Age-indexed cumulative risk of high myopia estimated from axial length and early axial elongation: a 7-year school-based longitudinal cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Purpose: To develop and validate age-indexed models estimating the cumulative risk of high myopia, defined as axial length (AL) ≥ 26.0 mm, using routinely collected ocular biometry, and to evaluate their potential for clinical risk stratification. Methods: This 7-year school-based longitudinal cohort included 7,052 Chinese children aged 6-16 years at baseline who participated in a school-based screening program in Tianjin, China, from 2018 to 2024. Discrete-time survival models with age as the timescale estimated cumulative risk from ages 9 to 18 years. Two models were tested: baseline AL plus sex and baseline AL plus first-year axial elongation (ΔAL) plus sex. Performance was assessed in a participant-level temporal holdout test set using iAUC, iBrier, calibration, and decision-curve analysis, and by school-level internal-external cross-validation using iAUC and iBrier. Results: = 5,245), the AL + ΔAL model outperformed the AL-only model, with higher discrimination [iAUC, 0.919 [95% CI, 0.902-0.933] vs. 0.851 [95% CI, 0.833-0.869]] and lower prediction error [iBrier, 0.074 [95% CI, 0.068-0.081] vs. 0.087 [95% CI, 0.080-0.095]]. Calibration was close to ideal, decision-curve analysis showed clinical net benefit, and school-level validation confirmed stable performance. Conclusions: Routine AL measurement, particularly when combined with early axial elongation, enables accurate age-specific risk estimation of AL-defined high myopia and provides a transparent basis for timely and proportionate myopia-control decisions.
Source: Frontiers in Medicine
Authors: Jing Yang, Hui Li, Bei Du, Desheng Song, Nan Jin, Ruihua Wei
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7219776247