Interocular Comparison of Refractive Development in Children With Unilateral Traumatic Optic Neuropathy.

PURPOSE: To characterize interocular refractive development in children with unilateral traumatic optic neuropathy (TON) and evaluate the effect of visual loss severity on myopia progression.

METHODS

This retrospective, longitudinal, self-controlled cohort included 21 children (18 boys) aged 3 to 15 years with unilateral TON, each having ≥2 cycloplegic spherical equivalent refractions (SERs) at least 6 months apart. Both eyes were analyzed, and TON eyes were stratified by baseline best-corrected visual acuity (BCVA) into no light perception (NLP) and better than NLP. Longitudinal SER trajectories were examined using linear mixed-effects models with subject-specific random intercepts and time slopes. Model 1 included Eye (TON versus fellow), Time (years since injury), Eye × Time, and baselineSER; model 2 additionally incorporated BCVA and interactions of Time with BCVA and baselineSER.

RESULTS

Mean age at injury was 11.29 ± 3.20 years, and mean follow-up was 2.94 ± 1.66 years. The Eye × Time coefficient was 0.250 D/y (95% confidence interval [CI], 0.170-0.330; P < 0.001), indicating significantly slower myopic progression in TON eyes. The Time × BCVA effect (0.195 D/y; 95% CI, 0.005-0.384; P = 0.044) indicated a flatter (less negative) myopic trajectory in NLP eyes.

CONCLUSIONS

In pediatric unilateral TON, the injured eye shows markedly slowed and, in severe cases, nearly arrested myopic progression compared with the fellow eye, supporting a key modulatory role of postretinal visual input in refractive development.

TRANSLATIONAL RELEVANCE: Unilateral TON provides a human model linking optic nerve integrity to refractive development and highlights the fellow eye as a high-risk target for myopia monitoring and control.