Concomitant associations of rapid axial growth with retinal curvature and dominant distribution patterns of choroidal thickness in children.

PURPOSE: To investigate the spatial distribution of choroidal thickness (CT) and retinal curvature (RC) in children, and their independent/synergistic associations with rapid axial growth.

METHODS

This retrospective cohort study included 469 children. Swept-source OCTA (SS-OCTA) quantified regional CT/RC; principal component analysis (PCA) extracted CT spatial patterns. Rapid axial growth was defined as a monthly axial length (AL) increase >0.025 mm. Multivariable logistic regression and ROC analysis were performed.

RESULTS

Eyes with rapid growth showed thinner CT and steeper RC, predominantly in the nasal mid-periphery (3-9 mm). The temporal-dominant choroidal thickness distribution pattern was independently associated with lower odds of rapid axial elongation, while increased nasal mid-peripheral RC showed a strong discriminative association with rapid axial growth. The combined model exhibited improved discriminative performance (AUC=0.723; 95% CI, 0.676-0.769), consistent across myopic, emmetropic, and hyperopic subgroups.

CONCLUSIONS

Increased nasal mid-peripheral RC and reduced temporal-dominant CT distribution are synergistic features of rapid pediatric axial growth. SS-OCTA-derived metrics provide incremental value beyond static measurements, supporting imaging-based risk stratification. Quantitative assessment of retinal and choroidal topography may help identify children with accelerated axial growth patterns, supporting proactive refractive management.