Normative data and percentile curves for axial length and axial length/corneal curvature in Chinese children and adolescents aged 4-18 years

Xiangui He; Padmaja Sankaridurg; Thomas Naduvilath; Jingjing Wang; Shuyu Xiong; Rebecca Weng; Linlin Du; Jun Chen; Haidong Zou; Xun Xu

doi:10.1136/bjophthalmol-2021-319431

Normative data and percentile curves for axial length and axial length/corneal curvature in Chinese children and adolescents aged 4-18 years

Br J Ophthalmol. 2023 Feb;107(2):167-175. doi: 10.1136/bjophthalmol-2021-319431. Epub 2021 Sep 16.

Authors

Xiangui He^{1

2

3}, Padmaja Sankaridurg^{4

5}, Thomas Naduvilath^{6

5}, Jingjing Wang^{1

2

3}, Shuyu Xiong^{1

2

3}, Rebecca Weng⁶, Linlin Du^{1

2

3}, Jun Chen^{1

2

3}, Haidong Zou^{1

2

3}, Xun Xu^{7

2

3}

Affiliations

¹ Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China.
² Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Center of Eye Shanghai Key Laboratory of Ocular Fundus Disease, Shanghai, China.
³ National Clinical Research Center for Eye Diseases, Shanghai, China.
⁴ Brien Holden Vision Institute, Sydney, New South Wales, Australia p.sankaridurg@bhvi.org drxuxun@sjtu.edu.cn.
⁵ School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.
⁶ Brien Holden Vision Institute, Sydney, New South Wales, Australia.
⁷ Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China p.sankaridurg@bhvi.org drxuxun@sjtu.edu.cn.

Abstract

Purpose: To develop age-specific and gender-specific reference percentile charts for axial length (AL) and AL/corneal radius of curvature (AL/CR) and, to use percentiles to determine probability of myopia and estimate refractive error (RE).

Methods: Analysis of AL, cycloplegic RE and CR of 14 127 Chinese participants aged 4-18 years from 3 studies. AL and AL/CR percentiles estimated using Lambda-Mu-Sigma method and compared for agreement using intraclass correlation (ICC). Logistic regression was used to model risk of myopia based on age, gender, AL and AL/CR percentiles. Accuracy of AL progression and RE estimated using percentiles was validated using an independent sample of 5742 eyes of children aged 7-10 years.

Results: Age-specific and gender-specific AL and AL/CR (3rd, 5th, 10th, 25th, 50th, 75th, 90th and 95th) percentiles are presented. Concordance between AL and AL/CR percentiles improved with age (0.13 at 4 years to >0.75 from 13 years) and a year-to-year change was observed for all except <10th percentile from 15 years. Increasing age, AL and AL/CR was associated with a more myopic RE (r²=0.45,0.70 and 0.83, respectively). The sensitivity and specificity of the model to estimate probability of myopia was 86.0% and 84.5%, respectively. Estimation of 1-year change in AL using percentiles correlated highly with actual AL (ICC=0.98). Concordance of estimated to actual RE was high (ICC=0.80) and within ±0.50D and ±1.0D of actual RE for 47.4% and 78.9% of eyes, respectively.

Conclusion: Age-specific and gender-specific AL and AL/CR percentiles provide reference data, aid in identifying and monitoring individuals at risk of myopia and have utility in screening for myopia. AL/CR percentiles were more accurate in estimating probability of myopia in younger children.

Keywords: diagnostic tests/investigation; embryology and development; epidemiology; optics and refraction; public health.

MeSH terms

Adolescent
Child
Cornea
East Asian People
Humans
Myopia* / diagnosis
Myopia* / epidemiology
Refraction, Ocular*
Vision Tests