AI-based oculomics for trajectory-driven risk stratification of pathologic myopia in paediatric high myopia

To identify early oculomic biomarkers predictive of pathologic myopia (PM) in children with high myopia (HM) and to develop an artificial intelligence (AI)-based model for individualised risk stratification.

This prospective longitudinal study included 375 children with bilateral HM (spherical equivalent ≤ -6.00 dioptres (D)) from the Zhongshan High Myopia Cohort, followed for a median of 15.0 years (IQR, 14.9-15.4; range, 14.7-15.7). Deep learning-based automated retinal vascular phenotyping was applied to fundus photographs and integrated with longitudinal ocular biometry and swept-source optical coherence tomography metrics. Multivariable models identified independent predictors of PM onset and predictive performance was assessed using area under the receiver operating characteristic curve (AUROC). A web-based prediction tool was developed for clinical deployment.

PM developed in 64 children (17.1%). Independent predictors included lower retinal vessel density (OR, 9.69; 95% CI 4.33 to 21.70), reduced fractal dimension (OR, 5.94; 95% CI 3.07 to 11.50), narrower arteriolar and venular calibres (central retinal arteriolar equivalent: OR, 3.44; 95% CI 1.86 to 6.34; central retinal venular equivalent: OR, 4.42; 95% CI 2.24 to 8.71), thinner subfoveal choroid (OR, 2.64; 95% CI 1.56 to 4.45), faster early axial elongation (OR, 1.72; 95% CI 1.17 to 2.50) and accelerated early choroidal thinning (OR, 2.33; 95% CI 1.41 to 3.84). The AI oculomic model achieved excellent discrimination (AUROC, 0.96; 95% CI 0.92 to 1.00), improving to 0.98 (95% CI 0.95 to 1.00) with biometric variables. These predictors were implemented in a publicly accessible risk prediction platform (System for Myopia AI-based Risk Tracking-PM).

PM risk in paediatric HM is detectable early through retinal microvascular architecture and ocular growth dynamics. AI-enabled oculomic profiling offers a scalable approach to early risk stratification, supporting targeted surveillance and timely prevention of sight-threatening pathology.