Kneepkens S C M, Vught L van, Polling J R, Klaver C C W, Tideman J W L, Beenakker J W M
Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands; The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
Am J Ophthalmol. 2025 Jun 16. doi: 10.1016/j.ajo.2025.06.013.
Optical solutions that create peripheral myopic defocus in the presence of a clear central image have shown to be effective as myopia treatment. This study investigates whether peripheral refraction measured via MRI and ray tracing can predict myopia progression in children.
A total of 1635 children from the Generation R Study, a population-based birth cohort in Rotterdam, the Netherlands, underwent T2 weighted MRI scanning at age 9 years. At both ages 9 and 14 years, ocular biometry, and cycloplegic autorefraction were assessed. Retinal curvature radii were computed from MRI segmentations using semi-automated, customized image processing algorithms. Individual peripheral refraction profiles were modelled through ray tracing. Horizontal and vertical peripheral refraction was analysed at 50-degrees eccentricity. Relative peripheral refraction (RPR) was calculated by subtracting peripheral refraction from central cycloplegic refraction. Yearly myopia progression was calculated and stratified into quantiles (∆AL), and the effect of RPR on the quantile outcomes was examined using ordinal regression analyses. Predictive performance of RPR on development of myopia was evaluated using ROC-analysis (fast vs slow progressors) and a logistic regression (incident myopia).
At age 9 years, 207/1635 (13%) children had developed myopia. Myopic children had a significantly more hyperopic RPR compared to emmetropic children at all horizontal eccentricities (-1.8±1.8D vs. 0.2±2.1D; P<0.001) and vertical eccentricities (-1.0±1.9D vs. 0.8±2.2D; P<0.001). Higher vertical (OR: 1.08, CI: 1.02-1.14) and horizontal RPR (OR: 1.16, CI: 1.10-1.22) was associated with faster AL progression. Each diopter increase in vertical RPR (OR: 1.10, CI: 1.01-1.20) and horizontal RPR (OR: 1.23, CI: 1.13-1.35) was associated with an increased risk of incident myopia. ROC analysis indicated that RPR had a maximum predictive AUC of 0.77 for identifying fast progressors. Furthermore, MRI data revealed significant interindividual variations in retinal curvature (SD 1 mm), which resulted in clinically relevant peripheral refractive differences exceeding 8D among children with similar axial length and central SE, suggesting that standard defocus strategies may require individualization.
Using this novel approach to calculate peripheral refraction, we provide evidence based on eye shape that peripheral hyperopic refractive error is more pronounced in myopic children and is strongly associated with myopia progression. The significant anatomical variability in retinal radii underscores the need for personalized treatment strategies, which may enhance the efficacy of optical interventions for myopia management.
在存在清晰中央图像的情况下产生周边近视性离焦的光学解决方案已被证明可有效治疗近视。本研究调查了通过磁共振成像（MRI）和光线追踪测量的周边屈光是否能预测儿童近视进展。
来自荷兰鹿特丹基于人群的出生队列“R世代研究”的1635名儿童在9岁时接受了T2加权MRI扫描。在9岁和14岁时，评估眼生物测量和睫状肌麻痹验光。使用半自动定制图像处理算法从MRI分割中计算视网膜曲率半径。通过光线追踪对个体周边屈光剖面进行建模。在50度偏心率下分析水平和垂直周边屈光。通过从中央睫状肌麻痹验光中减去周边屈光来计算相对周边屈光（RPR）。计算每年的近视进展并分层为分位数（∆AL），并使用有序回归分析检查RPR对分位数结果的影响。使用ROC分析（快速进展者与缓慢进展者）和逻辑回归（新发近视）评估RPR对近视发展的预测性能。
9岁时，207/1635（13%）的儿童已患近视。近视儿童在所有水平偏心率（-1.8±1.8D对0.2±2.1D；P<0.001）和垂直偏心率（-1.0±1.9D对0.8±2.2D；P<0.001）下的RPR远视程度明显高于正视儿童。更高的垂直（OR：1.08，CI：1.02 - 1.14）和水平RPR（OR：1.16，CI：1.10 - 1.22）与更快的眼轴长度（AL）进展相关。垂直RPR（OR：1.10，CI：1.01 - 1.20）和水平RPR（OR：1.23，CI：1.13 - 1.35）每增加1屈光度与新发近视风险增加相关。ROC分析表明，RPR在识别快速进展者方面的最大预测AUC为0.77。此外，MRI数据显示视网膜曲率存在显著个体差异（标准差1mm），这导致轴向长度和中央等效球镜度相似的儿童之间临床上相关的周边屈光差异超过8D，表明标准离焦策略可能需要个体化。
使用这种计算周边屈光的新方法，我们基于眼睛形状提供证据表明周边远视性屈光不正在近视儿童中更为明显，并且与近视进展密切相关。视网膜半径的显著解剖学变异性强调了个性化治疗策略的必要性，这可能会提高光学干预治疗近视的疗效。
