Application of spot vision screening combined with axial length measurement for early identification of myopia risk in Chinese Young children

Purpose To evaluate the efficacy of Spot vision screening combined with axial length measurement for early identification of myopia risk in Chinese Young children. Methods This cross-sectional study included 210 children aged 3–8 years, classified into a Myopia Risk Group [cycloplegic spherical equivalent, cycloplegic spherical equivalent (SE) ≤ +0.75 D] and a Sufficient Hyperopia Reserve Group (SE > +0.75 D). All participants underwent comprehensive examinations including axial length, anterior chamber depth (ACD), Spot vision screening, auto-refraction, and cycloplegic refraction. Results The Myopia Risk Group was significantly older and had a higher prevalence of parental myopia history. They also exhibited significantly longer axial length, deeper ACD, higher intraocular pressure, and higher best-corrected visual acuity. Refractive measurements from both the Spot screener and auto-refractor showed significantly lower spherical power, cylindrical power, and spherical equivalent values in the Myopia Risk Group (all P < 0.05). Multivariable analysis identified axial length as an independent risk factor (OR = 4.73, P = 0.002). Spot SE showed a strong correlation with cycloplegic SE (r = 0.85, P < 0.001) and demonstrated excellent predictive value for myopia risk (AUC = 0.931). The combination of axial length and Spot SE achieved an AUC of 0.956 for identifying children at risk of myopia. Conclusion The combination of Spot vision screening and axial length measurement effectively identifies young children at risk for myopia, supporting its use in early screening programs.