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Factors Influencing Refractive Severity and Visual Improvement in Pediatric Unilateral High Myopia With Myelinated
Ming-Rui Jin1, Jing-Hua Liu, Zhe Pan
1Beijing Tongren Eye Center (M.-R.J., J.-H.L., H.L., S.-F.L., G.-D.D., J.M., M.-Z.Y., X.-J.M., D.W., Y.-Y.Y., S.-M.B., C.-X.Z., Y.-H.J.), Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China; Tongren Eyecare (L.-Z.L.), Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Visual Science and Translational Eye Research Institute (BERI) (Z.P.), Beijing Tsinghua Changgung Hospital Eye Center, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China; and Department of Ophthalmology (X.-L.Y.), Dezhou Municipal Hospital, Dezhou, Shandong, China.
Objectives:
To investigate factors influencing refractive error severity and visual improvement in children with unilateral high myopia and myelinated retinal nerve fibers (MRNF).
Methods:
Thirty-six children (12 years and younger) with unilateral high myopia (spherical equivalent [SE] ≤ -6.0 D) and MRNF were prospectively enrolled. Twenty-two received rigid gas-permeable (RGP) contact lenses and 14 spectacles; all underwent occlusion therapy. Myelinated retinal nerve fiber features-including optic disc quadrant involvement, myelin-over-disc ratio, MRNF area, and fovea-to-myelination distance (Df-m)-were evaluated from fundus images. Best-corrected visual acuity (BCVA) change at one year was assessed.
Results:
Mean age was 5.2±2.4 years. Affected eyes had a mean SE of -10.01±2.80 D and baseline BCVA of 1.33±0.35 logMAR. Spherical equivalent severity correlated negatively with myelin-over-disc ratio, MRNF area, and Df-m (P<0.05). Mean BCVA improvement at 1 year was 0.65±0.32 logMAR, positively correlated with baseline SE and final BCVA, and negatively with optic disc quadrant involvement, myelin-over-disc ratio, MRNF area, and Df-m. Patients fitted with RGP lenses achieved significantly greater visual improvement than those with spectacles (P<0.001).
Conclusion:
Extensive MRNF involvement predicted more severe myopia and poorer recovery. Early amblyopia therapy, particularly with RGP lenses, achieved significant visual benefits.
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