Abstract / Summary
To investigate the effects of different myopia control interventions on choroidal structural changes in children, and to analyze the relationship between changes in choroidal thickness and choroidal vascularity index (CVI) and axial length growth. This was a single-center, real-world longitudinal follow-up study. A total of 300 eyes from participants aged 6–15 years with myopia who received myopia control management and completed 12 months of follow-up were included. According to the main intervention modality, the participants were divided into five groups: single-vision spectacle lens group, 0.01% atropine eye drops plus single-vision spectacle correction group, myopia-control multifocal soft contact lens group, overnight orthokeratology contact lens group, and defocus spectacle lens group, with 60 eyes in each group. Cycloplegic refraction was performed in all participants at baseline and at the 12-month follow-up, irrespective of age or intervention modality. The 12-month axial length growth, spherical equivalent change, choroidal thickness change, CVI change, and incidence of rapid axial length growth were compared among groups. Correlation analysis, multivariable linear regression, and generalized estimating equation models were used to analyze the associations of choroidal structural changes with axial elongation and rapid axial length growth. During the 12-month follow-up, axial length growth was greatest in the single-vision spectacle lens group (0.409 ± 0.092 mm) and lowest in the overnight orthokeratology contact lens group (0.172 ± 0.096 mm). The axial length growth in the 0.01% atropine eye drops plus single-vision spectacle correction group, myopia-control multifocal soft contact lens group, and defocus spectacle lens group was 0.243 ± 0.078 mm, 0.216 ± 0.077 mm, and 0.218 ± 0.081 mm, respectively, with a statistically significant difference among groups ( P < 0.001). The single-vision spectacle lens group showed the most pronounced decreases in choroidal thickness and CVI, whereas the overnight orthokeratology contact lens group showed a slight increase in choroidal thickness and relatively stable CVI. Multivariable linear regression showed that, compared with the single-vision spectacle lens group, 0.01% atropine, Myopia-control multifocal soft contact lenses, orthokeratology lenses, and defocus spectacle lenses were all associated with lower axial length growth (all P < 0.001), with the largest reduction observed in the overnight orthokeratology contact lens group ( β = -0.157, 95% CI : -0.187 to -0.126). For every 10-µm increase in choroidal thickness, axial length growth decreased by approximately 0.010 mm ( β = -0.010, 95% CI : -0.017 to -0.004, P = 0.002). For every 0.01 increase in CVI, axial length growth decreased by approximately 0.032 mm ( β = -0.032, 95% CI : -0.045 to -0.020, P < 0.001). Correlation analysis showed that both choroidal thickness change and CVI change were negatively correlated with axial length growth, with a numerically larger absolute Pearson correlation coefficient observed for CVI change ( r = − 0.520, P < 0.001) than for choroidal thickness change ( r = − 0.390, P < 0.001). Binomial generalized estimating equation analysis showed that each 0.01 increase in CVI was associated with lower odds of rapid axial length growth ( OR = 0.442, 95% CI : 0.253–0.770, P = 0.004). Compared with single-vision spectacles, 0.01% atropine, Myopia-control multifocal soft contact lenses, orthokeratology lenses, and defocus spectacle lenses were all associated with less axial length growth over 12 months, with orthokeratology lenses showing a relatively greater effect. Effective myopia control interventions were accompanied by smaller decreases in choroidal thickness and CVI. Choroidal structural changes, particularly CVI change, were concurrently associated with axial elongation and rapid axial length growth in children. CVI change may therefore serve as an imaging-based structural correlate of ocular growth and intervention response. However, because CVI change and axial elongation were assessed over the same follow-up interval, the present findings do not establish CVI as an early predictive biomarker for subsequent myopia progression.