Cutoff values of axial length/corneal radius ratio for determining myopia vary with age among 3-18 years old children and adolescents

Shang Liu; Jun Chen; Jingjing Wang; Zhuoting Zhu; Junyao Zhang; Bo Zhang; Jinliuxing Yang; Linlin Du; Jianfeng Zhu; Haidong Zou; Xiangui He; Xun Xu

doi:10.1007/s00417-023-06176-0

Cutoff values of axial length/corneal radius ratio for determining myopia vary with age among 3-18 years old children and adolescents

Graefes Arch Clin Exp Ophthalmol. 2024 Feb;262(2):651-661. doi: 10.1007/s00417-023-06176-0. Epub 2023 Aug 14.

Authors

Shang Liu^{1

2}, Jun Chen¹, Jingjing Wang¹, Zhuoting Zhu³, Junyao Zhang³, Bo Zhang¹, Jinliuxing Yang¹, Linlin Du¹, Jianfeng Zhu¹, Haidong Zou^{1

2}, Xiangui He^{4

5}, Xun Xu^{6

7}

Affiliations

¹ Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No.380 Kangding Road, Shanghai, 200040, China.
² Department of Ophthalmology, Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Jiao Tong University School of Medicine, No.100 Haining Road, Shanghai, 200080, China.
³ Centre for Eye Research Australia; Ophthalmology, University of Melbourne, Melbourne, Australia.
⁴ Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No.380 Kangding Road, Shanghai, 200040, China. xianhezi@163.com.
⁵ Department of Ophthalmology, Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Jiao Tong University School of Medicine, No.100 Haining Road, Shanghai, 200080, China. xianhezi@163.com.
⁶ Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No.380 Kangding Road, Shanghai, 200040, China. drxuxun@sjtu.edu.cn.
⁷ Department of Ophthalmology, Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Jiao Tong University School of Medicine, No.100 Haining Road, Shanghai, 200080, China. drxuxun@sjtu.edu.cn.

PMID: 37578514
DOI: 10.1007/s00417-023-06176-0

Abstract

Purpose: To investigate the effectiveness and cutoffs of axial length/corneal radius (AL/CR) ratio for myopia detection in children by age.

Methods: Totally, 21 kindergartens and schools were enrolled. Non-cycloplegic autorefraction (NCAR), axial length (AL), horizontal and vertical meridian of corneal radius (CR1, CR2), and cycloplegic autorefraction were measured. Receiver operating characteristic (ROC) curve was used to obtain the effectiveness and cutoff for myopia detection.

Results: Finally, 7803 participants aged 3-18 years with mean AL/CR ratio of 2.99 ± 0.16 were included. Area under the ROC curve (AUC) of AL/CR ratio for myopia detection (0.958 for AL/CR1, 0.956 for AL/CR2, 0.961 for AL/CR) was significantly larger than that of AL (0.919, all P < 0.001), while AUCs of the three were similar with different cutoffs (> 2.98, > 3.05, and > 3.02). When divided by age, the ROC curves of AL/CR ratio in 3- to 5-year-olds showed no significance or low accuracy (AUCs ≤ 0.823) in both genders. In ≥ 6-year-olds, the accuracies were promising (AUCs ≥ 0.883, all P < 0.001), the cutoffs basically increased with age (from > 2.93 in 6-year-olds to > 3.07 in 18-year-olds among girls, and from > 2.96 in 6-year-olds to > 3.07 in 18-year-olds among boys). In addition, boys presented slightly larger cutoffs than girls in all ages except for 16 and 18 years old. For children aged 3-5 years, AL/CR ratio or AL combined with NCAR increased AUC to > 0.900.

Conclusion: AL/CR ratio provided the best prediction of myopia with age-dependent cutoff values for all but preschool children, and the cutoffs of boys were slightly larger than those of girls. For preschool children, AL/CR ratio or AL combined with NCAR is recommended to achieve satisfactory accuracy. AL/CR ratio calculated by two meridians showed similar predictive power but with different cutoffs.

Keywords: Axial length/corneal radius ratio; Children; Cutoff value; Myopia detection.

MeSH terms

Adolescent
Child
Child, Preschool
Cornea
Female
Humans
Male
Mydriatics
Myopia* / diagnosis
Radius
Refraction, Ocular*
Vision Tests

Substances

Mydriatics

Abstract

MeSH terms

Substances

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