Longitudinal changes of refraction and visual acuity in children with early-onset high myopia

Abstract Objectives To investigate the longitudinal changes of refraction and visual acuity in children with early-onset high myopia (eoHM). Methods We retrospectively included children with eoHM, defined as cycloplegic spherical equivalent (SE) ≤ − 6.00 D or axial length (AL) ≥ 26mm in both eyes in children under 7 years old, who had at least three visits with available cycloplegic autorefraction records based on the electronic medical records (EMR) at the Zhongshan Ophthalmic Center between 2003 to 2023. Data on children’s demographic and clinical characteristics, including age, sex, best corrected visual acuity (BCVA) and presence of strabismus were also extracted from the EMR. Results A total of 930 children were included (median baseline age: 4.33 years, interquartile range [IQR], 3.42 to 5.25 years, 64.84% boys). The median baseline spherical equivalent (SE) was − 8.25D (IQR, -10.00D to -7.00D), and the median duration of follow-up was 2.85 years (IQR, 2.03 to 3.57 years). The mean myopia progression rate was − 0.33 (SD, 0.37) D/year, with 298 children (32.04%) demonstrated myopia progression of ≥ 0.50D/year. Older age (ß= -0.041, P  0.5 (20/40) ranged from 11.27% among the 4-year-olds to 73.58% among the 8-year-olds. Conclusion In this real-world hospital-based dataset, two-thirds of children with eoHM do not experience rapid myopia progression. Boys, children with older age and less myopic SE at baseline are more likely to experience faster myopia progression.