Axial length/corneal radius ratio for the diagnosis of myopia in children and adolescents: a meta-analysis.

CLINICAL RELEVANCE: Accurate and objective tools for myopia screening in children and adolescents are crucial to retard progression and avert vision-endangering complications.

BACKGROUND

This study aims to investigate the diagnostic performance of the axial length/corneal radius (AL/CR) ratio for myopia in children and adolescents.

METHODS

The literature search encompassed major electronic databases, key academic websites, and grey literature from inception to April 2025. Inclusion criteria were restricted to studies evaluating the diagnostic accuracy of AL/CR for myopia, with spherical equivalent (SE) ≤ -0.50 D as the gold standard for myopia diagnosis. The meta-analysis adhered to the Cochrane Handbook guidelines and PRISMA reporting standards.

RESULTS

A total of 9 studies involving 24,030 children and adolescents were included in the meta-analysis. The summary sensitivity, specificity, and area under the curve of AL/CR for diagnosing myopia were 0.88 [95% CI: 0.86-0.90], 0.89 [95% CI: 0.86-0.91], and 0.93 [95% CI: 0.91-0.95], respectively. Meta-regression analysis revealed that the sensitivity of AL/CR remained independent of sample size, SE, myopia prevalence, age, or recruitment setting (school-based vs. hospital-based) (all p > 0.05). Notably, increased diagnostic specificity was significantly associated with older age (p = 0.01). The combination of AL/CR with non-cycloplegic autorefraction demonstrated significantly higher sensitivity and specificity in detecting myopia compared to AL/CR alone (Sensitivity: 0.93 [95% CI: 0.92-0.95] VS 0.88 [95% CI: 0.86-0.90]; Specificity: 0.94 [95% CI: 0.94-0.95] VS 0.89 [95% CI: 0.86-0.91]). AL/CR cut-off value exhibited significant correlations with age.

CONCLUSION

AL/CR ratio demonstrates robust diagnostic efficacy for myopia in paediatric and adolescent populations, particularly when utilised in conjunction with non-cycloplegic autorefraction. However, the selection of age-specific AL/CR cut-off points is essential to maximise diagnostic precision.