Abstract / Summary
Purpose: To characterize the distributions of ocular and corneal higher-order aberrations (HOAs) in Chinese school-age children and examine their associations with spherical equivalent (SE), ocular biometry, and refractive status. Methods: This cross-sectional analysis included baseline data from a school-based cohort of Grade 3 students. Ocular and corneal HOAs were measured using the iTrace aberrometer and analyzed over a standardized 5.0-mm diameter. Axial length (AL), mean keratometry (Km), central corneal thickness (CCT), lens thickness (LT), and the axial length-to-corneal radius ratio (AL/CR) were assessed. Noncycloplegic refraction was used to calculate SE. AL/CR was analyzed primarily as a continuous variable, with a secondary categorical comparison using a cutoff of 3.03. Associations were assessed using Spearman rank correlation, and between-group differences using the Mann–Whitney U test. Multiple comparisons were controlled using the Benjamini–Hochberg false discovery rate (FDR) procedure. Results: A total of 1326 right eyes from 1326 participants were analyzed. Ocular and corneal Zernike coefficients showed distinct distribution patterns, with primary spherical aberration (Z 4 0 ) being positive in 97.44% of corneal measurements compared with 59.95% of ocular measurements. After FDR correction, 24 correlations remained statistically significant. Ocular Z 4 0 was negatively correlated with SE and AL and positively correlated with Km, CCT, LT, and AL/CR, with all six associations remaining significant after FDR correction. The correlation magnitudes were modest (absolute ρ ≤ 0.222). The myopia versus non-myopia difference in ocular Z 4 0 was nominally significant ( P = 0.031) but did not remain significant after FDR correction (FDR-adjusted P = 0.558); a sensitivity analysis excluding borderline SE values showed the same directional pattern but likewise did not remain significant after correction (FDR-adjusted P = 0.072). In the secondary AL/CR-based categorical analysis, only ocular Z 4 0 remained significant after FDR correction (FDR-adjusted P < 0.001; r = 0.119). Conclusions: Ocular and corneal HOAs showed distinct distribution patterns in school-age children, and selected HOA components were significantly associated with refractive and ocular biometric characteristics. Ocular Z 4 0 showed significant associations with multiple continuous refractive and biometric parameters after FDR correction. The refractive-status comparison showed a directionally consistent pattern that did not remain significant after correction, whereas the secondary AL/CR-based analysis identified a significant between-group difference in ocular Z 4 0 .