What question did this study set out to answer?

To explore how retinal curvature and choroidal thickness relate to rapid axial growth in children.

March 16, 2026Open Access

Concomitant Associations of Rapid Axial Growth with Retinal Curvature and Dominant Distribution Patterns of Choroidal Thickness in Children

AWAnqi WangTianjin Medical University Eye Hospital KAKadiya AbudukeyimuTianjin Medical University Eye Hospital HHHaoran HeTianjin Medical University Eye Hospital

Key Points

To explore how retinal curvature and choroidal thickness relate to rapid axial growth in children.
Conducted a retrospective cohort study with 469 children.
Utilized swept-source OCTA to measure regional choroidal thickness and retinal curvature.
Applied principal component analysis to identify choroidal thickness patterns.
Defined rapid axial growth as an increase in axial length greater than 0.025 mm monthly.
Employed multivariable logistic regression and ROC analysis for data interpretation.
Rapid axial growth was linked to increased nasal mid-peripheral retinal curvature.
A temporal-dominant choroidal thickness distribution was associated with lower odds of rapid growth.
The combined model provided an AUC of 0.723, indicating strong discriminative power.
Findings were consistent across different refractive error subgroups (myopic, emmetropic, hyperopic).

Abstract

• Rapid axial growth correlates with increased nasal mid-peripheral retinal curvature and reduced temporal-dominant CT distribution. • Nasal mid-peripheral (3 - 6 mm) RC is the strongest risk factor for rapid pediatric axial growth; temporal-dominant CT distribution is protective. • Combined model (AUC=0.723) outperforms single parameters, providing clinically meaningful incremental discriminative value. • The model exhibits stable efficacy across myopic, emmetropic, and hyperopic subgroups. To investigate the spatial distribution of choroidal thickness (CT) and retinal curvature (RC) in children, and their independent/synergistic associations with rapid axial growth. This retrospective cohort study included 469 children. Swept-source OCTA (SS-OCTA) quantified regional CT/RC; principal component analysis (PCA) extracted CT spatial patterns. Rapid axial growth was defined as a monthly axial length (AL) increase >0.025 mm. Multivariable logistic regression and ROC analysis were performed. Eyes with rapid growth showed thinner CT and steeper RC, predominantly in the nasal mid-periphery (3–9 mm). The temporal-dominant choroidal thickness distribution pattern was independently associated with lower odds of rapid axial elongation, while increased nasal mid-peripheral RC showed a strong discriminative association with rapid axial growth. The combined model exhibited improved discriminative performance (AUC=0.723; 95% CI, 0.676–0.769), consistent across myopic, emmetropic, and hyperopic subgroups. Increased nasal mid-peripheral RC and reduced temporal-dominant CT distribution are synergistic features of rapid pediatric axial growth. SS-OCTA-derived metrics provide incremental value beyond static measurements, supporting imaging-based risk stratification. Quantitative assessment of retinal and choroidal topography may help identify children with accelerated axial growth patterns, supporting proactive refractive management.

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