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Global Axial Length Centile Charts
Sander C M Kneepkens1,2, Gareth Lingham3,4,5, Dirk J van Hemert1,2
1Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands.
JAMA Ophthalmology
|July 16, 2026
Summary
New charts show axial length (AL) differences in children and adolescents by region and sex. These references aid in managing myopia and identifying atypical axial elongation for better eye health.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Myopia is a growing global health concern, with axial elongation being a key driver of vision-threatening complications.
- Accurate axial length (AL) measurements are crucial for myopia management, necessitating population-specific reference data.
Purpose of the Study:
- To develop region- and sex-specific reference centile charts for axial length (AL) in children and adolescents.
- To provide essential data for identifying atypical axial elongation and informing myopia management strategies.
Main Methods:
- A pooled cohort analysis of individual-participant data from population and school-based studies across East Asia, Europe, and Australia.
- Included 147,404 children and adolescents with 559,799 AL measurements, analyzed from 1999 to 2024.
Main Results:
- Significant variations in AL distributions were observed based on sex and geographic region.
- Modeled centile curves demonstrated a close agreement with empirical values, with minimal bias across subgroups (intraclass correlations >0.99).
Conclusions:
- The developed region- and sex-specific AL centile charts offer valuable reference values for clinical and research applications.
- These charts can support the identification of atypical axial elongation and guide targeted myopia prevention and management strategies.
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