Choroidal structural and perfusion characteristics across refractive groups in children

To characterize choroidal structural and perfusion changes in children with emmetropia, low myopia, and moderate myopia using enhanced depth imaging optical coherence tomography (EDI-OCT) and optical coherence tomography angiography (OCTA), and to examine their associations with spherical equivalent refraction (SER) and axial length (AL).

In this retrospective cross-sectional study, the clinical records and OCT/OCTA images of 140 children aged 8-14 years (140 right eyes) examined at the Ophthalmology Outpatient Department of the Affiliated Hospital of Inner Mongolia Medical University between October 2024 and October 2025 were reviewed. Participants were classified into emmetropia (30 eyes), low myopia (70 eyes), and moderate myopia (40 eyes) groups according to cycloplegic SER. EDI-OCT was used to measure choroidal thickness (CT), Haller layer thickness (HLT), Sattler's layer-choriocapillaris complex thickness (SLCCT), stromal area (SA), luminal area (LA), total choroidal area (TCA), and choroidal vascularity index (CVI). OCTA was used to quantify full choroidal perfusion density (FCPD), choriocapillaris perfusion ratio (CCPR), choriocapillaris flow-deficit percentage (CCFD), number of choriocapillaris flow deficits (CCFDN), and total choriocapillaris flow-deficit area (CCFDA). Correlations between imaging parameters and SER or AL were analyzed.

CT decreased significantly with increasing myopia severity at all measured macular locations. This reduction was driven mainly by thinning of Haller's layer, whereas changes in SLCCT were smaller and more regionally restricted. Area-based analysis showed significant reductions in LA and TCA in the full-thickness choroid; sublayer analysis showed reduced LA and TCA in Haller's layer and reduced SA and TCA in the Sattler's layer-choriocapillaris complex. No significant between-group differences were observed in OCTA-derived perfusion or flow-deficit parameters. OCT-derived structural parameters were positively correlated with SER and negatively correlated with AL. Among OCTA-derived parameters, FCPD was correlated with SER, whereas CCPR, CCFD, and CCFDA showed weak correlations with AL.

In school-aged children, increasing myopia severity was associated mainly with choroidal structural changes, including thinning of the total choroid, predominant involvement of Haller's layer, and reductions in choroidal area-related parameters. OCTA-derived perfusion parameters showed no significant between-group differences, although limited associations with SER and AL were observed. These findings suggest that structural OCT-based metrics may better reflect early choroidal changes across refractive groups in children than OCTA-derived perfusion parameters.