Ocular dominance is associated with interocular asymmetry in refractive error and axial length across childhood and early adulthood

Ocular dominance is associated with interocular asymmetry in refractive error and axial length across childhood and early adulthood | 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 is associated with interocular asymmetry in refractive error and axial length across childhood and early adulthood Síofra C. Harrington, Gareth Lingham, James Loughman, Ian Flitcroft, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8950954/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Purpose: To determine whether ocular dominance is associated with systematic interocular asymmetry in spherical equivalent refraction (SER) and axial length (AL) across childhood and early adulthood, and assess whether such asymmetry exceeds laterality effects. Methods Data were analysed from three population-based cohorts: 728 children (6-7-year-olds), 898 adolescents (12-13-year-olds) from Ireland, and 303 young adults (25-30-year-olds) from Western Australia. Ocular dominance was assessed using sighting tests. SER was measured by cycloplegic autorefraction, and AL by optical biometry. Interocular differences were evaluated using paired comparisons, concordance correlation coefficients, Deming regression, Bland–Altman analyses, and mediation modelling. Analyses were stratified by refractive status and anisometropia. Results Across all age groups, right–left differences in SER and AL were minimal (mean differences <0.05D and <0.05mm in children and adolescents), with small, significant laterality effects observed only in young adults (−0.13D in SER; 0.06mm in AL). In contrast, dominant–non-dominant comparisons demonstrated consistent directional asymmetry: the dominant eye was less hyperopic/more myopic (−0.09D at 6–7 years; −0.10D at 12–13 years; −0.20D at 25–30 years) and longer (0.03–0.07mm; all p<0.05). Deming regression and Bland–Altman analyses confirmed systematic deviation from interocular symmetry, most pronounced in childhood. Mediation analyses indicated that ocular dominance statistically explained over 85% of the observed interocular asymmetry, independent of laterality. Dominance-related asymmetry was most evident in non-myopes (SER −0.09 to −0.36D; AL 0.03–0.06mm), attenuated in myopia, and amplified in anisometropia (SER up to −1.09D; AL up to 0.42mm), particularly in younger cohorts. Conclusion In this cross-sectional analysis, ocular dominance was associated with small but systematic interocular asymmetry in SER and AL across childhood and early adulthood, which exceeds laterality effects. Dominance-related asymmetry was attenuated in myopia and amplified in anisometropia. Ocular dominance should be considered when analysing interocular refractive and biometric data in research and clinical contexts. Ocular dominance Interocular asymmetry Refractive error Axial length Anisometropia Myopia Full Text Additional Declarations No competing interests reported. Supplementary Files STROBEchecklistOculardominanceisassociatedwithinterocularasymmetryinrefractiveerrorandaxiallengthacrosschildhoodandearlyadulthood.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 17 Apr, 2026 Reviewers agreed at journal 19 Mar, 2026 Reviewers agreed at journal 19 Mar, 2026 Reviewers invited by journal 06 Mar, 2026 Editor assigned by journal 06 Mar, 2026 Submission checks completed at journal 06 Mar, 2026 First submitted to journal 23 Feb, 2026 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-8950954","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":602119650,"identity":"1fed5a3e-52db-4d51-a35f-39dd77f767b3","order_by":0,"name":"Síofra C. 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Ocular dominance was assessed using sighting tests. SER was measured by cycloplegic autorefraction, and AL by optical biometry.\u003c/p\u003e\n\u003cp\u003eInterocular differences were evaluated using paired comparisons, concordance correlation coefficients, Deming regression, Bland–Altman analyses, and mediation modelling. Analyses were stratified by refractive status and anisometropia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross all age groups, right–left differences in SER and AL were minimal (mean differences \u0026lt;0.05D and \u0026lt;0.05mm in children and adolescents), with small, significant laterality effects observed only in young adults (−0.13D in SER; 0.06mm in AL). In contrast, dominant–non-dominant comparisons demonstrated consistent directional asymmetry: the dominant eye was less hyperopic/more myopic (−0.09D at 6–7 years; −0.10D at 12–13 years; −0.20D at 25–30 years) and longer (0.03–0.07mm; all p\u0026lt;0.05). Deming regression and Bland–Altman analyses confirmed systematic deviation from interocular symmetry, most pronounced in childhood. Mediation analyses indicated that ocular dominance statistically explained over 85% of the observed interocular asymmetry, independent of laterality. Dominance-related asymmetry was most evident in non-myopes (SER −0.09 to −0.36D; AL 0.03–0.06mm), attenuated in myopia, and amplified in anisometropia (SER up to −1.09D; AL up to 0.42mm), particularly in younger cohorts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this cross-sectional analysis, ocular dominance was associated with small but systematic interocular asymmetry in SER and AL across childhood and early adulthood, which exceeds laterality effects. Dominance-related asymmetry was attenuated in myopia and amplified in anisometropia. Ocular dominance should be considered when analysing interocular refractive and biometric data in research and clinical contexts.\u003c/p\u003e","manuscriptTitle":"Ocular dominance is associated with interocular asymmetry in refractive error and axial length across childhood and early adulthood","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-12 23:07:10","doi":"10.21203/rs.3.rs-8950954/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-17T16:09:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202311764841561703277233816600858619398","date":"2026-03-19T10:52:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"16252205862428421417101928448567243549","date":"2026-03-19T09:21:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-06T16:08:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-06T16:05:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-06T05:56:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"Ophthalmic and Physiological Optics","date":"2026-02-23T22:09:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"ophthalmic-and-physiological-optics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Ophthalmic and Physiological Optics](https://link.springer.com/journal/44402)","snPcode":"44402","submissionUrl":"https://submission.springernature.com/new-submission/44402/3?","title":"Ophthalmic and Physiological Optics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"35da22ab-7cab-4d51-b2df-003ff1efa8c1","owner":[],"postedDate":"March 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-12T23:07:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-12 23:07:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8950954","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8950954","identity":"rs-8950954","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}