Clinical & experimental optometry · 2025
Correlation between axial length and refractive error in emmetropic and myopic Iraqi adults.
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Aljaberi Hassan A, Rahmani Saeed, Elzahra Zainab A
Аннотация
CLINICAL RELEVANCE: Integrating axial and anterior-segment measures, along with quadratic prediction and odds-based models, can support diagnosis, risk stratification, and management.
BACKGROUND: The aim of this work is to quantify the axial length (AL) - spherical equivalent (SE) relationship in Iraqi adults, assess sex differences within refractive categories, and develop prediction and risk models.
METHODS: Cross-sectional study of 2,948 eyes (18-33 years) at a university eye-care clinic (Feb - May 2025). SE was measured by non-cycloplegic autorefraction (Nidek ARK-1) and AL by SS-OCT biometry (ZEISS IOL-Master 700). Refractive groups were emmetropia (-0.50 D < SE ≤ +0.50 D), mild myopia (-0.50 to -3.00 D), and moderate myopia (-3.25 to -6.00 D). Group differences were analysed with t-tests/ANOVA. Sex-stratified, within-category SE was examined with equivalence testing (TOST; ±0.25 D). Ordinary least-squares models predicted AL from SE and SE2, and SE from AL and AL2, adjusting for age and sex. Logistic regression mapped AL to odds of any myopia versus emmetropia and of moderate versus emmetropia plus mild; discrimination was evaluated by the ROC/AUC.
RESULTS: Mean SE was +0.11 ± 0.29 D in emmetropia and -3.25 ± 1.67 D in myopia; mean AL 23.33 ± 0.60 mm and 26.03 ± 1.17 mm, respectively. AL differed across categories (p < 0.001). Females had longer AL within emmetropia (≈0.57 mm) and within mild - moderate myopia (≈0.70 mm; both p < 0.001), while SE was equivalent by TOST. The AL - SE association was range dependent: strong and negative in emmetropia/mild myopia (R2 ≈ 0.83) and weaker in moderate myopia (R2 ≈ 0.45). Quadratic models improved prediction (adjusted R2 ≈ 0.936 for AL; ≈ 0.934 for SE; RMSE 0.42 mm and 0.54 D). Longer AL significantly increased the odds of myopia after adjustment.
CONCLUSION: AL closely tracks refractive status with range-dependent coupling. Females show longer AL without SE shifts, implying anterior segment compensation.
BACKGROUND: The aim of this work is to quantify the axial length (AL) - spherical equivalent (SE) relationship in Iraqi adults, assess sex differences within refractive categories, and develop prediction and risk models.
METHODS: Cross-sectional study of 2,948 eyes (18-33 years) at a university eye-care clinic (Feb - May 2025). SE was measured by non-cycloplegic autorefraction (Nidek ARK-1) and AL by SS-OCT biometry (ZEISS IOL-Master 700). Refractive groups were emmetropia (-0.50 D < SE ≤ +0.50 D), mild myopia (-0.50 to -3.00 D), and moderate myopia (-3.25 to -6.00 D). Group differences were analysed with t-tests/ANOVA. Sex-stratified, within-category SE was examined with equivalence testing (TOST; ±0.25 D). Ordinary least-squares models predicted AL from SE and SE2, and SE from AL and AL2, adjusting for age and sex. Logistic regression mapped AL to odds of any myopia versus emmetropia and of moderate versus emmetropia plus mild; discrimination was evaluated by the ROC/AUC.
RESULTS: Mean SE was +0.11 ± 0.29 D in emmetropia and -3.25 ± 1.67 D in myopia; mean AL 23.33 ± 0.60 mm and 26.03 ± 1.17 mm, respectively. AL differed across categories (p < 0.001). Females had longer AL within emmetropia (≈0.57 mm) and within mild - moderate myopia (≈0.70 mm; both p < 0.001), while SE was equivalent by TOST. The AL - SE association was range dependent: strong and negative in emmetropia/mild myopia (R2 ≈ 0.83) and weaker in moderate myopia (R2 ≈ 0.45). Quadratic models improved prediction (adjusted R2 ≈ 0.936 for AL; ≈ 0.934 for SE; RMSE 0.42 mm and 0.54 D). Longer AL significantly increased the odds of myopia after adjustment.
CONCLUSION: AL closely tracks refractive status with range-dependent coupling. Females show longer AL without SE shifts, implying anterior segment compensation.