sighted, under the background of the new era of lifestyle and myopia where close-up work dominates visual activities [ 33 ], it is necessary to pay attention to the differences between the two and the impact on the different results brought about by relevant research. The close-up dominant eye has a stronger correlation with the increase of myopia and the growth of the eye axis [ 24 ], and bears more significant biometric consequences [ 34 ]. In addition, our study found that the columnar degree of the dominant eye is lower than that of the non-dominant eye, indicating that the brain optimizes the image quality by prioritizing the eyes that are structurally closer to the orthographic state (perfect focus) or have a more regular optical surface, and tend to provide images that can provide clearer and less aberration (i.e. lower astigmatism) The eye is chosen as the dominant eye to complete the task of high visual fidelity [ 35 ]. Lower astigmatism may be the reason why it was chosen as the dominant eye, not the consequence of the dominant position. This study found that it has important clinical guidance value for ophthalmology and optics: presbyopia correction: It is very important to accurately determine the dominant eye before monocular or regulatory accommodative intraocular lens implantation. Traditional preoperative evaluation often relies on long-distance dominant eye tests. The results of this study strongly recommend that for patients who plan to undergo monocular correction, their close-up dominant eyes must be measured and considered at the same time. If the patient's close-range dominant eye is different from his long-range dominant eye, and the crystal degree is allocated only based on the long-range results, it may lead to near-range visual dysfunction or visual discomfort. Visual training: This switching phenomenon can help clinicians identify potential instability in the binocular vision system. For some patients with near-range visual fatigue or reading difficulties, evaluating the consistency of their near-range dominant eye may provide new diagnostic clues [ 36 ]. Of course, the relationship between the dominant eye and the growth of the eye axis of adolescents and children still needs more data and longer observation. Conclusion It is of great clinical significance to distinguish the dominant eye into two types: near-sighted and far-sighted. In the designation of myopia prevention, control and correction strategies, the dominant eye measured by the improved near-hole method should be considered as the risk eye for myopia progression that needs more attention. Evidence suggests that the visual cortex, along with its neurophysiological circuits, tends to prioritize signals from the eye providing superior retinal clarity—often the one with minimal astigmatism. This selective processing serves as a mechanism to streamline neural efficiency and sharpen visual outcomes. Such dynamics suggest that a shift is needed in clinical and research protocols: moving beyond isolated metrics toward a more integrated framework that weighs both NOD and optical integrity. Declarations Acknowledgments: The authors express their sincere appreciation to all study participants and their legal guardians. We also extend our thanks to the volunteers whose dedicated support was instrumental in the execution of this research. Author Contributions: This work represents a collaborative effort by all authors. Wenfang Ye and Huan Ding contributed equally to ocular dominance measurement, and drafted the initial manuscript. Zhujiang Bai and Shuyuan Zhang performed data collection and statistical analyses. Dehai Zheng was responsible for the refractive examinations. Lianyi Han conduct data collection and cross‑checking. Lin Lin carried out the AL measurements. Kaiyan Zhang contributed to the study conceptualization, design, and critical revision of the manuscript. All authors reviewed, approved, and take full responsibility for the final version of the manuscript, including the integrity, accuracy, and transparency of the work. Funding: This research was not supported by any funding. Data Availability: This article has presented all the data. If you require the raw data, please contact the corresponding author. Ethics Approval and Consent to Participate: The study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Institutional Ethics Committee of Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University) (Approval No. EC-YLY-2025-272-01). Written informed consent was obtained from all participants or their legal guardians prior to enrollment. Clinical trial registration number: Not applicable Conflict of Interest: The author declares no competing interests. References Verhoeven VJM, Wong KT, Buitendijk GHS, Boon CJF, Fontana RK, Erke MG et al (2015) Visual consequences of refractive errors in the general population. Ophthalmology 122:101–109. 10.1016/j.ophtha.2014.07.030 Dirani M, Chamberlain M, Shekar SN, Islam AF, Garoufalis P, Chen CY et al (2006) Heritability of refractive error and ocular biometrics: the genes in myopia (GEM) twin study. Invest Ophthalmol Vis Sci 47:4756–4761. 10.1167/iovs.06-0270 CREAM Consortium, 23andMe Research Team, UK Biobank Eye and Vision Consortium, Tedja MS, Wojciechowski R, Hysi PG et al (2018) Genome-wide association meta-analysis highlights light-induced signaling as a driver for refractive error. Nat Genet 50:834–848. 10.1038/s41588-018-0127-7 Huang HM, Chang DST, Wu PC (2015) The association between near work activities and myopia in children—a systematic review and meta-analysis. PLoS ONE 10:e0140419. 10.1371/journal.pone.0140419 Karthikeyan SK, Ashwini DL, Priyanka M, Nayak A, He M, Sankaridurg P et al (2022) Physical activity, time spent outdoors, and near work in relation to myopia prevalence, incidence, and progression: an overview of systematic reviews and meta-analyses. Indian J Ophthalmol 70:728–739. 10.4103/ijo.IJO_1564_21 Logan NS, Radhakrishnan H, Cruickshank FE, Allen PM, Retallic JS, Wolffsohn JS et al (2021) IMI accommodation and binocular vision in myopia development and progression. Invest Ophthalmol Vis Sci 62:4. 10.1167/iovs.62.5.4 Bullimore MA, Saunders KJ, Baraas RC, Cheng H, Dinardo C, Flitcroft DI et al (2025) IMI—interventions for controlling myopia onset and progression 2025. Invest Ophthalmol Vis Sci 66:39. 10.1167/iovs.66.12.39 Mutti DO, Mitchell GL, Hayes JR, Jones LA, Moeschberger ML, Cotter SA et al (2006) Accommodative lag before and after the onset of myopia. Invest Ophthalmol Vis Sci 47:837–846. 10.1167/iovs.05-0888 Bowrey HE, Metse AP, Leotta AJ, Erichsen JT, Stell WK, Crewther SG et al (2015) The relationship between image degradation and myopia in the mammalian eye. Clin Exp Optom 98:555–563. 10.1111/cxo.12316 Ostrin LA, Erb C, Lan W, Lingham G, Troilo D, Wildsoet CF et al (2023) IMI—the dynamic choroid: new insights, challenges, and potential significance for human myopia. Invest Ophthalmol Vis Sci 64:4. 10.1167/iovs.64.6.4 Zhou X, Ye C, Wang X, Zhou W, Zhao Q, Hu W et al (2021) Choroidal blood perfusion as a potential rapid predictive index for myopia development and progression. Eye Vis 8:1. 10.1186/s40662-020-00224-0 Wang P, Chen S, Liu Y, Li G, Wei R, Cheng J et al (2021) Lowering intraocular pressure: A potential approach for controlling the progression of high myopia. Invest Ophthalmol Vis Sci 62:17. 10.1167/iovs.62.14.17 Potts RA, Dreher B, Bennett MR (1982) The loss of ganglion cells in the developing retina of the rat. Brain Res 255:101–116. 10.1016/0165-3806(82)90013-x Porac C, Coren S (1976) The dominant eye. Psychol Bull 83(5):880–889 Robert R, Babu M, Unnikannan K (2023) Sighting dominance, biometric parameters, and refractive status: analyzing the role of ocular dominance. Beyoglu Eye J 8:104–109. 10.14744/bej.2023.46504 Cheng CY, Yen MY, Lin HY, Hsia WW, Hsu WM (2004) Association of ocular dominance and anisometropic myopia. Invest Ophthalmol Vis Sci 45:2856–2860. 10.1167/iovs.03-0878 Chia A, Jaurigue A, Gazzard G, Lim L, Tan DT, Saw SM et al (2007) Ocular dominance, laterality, and refraction in singaporean children. Invest Ophthalmol Vis Sci 48:3533–3538. 10.1167/iovs.06-1489 Hoshikawa R, Ito M, Yano T, Yamamoto S (2016) Association between ocular dominance and anisometropic hyperopia. Am Orthopt J 66:107–113. 10.3368/aoj.66.1.107 Jiang F, Chen Z, Bi H, Gu T, Wu H, Xu J et al (2015) Association between ocular sensory dominance and refractive error asymmetry. PLoS ONE 10:e0136222. 10.1371/journal.pone.0136222 Khan FA, Kasturi N, Deb AK (2024) Ocular dominance and its association with retinal thickness profile – a cross-sectional study. Indian J Ophthalmol 72:1181–1185. 10.4103/IJO.IJO_203_24 Yang Z, Lan W, Liu W, Chen X, Ge J (2008) Association of ocular dominance and myopia development: a 2-year longitudinal study. Invest Ophthalmol Vis Sci 49:4779–4783. 10.1167/iovs.07-1616 Rice ML, Leske DA, Smestad CE, Holmes JM (2008) Results of ocular dominance testing depend on assessment method. J AAPOS 12(4):365–369. 10.1016/j.jaapos.2008.01.017 Ho R, Thompson B, Babu RJ, Dalton K (2018) Sighting ocular dominance magnitude varies with test distance. Clin Exp Optom 101(2):276–280. 10.1111/cxo.12627 Negida A (2020) Sample Size Calculation Guide - Part 7: How to Calculate the Sample Size Based on a Correlation. Adv J Emerg Med 4(2):e34. 10.22114/ajem.v0i0.344 Seijas O, Gómez de Liaño P, Gómez de Liaño R, Roberts CJ, Piedrahita E, Diaz E (2007) Ocular dominance diagnosis and its influence in monovision. Am J Ophthalmol 144(2):209–216. 10.1016/j.ajo.2007.03.053 Zhu X, Chen M, Dai J, Lu Y (2014) The effect of 0.5% tropicamide/0.5% phenylephrine mixed eye drop in Chinese adults with myopia and its inter-eye difference in refractive outcomes. Curr Med Res Opin 30(3):481–487. 10.1185/03007995.2013.861348 Zeri F, De Luca M, Spinelli D, Zoccolotti P (2011) Ocular dominance stability and reading skill: a controversial relationship. Optom Vis Sci 88(11):1353–1362. 10.1097/OPX.0b013e318229635a Li J, Lam CS, Yu M, Hess RF, Chan LY, Maehara G, Woo GC, Thompson B (2010) Quantifying sensory eye dominance in the normal visual system: a new technique and insights into variation across traditional tests. Invest Ophthalmol Vis Sci 51(12):6875–6881. 10.1167/iovs.10-5549 Dellatolas G, Curt F, Dargent-Paré C, De Agostini M (1998) Eye dominance in children: a longitudinal study. Behav Genet 28(3):187–195. 10.1023/a:1021471129962 Cheng CY, Yen MY, Lin HY, Hsia WW, Hsu WM (2004) Association of ocular dominance and anisometropic myopia. Invest Ophthalmol Vis Sci 45(8):2856–2860. 10.1167/iovs.03-087 Khan FA, Kasturi N, Deb AK (2024) Ocular dominance and its association with retinal thickness profile - A cross-sectional study. Indian J Ophthalmol 72(8):1181–1185. 10.4103/IJO.IJO_203_24 Vincent SJ, Collins MJ, Read SA, Carney LG, Yap MK (2011) Interocular symmetry in myopic anisometropia. Optom Vis Sci 88(12):1454–1462. 10.1097/OPX.0b013e318233ee5f Neitz M, Wagner-Schuman M, Rowlan JS, Kuchenbecker JA, Neitz J (2022) Insight from OPN1LW Gene Haplotypes into the Cause and Prevention of Myopia. Genes (Basel) 13(6):942. 10.3390/genes13060942 Lopes-Ferreira D, Neves H, Queiros A, Faria-Ribeiro M, Peixoto-de-Matos SC, González-Méijome JM (2013) Ocular dominance and visual function testing. Biomed Res Int 2013:238943. 10.1155/2013/23894 Ooi TL, He ZJ (2020) Sensory Eye Dominance: Relationship Between Eye and Brain. Eye Brain 12:25–31. 10.2147/EB.S176931 Chawla O, Deepak D (2022) Ocular dominance: a narrative review. Himal J Ophthalmol 16:16 : 10.4103/hjo. HJO_7_2 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8684859","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":581129471,"identity":"ce569f04-c431-4949-946d-ce427a5a2bf6","order_by":0,"name":"Wenfang Ye","email":"","orcid":"","institution":"Hainan Affiliated Hospital of Hainan Medical University (Hainan General Hospital)","correspondingAuthor":false,"prefix":"","firstName":"Wenfang","middleName":"","lastName":"Ye","suffix":""},{"id":581129473,"identity":"76cc86de-9aa9-418c-8b8c-b8fb72655130","order_by":1,"name":"Huan Ding","email":"","orcid":"","institution":"Hainan Affiliated Hospital of Hainan Medical University (Hainan General Hospital)","correspondingAuthor":false,"prefix":"","firstName":"Huan","middleName":"","lastName":"Ding","suffix":""},{"id":581129475,"identity":"e41727e7-5d9f-43ae-a5a8-57552e2aa1de","order_by":2,"name":"Zhujiang Bai","email":"","orcid":"","institution":"Hainan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhujiang","middleName":"","lastName":"Bai","suffix":""},{"id":581129477,"identity":"66d5fdac-af7e-45a3-8c14-e0946eb81c01","order_by":3,"name":"Shuyuan Zhang","email":"","orcid":"","institution":"Hainan Affiliated Hospital of Hainan Medical University (Hainan General Hospital)","correspondingAuthor":false,"prefix":"","firstName":"Shuyuan","middleName":"","lastName":"Zhang","suffix":""},{"id":581129479,"identity":"b7ecc859-0e4e-4171-aca9-68b103b6fda0","order_by":4,"name":"Dehai Zheng","email":"","orcid":"","institution":"Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University)","correspondingAuthor":false,"prefix":"","firstName":"Dehai","middleName":"","lastName":"Zheng","suffix":""},{"id":581129481,"identity":"3f9c0fd7-f8e8-418c-b5ec-31a898e4e955","order_by":5,"name":"Lin Lin","email":"","orcid":"","institution":"Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University)","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Lin","suffix":""},{"id":581129484,"identity":"153f4879-472e-4910-b933-6b8693979254","order_by":6,"name":"Lianyi Han","email":"","orcid":"","institution":"Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University)","correspondingAuthor":false,"prefix":"","firstName":"Lianyi","middleName":"","lastName":"Han","suffix":""},{"id":581129486,"identity":"df09a66c-8573-4d2d-9dfe-fe1521c88ffe","order_by":7,"name":"Kaiyan Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIie3RsQrCMBCA4ZPAuQS7ngjxCYRCoFCQPkuK4FREcHEMCG7iC/gWQueA0KnuHVy6OLlkdCnqplPiJph//7g7DiAU+sGQRba1XScw2hg/MuiDlIRGDqhSfkREkBBHkwsoYt/FQBHxi0KobXODTEy0m5h4SdcFst0xPcBMJsZJelpRzFYI53LEweSlmzzHcMXyLRRXX4I9zc3pRdCXcMaGei6RKpkeYo9bxvu6f7d6Ksb7Tdvc1plwko+Ie77mnXwrQqFQ6C96AMZTOidWUpsqAAAAAElFTkSuQmCC","orcid":"","institution":"Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University)","correspondingAuthor":true,"prefix":"","firstName":"Kaiyan","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2026-01-24 08:08:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8684859/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8684859/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101789800,"identity":"9a6b5ed1-166d-4fbd-8fd8-4cdb1ab74ef8","added_by":"auto","created_at":"2026-02-03 16:02:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":316931,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSchematic and dimensions of the modified near hole-in-the-card apparatus \u003c/strong\u003e(A) Front view: A transparent, lidded labselect® polyethylene culture dish (25 x 150 mm) is shown. (B) An opaque black square (30 × 30 mm) with a central 1.5 × 1.5 mm square aperture is fixed to the outside of the lid. Participants visualized a 1-mm² black 'C' positioned against a white substrate within the dish, observing the target through the designated aperture. (C) The lid and base of the dish are displayed separately. (D) Side view: A lateral profile of the assembled dish is presented.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8684859/v1/1bedc5cc9405401146e6c799.png"},{"id":101881221,"identity":"36c9c8a8-929a-4b37-ae9b-249f4e52416e","added_by":"auto","created_at":"2026-02-04 15:10:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":50917,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGender-based disparities in near and distance ocular dominance distribution\u003c/strong\u003e In Group A, near\u003c/p\u003e\n\u003cp\u003eocular dominance (NOD) was determined using the modified hole-in-the-card test; in Group B, distance ocular dominance (DOD) was assessed via the standard version.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8684859/v1/308ea4002b3e5b35eb8b6571.png"},{"id":102397515,"identity":"31d0b3e7-0b5e-4939-920b-833562f8e222","added_by":"auto","created_at":"2026-02-11 10:17:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1399235,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8684859/v1/175c2b65-921a-41a9-b378-e3d06a7f89ac.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ocular Dominance at Near versus Distance: Links to Axial Elongation and Refractive Progression","fulltext":[{"header":"Key message","content":"\u003cul start=\"50\"\u003e\n \u003cli\u003eCurrent research indicates that ocular dominance varies with testing distance.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eIndividuals may utilize different dominant eyes depending on the viewing distance.\u003c/li\u003e\n \u003cli\u003eNear ocular dominance is the primary predictor of accelerated axial elongation and myopic progression. \u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eMyopia has increased rapidly worldwide, especially in East Asia, and childhood-onset myopia often progresses during the school years. Axial elongation is the key structural change, and excessive elongation can lead to high myopia with sight-threatening complications such as myopic macular degeneration, retinal detachment, and glaucoma [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Myopia arises from interactions between genetic susceptibility, environmental, and lifestyle factors [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Among modifiable factors, prolonged near work and limited time outdoors are consistently associated with incident myopia and faster progression [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Clinical and experimental evidence supports sustained near visual demand as a major environmental driver [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Mechanistically, near tasks may promote accommodative lag and hyperopic defocus: when accommodation is insufficient, the focal plane falls behind the retina, providing a stimulus for axial elongation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Moreover, prolonged near work often introduces peripheral blur from printed text or digital screens, degrading the retinal image in a way reminiscent of form deprivation, which can promote abnormal ocular growth [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In this setting, the choroid may thin and its perfusion decline, reducing blood supply and creating relative hypoxia in the adjacent outer sclera [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Hypoxia-driven scleral remodeling can then weaken the tissue, facilitating excessive axial elongation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOcular dominance (ocular preference) refers to the eye that is more often selected for binocular fixation and that tends to contribute more strongly to perception and afferent signaling [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Ocular laterality has been linked to interocular differences in retinal architecture, including photoreceptor, ganglion-cell, and bipolar-cell densities. Correspondingly, processing of input from the dominant eye is often faster and more accurate, supporting a sharper and more stable internal visual representation. Evidence on whether ocular dominance relates to axial length is still sparse and mixed. Several reports describe a longer axial length in the dominant eye than in the fellow eye [\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], whereas other studies have found the opposite or no clear association [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Notably, ocular dominance has been shown to be task- and distance dependent, with potential shifts between near and distance viewing conditions [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Current literature shows that most investigations have leaned on aperture-sighting assessments at a distance of 6 m as the primary metric for eye dominance. which predominantly captures distance-related dominance rather than dominance during near visual tasks. Given the well-established role of sustained near work in axial elongation, a mismatch between near and distance ocular dominance may contribute to the heterogeneity of reported findings. A clearer delineation of distance-specific ocular dominance and its relationship with axial length may therefore provide further insight into myopiarelated mechanisms and support the development of more individualized preventive or therapeutic approaches, including vision-based interventions.\u003c/p\u003e"},{"header":"Subjects and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003eChildren and adolescents were recruited for this prospective study. Based on a two-sided α of 0.05 and 80% power, the estimated minimum sample size was 118; this was inflated by 20% to allow for potential loss to follow-up [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Between September 2024 and September 2025, participants were consecutively recruited from the Ophthalmology Outpatient Clinic of Hainan General Hospital. Inclusion criteria were an age of 6\u0026ndash;16 years and best-corrected visual acuity of 20/20 or better at both near and distance. Exclusion criteria included: abnormal axial length (AL\u0026thinsp;\u0026lt;\u0026thinsp;20 mm or \u0026gt;\u0026thinsp;27 mm), anisometropia exceeding 1.75 D, manifest strabismus, amblyopia, significant heterophoria, coexisting anterior or posterior segment disease, or a history of ocular surgery. By September 2025, 8 of them had been missed the interview, and another 5 had been excluded due to two examinations and found that the superiority of distant eyes was different, considering poor compliance. In the end, there were 105 subjects.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMethods\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eOcular Dominance Measurement\u003c/h2\u003e \u003cp\u003eMethod A adopted the improved near-hole method [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], using a 25 x 150mm polyethylene transparent culture dish. A 30 x 30mm black square sticker with a square opening in the center of 1.5 x 1.5 mm was pasted to the surface of the culture dish. The black letters (height and width were 1 mm) were pasted in the center of the white background at the bottom of the culture dish, and the distance between the hole and the observation letter was 25mm, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The culture dish was fixed on the bookshelf. The subject adjusted the height of the seat so that he could use the reading distance (40cm) to see the letters through the opening. The eye that continued to see the target was recorded as the Near Ocular Dominance (NOD).We employed the validated hole-in-the-card (Miles Test) approach (Method B) as a benchmark for measuring Distance Ocular Dominance (DOD) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Participants were instructed to hold the test card with both hands and to view a target optotype on a Snellen chart at a distance of 6 meters through a central opening of 3 centimeters. After binocular localization, each eye was alternately occluded, and the eye maintaining stable fixation on the target was identified as the distance-dominant eye. Each assessment was performed three times to ensure reliability. In addition, all dominance measurements were repeated after a 6-month interval to evaluate longitudinal stability.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRefraction and AL Measurement\u003c/h3\u003e\n\u003cp\u003eTo standardize the examination procedure and improve participant compliance, a uniform cycloplegic protocol was applied to all subjects. Cycloplegia was induced using a combined eyedrop of 0.5% Tropicamide and 0.5% Phenylephrine Hydrochloride (Jinyao, China), administered four times at 10-minute intervals. Refractive measurements began at least 30 minutes after the final instillation of the cycloplegic eyedrops and only after confirming the absence of the pupillary light reflex [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Refractions were measured using an automated refractor (Digital Ref-Ractor DR-900, Japan). All measurements were conducted by a single experienced optometrist, with a minimum of three reliable readings obtained and averaged for each eye. Spherical equivalent (SE) was subsequently defined as sphere power plus half of the cylinder power SE\u0026thinsp;=\u0026thinsp;Sphere\u0026thinsp;+\u0026thinsp;1/2Cylinder. Axial length was measured using an IOLMaster 500 (Carl Zeiss Meditec, Jena, Germany). Both refractive status and axial length were reassessed at the 6-month follow-up.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using IBM SPSS Statistics (version 27.0; IBM Corp., Armonk, NY, USA). Figures were generated using GraphPad Prism (version 10.6; GraphPad Software, San Diego, CA, USA). Statistical normality was determined using the Shapiro-Wilk test, after which paired t-tests were applied to compare conditions for variables meeting the normal distribution (reported as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD). For non-parametric datasets, values were reported as medians (P25, P75), with the Wilcoxon signed-rank test applied to evaluate longitudinal changes in axial elongation and refractive progression between eyes. Categorical data are summarized as frequencies (%). Differences in sex distribution were examined using Fisher\u0026rsquo;s exact test, while the McNemar test was applied to evaluate agreement and distribution shifts between near- and distance-ocular dominance. Statistical significance was defined by a two-tailed P-value of less than 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDifference between Distance and Near Ocular Dominance\u003c/h2\u003e \u003cp\u003eThe study included 105 participants aged 6\u0026ndash;16 years (mean age 10.04\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41 years), of whom 46 (43.81%) were female and 59 (56.19%) were male. Right-eye dominance was predominant in this cohort, observed in 64 participants (60.95%) for near vision and 78 participants (74.29%) for distance vision. The distribution of ocular dominance by gender is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. No statistically significant sex-based difference was found in near or distance ocular dominance (Fisher's Exact Test, near \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.546; distant \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.0) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A kappa coefficient of 0.275 and an agreement rate of 67.6% point toward weak concordance between dominance patterns at different ranges. Significant binocular distribution differences surfaced during McNemar testing (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.024), confirming that viewing distance exerts a substantial influence on the determination of the dominant eye (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eocular dominance (NOD) was determined using the modified hole-in-the-card test; in Group B, distance ocular\u003c/p\u003e \u003cp\u003edominance (DOD) was assessed via the standard version.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe relationship between the types of dominant eye and gender\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNear hole-in-the-card\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eHole-in-the-card\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRight eye\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLeft eye\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRight eye\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLeft eye\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59 (56.48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46 (43.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ea\u003c/sup\u003e: Fisher\u0026rsquo;s exact test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe relationship between the near and distance-dominant eye\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHole-in-\u003c/p\u003e \u003cp\u003ethe-card\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNear hole-in-the-card\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo. (%) \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight eye\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLeft eye\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight eye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e78 (74.29%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft eye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27 (25.71%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (60.95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (39.05%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e105 (100.00%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eb\u003c/sup\u003e: McNemar test, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.024, (κ\u0026thinsp;=\u0026thinsp;0.275)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eNear and Distance Ocular Dominance and Axial Elongation\u003c/h3\u003e\n\u003cp\u003eAxial elongation was defined as the longitudinal change in AL from baseline to the 6-month follow-up. A statistically significant difference in axial elongation was observed based on near ocular dominance (dominant: 0.19mm (0.11, 0.35) vs non-dominant eye: 0.17mm (0.09, 0.34); P\u0026thinsp;=\u0026thinsp;0.001). In contrast, no significant difference was found based on distance ocular dominance (dominant eye: 0.18 mm (0.11, 0.35) vs non-dominant eye: 0.17 mm (0.10, 0.35); P\u0026thinsp;=\u0026thinsp;0.766). The results indicate that axial elongation was significantly faster in the near-dominant eye compared to its fellow non-dominant eye. However, no such difference existed between the distance-dominant and non-dominant eyes (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInterocular comparison of AL and SE changes by ocular dominance\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDominant Eye\u003c/p\u003e \u003cp\u003eM (P25, P75)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-dominant Eye\u003c/p\u003e \u003cp\u003eM (P25, P75)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup A\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAL elongation(mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.19 (0.11, 0.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.17 (0.09, 0.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChange in SE (D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.25 (-0.50, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.13 (-0.50, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup B\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAL elongation (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.18 (0.11, 0.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.17 (0.10, 0.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.766\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChange in SE(D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.25 (-0.50, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.25 (-0.50, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.104\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eSE: spherical equivalent; D: diopters; \u003csup\u003ec\u003c/sup\u003e: Wilcoxon signed-rank test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eNear and Distance Ocular Dominance and Refractive Progression\u003c/h2\u003e \u003cp\u003eRefractive progression was defined as the change in spherical equivalent (SE) from baseline to the 6-month follow-up. A significant inter-eye difference in refractive progression was observed based on near ocular dominance (dominant eye: -0.25D (-0.50, 0) vs nondominant eye: -0.13D (-0.50, 0); P\u0026thinsp;=\u0026thinsp;0.009). In contrast, no significant difference was found based on distance ocular dominance (dominant eye: -0.25D (-0.50, 0) vs non-dominant eye: -0.25D (-0.50, 0); P\u0026thinsp;=\u0026thinsp;0.104). These results indicate that myopic progression was significantly greater in the near-dominant eye than in the contralateral non-dominant eye. No such difference was observed between the distance-dominant eye and its non-dominant fellow (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eNear and Distance Ocular Dominance and Astigmatism (Cylinder Power)\u003c/h2\u003e \u003cp\u003eAlthough the change in cylinder power over the follow-up period was not statistically significant, a cross-sectional analysis of astigmatism at both baseline and final visits was conducted to evaluate inter-eye asymmetry between the dominant and non-dominant eyes. For consistency, all cylinder values were uniformly converted to negative notation. The analysis revealed that the dominant eye consistently exhibited a significantly lower degree of astigmatism than the non-dominant eye under both near and distance viewing conditions (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCross-sectional analysis of cylindrical power\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eastigmatism\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDominant Eye\u003c/p\u003e \u003cp\u003eM (P25, P75)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-dominant Eye\u003c/p\u003e \u003cp\u003eM (P25, P75)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup A\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInitial Cylinder Power (D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e-0.50 (-1.50, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e-0.75 (-2.00, -0.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe second Cylinder Power (D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e-0.50 (-1.50, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e-0.75 (-1.88, -0.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup B\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInitial Cylinder Power (D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e-0.50 (-1.50, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e-0.75 (2.00, -0.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe second Cylinder Power (D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c2\"\u003e \u003cp\u003e-0.50 (-1.50, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e-0.75 (2.00, -0.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eD: diopters; \u003csup\u003ec\u003c/sup\u003e: Wilcoxon signed-rank test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOcular dominance was first described by Rosenbach in 1903 and is currently classified into three principal types: motor (or aiming) dominance, sensory dominance, and fixational dominance. Aiming dominance refers to the eye preferentially used for pointing/aiming tasks, reflecting neural preference for motor coordination and spatial localization, and is typically assessed by tests such as hole-in-thecard, pointing, near-convergence, and near hole-in-the-card procedures. Sensory dominance reflects cortical prioritization of one eye\u0026rsquo;s input during binocular stimulation, supporting clearer and more stable perception, and is often quantified using binocular rivalry or fusion-based measures. Fixation dominance is frequently evaluated in clinical contexts involving binocular dysfunction (e.g., strabismus, amblyopia) and denotes the eye that can promptly and stably refixate on a target after visual interruption, commonly assessed via alternating cover tests or Worth four-dot testing [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Because the conventional hole-in-the-card test primarily captures distance sighting dominance, we incorporated both standard distance testing and a near-task variant to better reflect dominance relevant to sustained near work [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFive participants were excluded due to inconsistent distance dominance shifts between baseline and the 6-month follow-up. This discordance could reflect subjective variation in the test procedure or a genuine change in dominance over time; the underlying reason cannot be determined from our data. Dellatolas (1998) reported that about two-thirds of children show completely stable ocular dominance, with stability improving with age [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], but long-term evidence remains limited. Although we excluded these five participants from the main analysis, we will continue to follow them longitudinally for further evaluation. Current evidence does not clearly indicate whether an interocular AL difference is a cause or a consequence of ocular dominance. Cheng et al. and others have noted that when anisometropia exceeds 1.75 D, the dominant eye is almost always the more myopic eye [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Because the inclusion of individuals with extremely long or short axial lengths would substantially increase the overall variability (σ) of the study population [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], participants with axial lengths\u0026thinsp;\u0026lt;\u0026thinsp;20 mm or \u0026gt;\u0026thinsp;27 mm, as well as those with interocular refractive differences exceeding 1.75 D, were therefore excluded from the analysis [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study demonstrates that ocular dominance may differ between near and distance visual tasks, and such task-dependent dominance has important implications for investigations of ocular biometric parameters, particularly axial elongation and refractive progression. The eye preferentially engaged during sustained, high-intensity near work may be subjected to greater visual load or functional demand. The eyes that are selected for continuous high-intensity close-up work may be under greater visual pressure or functional needs. This increase in demand may trigger some biological mechanisms (such as retinal defocus, ciliary muscle tone or growth factor release), thus accelerating eyeball elongation. Due to the different advantages of near-sighted and far-sighted, under the background of the new era of lifestyle and myopia where close-up work dominates visual activities [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], it is necessary to pay attention to the differences between the two and the impact on the different results brought about by relevant research. The close-up dominant eye has a stronger correlation with the increase of myopia and the growth of the eye axis [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and bears more significant biometric consequences [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition, our study found that the columnar degree of the dominant eye is lower than that of the non-dominant eye, indicating that the brain optimizes the image quality by prioritizing the eyes that are structurally closer to the orthographic state (perfect focus) or have a more regular optical surface, and tend to provide images that can provide clearer and less aberration (i.e. lower astigmatism) The eye is chosen as the dominant eye to complete the task of high visual fidelity [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Lower astigmatism may be the reason why it was chosen as the dominant eye, not the consequence of the dominant position.\u003c/p\u003e \u003cp\u003eThis study found that it has important clinical guidance value for ophthalmology and optics: presbyopia correction: It is very important to accurately determine the dominant eye before monocular or regulatory accommodative intraocular lens implantation. Traditional preoperative evaluation often relies on long-distance dominant eye tests. The results of this study strongly recommend that for patients who plan to undergo monocular correction, their close-up dominant eyes must be measured and considered at the same time. If the patient's close-range dominant eye is different from his long-range dominant eye, and the crystal degree is allocated only based on the long-range results, it may lead to near-range visual dysfunction or visual discomfort. Visual training: This switching phenomenon can help clinicians identify potential instability in the binocular vision system. For some patients with near-range visual fatigue or reading difficulties, evaluating the consistency of their near-range dominant eye may provide new diagnostic clues [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Of course, the relationship between the dominant eye and the growth of the eye axis of adolescents and children still needs more data and longer observation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIt is of great clinical significance to distinguish the dominant eye into two types: near-sighted and far-sighted. In the designation of myopia prevention, control and correction strategies, the dominant eye measured by the improved near-hole method should be considered as the risk eye for myopia progression that needs more attention. Evidence suggests that the visual cortex, along with its neurophysiological circuits, tends to prioritize signals from the eye providing superior retinal clarity\u0026mdash;often the one with minimal astigmatism. This selective processing serves as a mechanism to streamline neural efficiency and sharpen visual outcomes. Such dynamics suggest that a shift is needed in clinical and research protocols: moving beyond isolated metrics toward a more integrated framework that weighs both NOD and optical integrity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eThe authors express their sincere appreciation to all study participants and their legal guardians. We also extend our thanks to the volunteers whose dedicated support was instrumental in the execution of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003eThis work represents a collaborative effort by all authors. Wenfang Ye and Huan Ding contributed equally to ocular dominance measurement, and drafted the initial manuscript. Zhujiang Bai and Shuyuan Zhang performed data collection and statistical analyses. Dehai Zheng was responsible for the refractive examinations. Lianyi Han conduct data collection and cross‑checking. Lin Lin carried out the AL measurements. Kaiyan Zhang contributed to the study conceptualization, design, and critical revision of the manuscript. All authors reviewed, approved, and take full responsibility for the final version of the manuscript, including the integrity, accuracy, and transparency of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research was not supported by any funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u0026nbsp;\u003c/strong\u003eThis article has presented all the data. If you require the raw data, please contact the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate:\u0026nbsp;\u003c/strong\u003eThe study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Institutional Ethics Committee of Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University) (Approval No. EC-YLY-2025-272-01). Written informed consent was obtained from all participants or their legal guardians prior to enrollment. Clinical trial registration number: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eThe author declares no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVerhoeven VJM, Wong KT, Buitendijk GHS, Boon CJF, Fontana RK, Erke MG et al (2015) Visual consequences of refractive errors in the general population. Ophthalmology 122:101\u0026ndash;109. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ophtha.2014.07.030\u003c/span\u003e\u003cspan address=\"10.1016/j.ophtha.2014.07.030\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDirani M, Chamberlain M, Shekar SN, Islam AF, Garoufalis P, Chen CY et al (2006) Heritability of refractive error and ocular biometrics: the genes in myopia (GEM) twin study. Invest Ophthalmol Vis Sci 47:4756\u0026ndash;4761. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1167/iovs.06-0270\u003c/span\u003e\u003cspan address=\"10.1167/iovs.06-0270\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCREAM Consortium, 23andMe Research Team, UK Biobank Eye and Vision Consortium, Tedja MS, Wojciechowski R, Hysi PG et al (2018) Genome-wide association meta-analysis highlights light-induced signaling as a driver for refractive error. Nat Genet 50:834\u0026ndash;848. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41588-018-0127-7\u003c/span\u003e\u003cspan address=\"10.1038/s41588-018-0127-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang HM, Chang DST, Wu PC (2015) The association between near work activities and myopia in children\u0026mdash;a systematic review and meta-analysis. PLoS ONE 10:e0140419. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0140419\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0140419\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarthikeyan SK, Ashwini DL, Priyanka M, Nayak A, He M, Sankaridurg P et al (2022) Physical activity, time spent outdoors, and near work in relation to myopia prevalence, incidence, and progression: an overview of systematic reviews and meta-analyses. Indian J Ophthalmol 70:728\u0026ndash;739. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/ijo.IJO_1564_21\u003c/span\u003e\u003cspan address=\"10.4103/ijo.IJO_1564_21\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLogan NS, Radhakrishnan H, Cruickshank FE, Allen PM, Retallic JS, Wolffsohn JS et al (2021) IMI accommodation and binocular vision in myopia development and progression. Invest Ophthalmol Vis Sci 62:4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1167/iovs.62.5.4\u003c/span\u003e\u003cspan address=\"10.1167/iovs.62.5.4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBullimore MA, Saunders KJ, Baraas RC, Cheng H, Dinardo C, Flitcroft DI et al (2025) IMI\u0026mdash;interventions for controlling myopia onset and progression 2025. Invest Ophthalmol Vis Sci 66:39. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1167/iovs.66.12.39\u003c/span\u003e\u003cspan address=\"10.1167/iovs.66.12.39\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMutti DO, Mitchell GL, Hayes JR, Jones LA, Moeschberger ML, Cotter SA et al (2006) Accommodative lag before and after the onset of myopia. Invest Ophthalmol Vis Sci 47:837\u0026ndash;846. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1167/iovs.05-0888\u003c/span\u003e\u003cspan address=\"10.1167/iovs.05-0888\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBowrey HE, Metse AP, Leotta AJ, Erichsen JT, Stell WK, Crewther SG et al (2015) The relationship between image degradation and myopia in the mammalian eye. Clin Exp Optom 98:555\u0026ndash;563. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/cxo.12316\u003c/span\u003e\u003cspan address=\"10.1111/cxo.12316\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOstrin LA, Erb C, Lan W, Lingham G, Troilo D, Wildsoet CF et al (2023) IMI\u0026mdash;the dynamic choroid: new insights, challenges, and potential significance for human myopia. Invest Ophthalmol Vis Sci 64:4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1167/iovs.64.6.4\u003c/span\u003e\u003cspan address=\"10.1167/iovs.64.6.4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou X, Ye C, Wang X, Zhou W, Zhao Q, Hu W et al (2021) Choroidal blood perfusion as a potential rapid predictive index for myopia development and progression. Eye Vis 8:1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s40662-020-00224-0\u003c/span\u003e\u003cspan address=\"10.1186/s40662-020-00224-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang P, Chen S, Liu Y, Li G, Wei R, Cheng J et al (2021) Lowering intraocular pressure: A potential approach for controlling the progression of high myopia. Invest Ophthalmol Vis Sci 62:17. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1167/iovs.62.14.17\u003c/span\u003e\u003cspan address=\"10.1167/iovs.62.14.17\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePotts RA, Dreher B, Bennett MR (1982) The loss of ganglion cells in the developing retina of the rat. Brain Res 255:101\u0026ndash;116. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/0165-3806(82)90013-x\u003c/span\u003e\u003cspan address=\"10.1016/0165-3806(82)90013-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePorac C, Coren S (1976) The dominant eye. Psychol Bull 83(5):880\u0026ndash;889\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobert R, Babu M, Unnikannan K (2023) Sighting dominance, biometric parameters, and refractive status: analyzing the role of ocular dominance. Beyoglu Eye J 8:104\u0026ndash;109. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.14744/bej.2023.46504\u003c/span\u003e\u003cspan address=\"10.14744/bej.2023.46504\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng CY, Yen MY, Lin HY, Hsia WW, Hsu WM (2004) Association of ocular dominance and anisometropic myopia. Invest Ophthalmol Vis Sci 45:2856\u0026ndash;2860. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1167/iovs.03-0878\u003c/span\u003e\u003cspan address=\"10.1167/iovs.03-0878\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChia A, Jaurigue A, Gazzard G, Lim L, Tan DT, Saw SM et al (2007) Ocular dominance, laterality, and refraction in singaporean children. Invest Ophthalmol Vis Sci 48:3533\u0026ndash;3538. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1167/iovs.06-1489\u003c/span\u003e\u003cspan address=\"10.1167/iovs.06-1489\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoshikawa R, Ito M, Yano T, Yamamoto S (2016) Association between ocular dominance and anisometropic hyperopia. Am Orthopt J 66:107\u0026ndash;113. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3368/aoj.66.1.107\u003c/span\u003e\u003cspan address=\"10.3368/aoj.66.1.107\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang F, Chen Z, Bi H, Gu T, Wu H, Xu J et al (2015) Association between ocular sensory dominance and refractive error asymmetry. PLoS ONE 10:e0136222. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0136222\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0136222\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan FA, Kasturi N, Deb AK (2024) Ocular dominance and its association with retinal thickness profile \u0026ndash; a cross-sectional study. Indian J Ophthalmol 72:1181\u0026ndash;1185. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/IJO.IJO_203_24\u003c/span\u003e\u003cspan address=\"10.4103/IJO.IJO_203_24\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang Z, Lan W, Liu W, Chen X, Ge J (2008) Association of ocular dominance and myopia development: a 2-year longitudinal study. Invest Ophthalmol Vis Sci 49:4779\u0026ndash;4783. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1167/iovs.07-1616\u003c/span\u003e\u003cspan address=\"10.1167/iovs.07-1616\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRice ML, Leske DA, Smestad CE, Holmes JM (2008) Results of ocular dominance testing depend on assessment method. J AAPOS 12(4):365\u0026ndash;369. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jaapos.2008.01.017\u003c/span\u003e\u003cspan address=\"10.1016/j.jaapos.2008.01.017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHo R, Thompson B, Babu RJ, Dalton K (2018) Sighting ocular dominance magnitude varies with test distance. Clin Exp Optom 101(2):276\u0026ndash;280. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/cxo.12627\u003c/span\u003e\u003cspan address=\"10.1111/cxo.12627\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNegida A (2020) Sample Size Calculation Guide - Part 7: How to Calculate the Sample Size Based on a Correlation. Adv J Emerg Med 4(2):e34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.22114/ajem.v0i0.344\u003c/span\u003e\u003cspan address=\"10.22114/ajem.v0i0.344\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeijas O, G\u0026oacute;mez de Lia\u0026ntilde;o P, G\u0026oacute;mez de Lia\u0026ntilde;o R, Roberts CJ, Piedrahita E, Diaz E (2007) Ocular dominance diagnosis and its influence in monovision. Am J Ophthalmol 144(2):209\u0026ndash;216. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajo.2007.03.053\u003c/span\u003e\u003cspan address=\"10.1016/j.ajo.2007.03.053\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhu X, Chen M, Dai J, Lu Y (2014) The effect of 0.5% tropicamide/0.5% phenylephrine mixed eye drop in Chinese adults with myopia and its inter-eye difference in refractive outcomes. Curr Med Res Opin 30(3):481\u0026ndash;487. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1185/03007995.2013.861348\u003c/span\u003e\u003cspan address=\"10.1185/03007995.2013.861348\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeri F, De Luca M, Spinelli D, Zoccolotti P (2011) Ocular dominance stability and reading skill: a controversial relationship. Optom Vis Sci 88(11):1353\u0026ndash;1362. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/OPX.0b013e318229635a\u003c/span\u003e\u003cspan address=\"10.1097/OPX.0b013e318229635a\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi J, Lam CS, Yu M, Hess RF, Chan LY, Maehara G, Woo GC, Thompson B (2010) Quantifying sensory eye dominance in the normal visual system: a new technique and insights into variation across traditional tests. Invest Ophthalmol Vis Sci 51(12):6875\u0026ndash;6881. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1167/iovs.10-5549\u003c/span\u003e\u003cspan address=\"10.1167/iovs.10-5549\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDellatolas G, Curt F, Dargent-Par\u0026eacute; C, De Agostini M (1998) Eye dominance in children: a longitudinal study. Behav Genet 28(3):187\u0026ndash;195. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1023/a:1021471129962\u003c/span\u003e\u003cspan address=\"10.1023/a:1021471129962\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng CY, Yen MY, Lin HY, Hsia WW, Hsu WM (2004) Association of ocular dominance and anisometropic myopia. Invest Ophthalmol Vis Sci 45(8):2856\u0026ndash;2860. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1167/iovs.03-087\u003c/span\u003e\u003cspan address=\"10.1167/iovs.03-087\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan FA, Kasturi N, Deb AK (2024) Ocular dominance and its association with retinal thickness profile - A cross-sectional study. Indian J Ophthalmol 72(8):1181\u0026ndash;1185. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/IJO.IJO_203_24\u003c/span\u003e\u003cspan address=\"10.4103/IJO.IJO_203_24\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVincent SJ, Collins MJ, Read SA, Carney LG, Yap MK (2011) Interocular symmetry in myopic anisometropia. Optom Vis Sci 88(12):1454\u0026ndash;1462. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/OPX.0b013e318233ee5f\u003c/span\u003e\u003cspan address=\"10.1097/OPX.0b013e318233ee5f\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeitz M, Wagner-Schuman M, Rowlan JS, Kuchenbecker JA, Neitz J (2022) Insight from OPN1LW Gene Haplotypes into the Cause and Prevention of Myopia. Genes (Basel) 13(6):942. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/genes13060942\u003c/span\u003e\u003cspan address=\"10.3390/genes13060942\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLopes-Ferreira D, Neves H, Queiros A, Faria-Ribeiro M, Peixoto-de-Matos SC, Gonz\u0026aacute;lez-M\u0026eacute;ijome JM (2013) Ocular dominance and visual function testing. Biomed Res Int 2013:238943. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2013/23894\u003c/span\u003e\u003cspan address=\"10.1155/2013/23894\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOoi TL, He ZJ (2020) Sensory Eye Dominance: Relationship Between Eye and Brain. Eye Brain 12:25\u0026ndash;31. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/EB.S176931\u003c/span\u003e\u003cspan address=\"10.2147/EB.S176931\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChawla O, Deepak D (2022) Ocular dominance: a narrative review. Himal J Ophthalmol 16:16 : 10.4103/hjo. HJO_7_2\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ocular dominance, Axial elongation, Refractive progression, Astigmatism","lastPublishedDoi":"10.21203/rs.3.rs-8684859/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8684859/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective: To investigate the associations between ocular dominance under near and distance viewing conditions and subsequent axial elongation as well as refractive progression.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: A total of 105 children and adolescents aged 6–16 years who attended the Ophthalmology Outpatient Clinic of Hainan General Hospital between September 2024 and September 2025 were enrolled. Ocular dominance was determined using two approaches: near dominance was identified with a modified near-hole-in-the-card test (Group A), while distance dominance was assessed using the conventional hole-in-the-card test (Group B). Consistency between dominance classifications obtained by the two methods was evaluated. Furthermore, axial length elongation and refractive change were compared between dominant and non-dominant eyes as defined by each method.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: Ocular dominance differed between near and distance testing (McNemar test, \u003cem\u003eP\u003c/em\u003e = 0.024). During near viewing, dominant eyes showed greater axial elongation (\u003cem\u003eP\u003c/em\u003e = 0.001) and faster refractive progression (\u003cem\u003eP\u003c/em\u003e = 0.009) than non-dominant eyes; these associations were not observed for distance dominance. Across both testing distances, dominant eyes had lower cylindrical power than nondominant eyes (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: Near and distance ocular dominance are not interchangeable. Near dominant eyes are more prone to accelerated axial growth and myopic progression, and dominance at either distance was associated with lower astigmatism than the non-dominant eye.\u003c/p\u003e","manuscriptTitle":"Ocular Dominance at Near versus Distance: Links to Axial Elongation and Refractive Progression","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-03 16:02:04","doi":"10.21203/rs.3.rs-8684859/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"93eb9d65-c680-433a-bd31-3524c65deef2","owner":[],"postedDate":"February 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-03T04:23:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-03 16:02:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8684859","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8684859","identity":"rs-8684859","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}