Abstract
BackgroundWith increasing axial length and myopia progression, the micro-structure of the retina and choroid gradually changes. Our study describes the longitudinal changes in retinal and choroidal thickness in school-aged children with myopia and explores the relationship between changes in choroidal thickness and myopia progression.MethodsAn exploratory analysis of a randomized trial was performed. Children (n = 168, aged 7 to 12 years) with myopia from − 0.75 dioptre (D) to − 4.00 D were enrolled in this prospective longitudinal study. Cycloplegic refraction, axial length (AL), retinal and choroidal thicknesses were measured at baseline and at 1- and 2-year follow-ups. “Rapid progression myopia” was defined as increasing in myopia > 1.00 D and “stable progression myopia” was ≤ 1.00 D during the 2-year follow-up. Factors affecting the changes in choroidal thickness were analysed using linear mixed models.ResultsAL significantly increased by 0.67 ± 0.24 mm with a myopic shift of − 1.50 ± 0.64 D over the 2 years. The overall retinal thickness increased from 251.12 ± 15.91 µm at baseline to 253.47 ± 15.74 µm at the 2-year follow-up (F = 23.785, P < 0.001). The subfoveal choroidal thickness decreased from 231.03 ± 54.04 µm at baseline to 206.53 ± 59.71 µm at the 2-year follow-up (F = 73.358, P < 0.001). Choroidal thinning was significantly associated with AL elongation (β = − 43.579 μm/mm, P = 0.002) and sex (β = − 17.258, P = 0.001). Choroidal thickness continued to decrease in subjects with rapid progression (F = 92.06, P < 0.001) but not in those with steady progression (F = 2.23, P = 0.119).ConclusionSignificant choroidal thinning was observed and was associated with rapid progression and sex. These findings indicate a need to understand the role of the choroid in eye growth and myopia development.Synopsis/PrecisThe macular choroidal thickness of myopic children is relevant to different degrees of myopic progression in this 2-year longitudinal study. These findings suggest that control of choroidal thickness might work to regulate human ocular growth.Trial registration Chinese Clinical Trial Register (ChiCTR): ChiCTR-INR-16007722
Highlights
With increasing axial length and myopia progression, the micro-structure of the retina and choroid gradually changes
This study was a part of the Personalized Addition Lenses Clinical Trials (PACT) [31], which was a randomized clinical trial to determine if myopia progression is different between children wearing personalized progressive addition lenses (PPALs) versus + 2.00 D fixed progressive addition lenses (FPALs) or single vision lenses (SVLs)
The characteristics of retinal and choroidal thickness changes in myopic schoolchildren have not been clearly described. This longitudinal study included a large sample of myopic children to observe the morphological changes in retinal and choroidal thickness that correlated with changes in spherical equivalent of refraction (SER) and axial length (AL) over 2 years
Summary
With increasing axial length and myopia progression, the micro-structure of the retina and choroid gradually changes. Zhou and colleagues found that changes in CT were positively correlated with changes in choroidal blood flow in guinea pig myopia [14] and increased choroidal blood flow attenuates scleral hypoxia as well as inhibits myopia development [15]. Clinical studies found significantly decreased CT and choroidal blood perfusion after near work, which is a risk factor for myopia [16,17,18]. Such decreased choroidal blood perfusion might cause scleral hypoxia
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