Short-Term Axial Length Changes Predict Progression of Myopic Maculopathy in Pediatric High Myopia.

Abstract

To characterize changes in long-term myopic maculopathy (MM) progression and to investigate short-term axial length (AL) and spherical equivalent (SE) changes as predictors for long-term MM progression in highly myopic children and adolescents. Prospective cohort study. A total of 310 eyes from 155 highly myopic individuals aged 7 to 17 years with an 8-year follow-up. Ocular examinations were performed every two years. MM was classified according to the Meta-PM system. Logistic regression models with generalized estimating equations were used to identify predictors of MM progression. Internal validation was performed using bootstrap resamples. Two-year changes of AL and SE to predict 8-year MM progression. Over 8 years, 31.29% of eyes showed MM progression. A total of 97 participants demonstrated 112 lesion changes, with the most common being the new appearance of tessellated fundus (44.64%). Multivariable models demonstrated that combination of baseline AL (odds ratio [OR] = 1.62; 95% confidence interval [CI]: 1.15-2.28, P = .005) and 2-year AL change rate (OR = 1.62; 95% CI: 1.27-2.07, P < .001) provided superior predictive performance for long-term MM progression compared to baseline AL alone (OR = 1.52, 95% CI: 1.13-2.05, P = .006), after adjustment for age and pathologic myopia (PM). The area under the receiver operating characteristic curve (AUC) values were 0.829 (combined model) and 0.772 (baseline AL-only model), respectively (P = .013). Similarly, the model incorporating baseline SE (OR = 0.83; 95% CI, 0.73-0.96; P = .011) and 2-year SE change rate (OR = 0.44; 95% CI, 0.22-0.88; P = .020) achieved a higher AUC (0.793) than the baseline SE model (AUC = 0.764; P = .039) following adjustment for age and PM. The predictive model demonstrated an optimism-corrected AUC of 0.821 based on bootstrap internal validation. The optimal cut-off value for the 2-year AL change rate, determined by maximizing Youden's Index, was 0.325 mm/year. Nearly one-third of pediatric high myopes experienced MM progression over 8 years. Short-term changes in AL could predict MM progression with high accuracy, highlighting the importance of early risk identification and timely intervention in high-risk children.