Contact lens & anterior eye : the journal of the British Contact Lens Association · 2026
Longitudinal rebalancing of axial length asymmetry in anisometropic children under orthokeratology: a large-scale cohort study.
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Huang Kaiyan, Wang Lili, Ma Runting, Han Mengya, Chen Weiyin, Lei Xingyu, Hu Yin, Yang Xiao
Аннотация
PURPOSE: To characterize longitudinal changes in axial length (AL) in anisometropic children undergoing orthokeratology, focusing on eye-specific elongation and change in inter-ocular AL difference (IALD).
METHODS: This retrospective longitudinal study included 79,409 visits from 9,978 orthokeratology-treated children (8,133 isometropic, 1,845 anisometropic). Propensity score-matched (PSM) subsets were constructed for the more-myopic (PSM1, n = 3,682) and less-myopic eyes (PSM2, n = 2,326). Linear mixed-effects models based on the full cohort estimated AL changes and their associations with baseline inter-ocular spherical equivalent refraction (SER) difference, adjusting for age, gender, axial length, and corneal curvature.
RESULTS: After matching, anisometropic children exhibited modestly slower axial elongation than isometropic controls in both eyes (more-myopic: 0.093 ± 0.156 vs. 0.110 ± 0.158 mm/year; less-myopic: 0.133 ± 0.156 vs. 0.146 ± 0.161 mm/year; both P < 0.05). Linear mixed‑effects models revealed a dose‑dependent rebalancing effect: each 1‑D increase in baseline inter‑ocular SER difference was associated with 0.020 mm less annual elongation in the more‑myopic eye and 0.016 mm more in the less‑myopic eye (both P < 0.001), leading to a faster reduction in IALD (β = - 0.036 mm/year per D; P < 0.001). Younger age and a smaller initial IALD predicted successful isometropic conversion (defined as achieving an IALD < 0.4 mm), a group which exhibited markedly faster IALD reduction than those with persistent anisometropia (-0.081 vs. - 0.030 mm/year; P < 0.001).
CONCLUSIONS: In anisometropic children undergoing orthokeratology, greater baseline anisometropia was associated with an asymmetric pattern of axial growth, characterised by stronger suppression in the more-myopic eye and comparatively less suppression in the less-myopic eye. This anisometropia-dependent modulation was associated with an accelerated reduction in the inter‑ocular AL difference, suggesting that orthokeratology facilitates progressive inter‑ocular convergence in children with higher baseline anisometropia. The treatment-driven heterogeneity and age-dependent sensitivity highlight a critical window for early clinical intervention.
METHODS: This retrospective longitudinal study included 79,409 visits from 9,978 orthokeratology-treated children (8,133 isometropic, 1,845 anisometropic). Propensity score-matched (PSM) subsets were constructed for the more-myopic (PSM1, n = 3,682) and less-myopic eyes (PSM2, n = 2,326). Linear mixed-effects models based on the full cohort estimated AL changes and their associations with baseline inter-ocular spherical equivalent refraction (SER) difference, adjusting for age, gender, axial length, and corneal curvature.
RESULTS: After matching, anisometropic children exhibited modestly slower axial elongation than isometropic controls in both eyes (more-myopic: 0.093 ± 0.156 vs. 0.110 ± 0.158 mm/year; less-myopic: 0.133 ± 0.156 vs. 0.146 ± 0.161 mm/year; both P < 0.05). Linear mixed‑effects models revealed a dose‑dependent rebalancing effect: each 1‑D increase in baseline inter‑ocular SER difference was associated with 0.020 mm less annual elongation in the more‑myopic eye and 0.016 mm more in the less‑myopic eye (both P < 0.001), leading to a faster reduction in IALD (β = - 0.036 mm/year per D; P < 0.001). Younger age and a smaller initial IALD predicted successful isometropic conversion (defined as achieving an IALD < 0.4 mm), a group which exhibited markedly faster IALD reduction than those with persistent anisometropia (-0.081 vs. - 0.030 mm/year; P < 0.001).
CONCLUSIONS: In anisometropic children undergoing orthokeratology, greater baseline anisometropia was associated with an asymmetric pattern of axial growth, characterised by stronger suppression in the more-myopic eye and comparatively less suppression in the less-myopic eye. This anisometropia-dependent modulation was associated with an accelerated reduction in the inter‑ocular AL difference, suggesting that orthokeratology facilitates progressive inter‑ocular convergence in children with higher baseline anisometropia. The treatment-driven heterogeneity and age-dependent sensitivity highlight a critical window for early clinical intervention.