Factors Influencing Refractive Severity and Visual Improvement in Pediatric Unilateral High Myopia With Myelinated Retinal Nerve Fibers.

OBJECTIVES

To investigate factors influencing refractive error severity and visual improvement in children with unilateral high myopia and myelinated retinal nerve fibers (MRNF).

METHODS

Thirty-six children (12 years and younger) with unilateral high myopia (spherical equivalent [SE] ≤ -6.0 D) and MRNF were prospectively enrolled. Twenty-two received rigid gas-permeable (RGP) contact lenses and 14 spectacles; all underwent occlusion therapy. Myelinated retinal nerve fiber features-including optic disc quadrant involvement, myelin-over-disc ratio, MRNF area, and fovea-to-myelination distance (D f-m )-were evaluated from fundus images. Best-corrected visual acuity (BCVA) change at one year was assessed.

RESULTS

Mean age was 5.2±2.4 years. Affected eyes had a mean SE of -10.01±2.80 D and baseline BCVA of 1.33±0.35 logMAR. Spherical equivalent severity correlated negatively with myelin-over-disc ratio, MRNF area, and D f-m ( P <0.05). Mean BCVA improvement at 1 year was 0.65±0.32 logMAR, positively correlated with baseline SE and final BCVA, and negatively with optic disc quadrant involvement, myelin-over-disc ratio, MRNF area, and D f-m . Patients fitted with RGP lenses achieved significantly greater visual improvement than those with spectacles ( P <0.001).

CONCLUSION

Extensive MRNF involvement predicted more severe myopia and poorer recovery. Early amblyopia therapy, particularly with RGP lenses, achieved significant visual benefits.