The aim of this study is to analyze the association between ocular biological parameters and the risk of myopia progression in children in Jinhua City of Zhejiang Province, and to explore the application value of combined multi-parameter assessment in predicting the risk of myopia progression.

Clinical data of 9567 children aged 6 to 12 years at baseline who underwent myopia screening and prevention programs in the Jinhua area of Zhejiang Province from January 2014 to December 2023 were collected. Among them, 4872 were boys and 4695 were girls, with a mean age of (8.0±2.0) years (ranging from 6 to 12 years). All participants were followed up for 5 years. Demographic information, ocular biometric parameters, and non-cycloplegic refractive data were obtained. According to the 5-year progression of spherical equivalent (SE), participants were classified into the non-progression group, slow progression group, and rapid progression group. Continuous variables were first tested for normality and further evaluated using histograms and Q-Q plots. Skewed distributions were described as median (interquartile range) and were performed using the Kruskal-Wallis rank-sum test between-group comparisons. Normal distributions were described as ±s and were performed using one-way analysis of variance between-group comparisons. Categorical variables were expressed as number and percentage and compared using the Pearson chi-square test. Myopia progression was performed by Jonckheere-Terpstra trend test, and pairwise comparisons with Bonferroni correction. Univariate and multivariable ordinal logistic regression analyses were performed with myopia progression grade as the dependent variable, and β coefficients, Z values, Wald χ² values, odds ratio (OR), 95% confidence intervals (CI), and P values were calculated. The multivariable model included baseline age, BMI, baseline SE, baseline AL/CR, and baseline IOP. Variance inflation factor (VIF) was used to assess multicollinearity among independent variables.

After correlation analysis, a strong positive correlation was observed between the SE of the left and right eyes in all subjects, with statistical significance (r=0.89, P<0.05). Therefore, the right eye data were used as the primary analysis object in this study. Among of them, the median age was 8.0 (7.0, 9.0) years, the median height was 130.0 (124.0, 140.0) cm, the median body mass was 26.5 (23.0, 32.0) kg, and the median BMI was 15.63 (14.42, 17.36) kg/m². The mean AL, CR, AL/CR, and IOP of all subjects were (23.30±1.07) mm, (7.81±0.25) mm, (2.99±0.13), and (15.23±2.83) mmHg (1 mmHg=0.133 kPa), respectively. The median SE was 0.00 (-1.00, 0.38) D. There were 5458 eyes with emmetropia, 2250 eyes with low myopia, and 1160 eyes with hyperopia, accounting for 57.0%, 24.0%, and 12.0%, respectively. Among of the 9567 participants, there were 767 cases (767 eyes) in the non-progression group, 3359 cases (3359 eyes) in the slow progression group, and 5441 cases (5441 eyes) in the rapid progression group. Kruskal-Wallis tests showed significant overall differences in baseline age, BMI, and SE among the three groups (H=245.07, 20.30, 622.58; P<0.05). One-way analysis of variance showed significant overall differences in baseline AL, CR, AL/CR, and IOP (F=277.14, 10.28, 392.62, 9.70; P<0.05). Jonckheere-Terpstra trend analysis showed that with increasing myopia progression grade, age, BMI, AL, AL/CR, and IOP showed increasing trends, whereas CR and SE showed decreasing trends (Z=15.09, 2.73, 24.11, -4.01, 31.34, 3.92, -20.99; P<0.05). After correction using the Bonferroni method, pairwise comparisons showed that there were statistically significant differences in age, BMI, AL, AL/CR, and SE among the non-progression group, the slow progression group, and the rapid progression group(P<0.05). There was no significant overall difference in sex distribution among the three groups (χ²=2.190, P>0.05). In contrast, refractive status distribution differed significantly overall (χ²=811.670, P<0.05), and all three pairwise comparisons were also significant (χ²=91.05, 312.08, 571.32; P<0.05). Multivariable ordinal logistic regression analysis showed that age and BMI were independent protective factors for myopia progression in the baseline school-age population (OR=0.947, 0.983; 95%CI: 0.919 to 0.976, 0.967 to 0.999; P<0.05), whereas SE, AL/CR, and IOP were independent risk factors for progression to a higher myopia grade (OR=1.177, 712.007, 1.019; 95%CI: 1.124 to 1.232, 399.544 to 1275.193, 1.004 to 1.033; P<0.05). Among them, AL/CR showed the strongest association, and each 0.1 increase in AL/CR was associated with an approximately 93% increase in the risk of progression to a higher myopia grade. Collinearity diagnostics showed that all VIF were <5, indicating no evident multicollinearity.

Multiple ocular biological parameters were closely associated with myopia progression in children and adolescents. Among them, AL/CR was the core indicator for predicting myopia progression, while IOP may serve as an additional reference indicator. A multi-parameter assessment strategy centered on AL/CR may facilitate early identification of individuals at high risk of rapid myopia progression and provide an evidence-based basis for early screening, stratified management, and public health prevention and control of myopia in children and adolescents.