Effect of spectacle correction on visual development and axial length in children with moderate to high astigmatism: a nested cohort study
- 1Beijing Key Laboratory of Ophthalmology & Vision Sciences, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- 2Department of Ophthalmology, Beijing United Family Hospital and Clinics, Beijing, China
- 3Anyang Eye Hospital, Anyang, China
Abstract
Background: To investigate the impact of spectacle correction on visual development and axial length (AL) in children with moderate to high astigmatism.
Methods: A nested cohort study analyzed 82 first-grade students (age: 7.13 ± 0.36 years) with cylindrical power ≥ 1.25 diopters (D) and best corrected visual acuity (BCVA) ≤ 0.1 (logMAR) from the Anyang Childhood Eye Study. Uncorrected visual acuity (UCVA), BCVA, cycloplegic autorefraction and AL were measured at baseline, 1-year and 2-year follow-up. Based on whether parents provided spectacle correction for their children, children were categorized into the spectacles group (n = 17) and non-spectacles group (n = 65), which was stratified into tertiles by cylindrical power (C): 1.25 D ≤ C < 1.50 D (n = 18), 1.50 D ≤ C < 1.75 D (n = 21), C ≥ 1.75 D (n = 26).
Results: Compared to the non-spectacles group, the spectacles group exhibited a significantly greater myopic shift in spherical equivalent refraction (P = 0.006) and longer AL (P < 0.05) by the 2-year follow-up. Conversely, the non-spectacles group demonstrated a significant reduction in cylindrical power (P < 0.001) and improvement in UCVA (P = 0.013). Longitudinal analysis of the non-spectacles subgroups revealed a significant emmetropization in SER and axial elongation over the 2-year period (all P < 0.05), with no significant inter-group deviations among the three subgroups (P > 0.05). However, higher baseline astigmatism was significantly associated with worse BCVA at the 2-year follow-up (P = 0.014).
Conclusions: For school-aged children with moderate to high astigmatism and normal baseline BCVA (≤ 0.1 logMAR), the absence of spectacle correction may not impede visual development or accelerate axial elongation. Clinical decision-making should prioritize individualized assessment of visual demands and symptoms, rather than relying solely on cylindrical power.
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BibTeX
@article{huang2026effect,
title = {{Effect of spectacle correction on visual development and axial length in children with moderate to high astigmatism: a nested cohort study}},
author = {Ying Huang and Congying Li and Lei Li and He Li and Yongfang Tu and Mengtian Kang and Ningli Wang and Shi-Ming Li},
journal = {BMC Ophthalmology},
year = {2026},
month = jul,
doi = {10.1186/s12886-026-05140-w},
url = {https://doi.org/10.1186/s12886-026-05140-w},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Effect of spectacle correction on visual development and axial length in children with moderate to high astigmatism: a nested cohort study
AU - Ying Huang
AU - Congying Li
AU - Lei Li
AU - He Li
AU - Yongfang Tu
AU - Mengtian Kang
AU - Ningli Wang
AU - Shi-Ming Li
PY - 2026
DA - 2026/07/29
JO - BMC Ophthalmology
DO - 10.1186/s12886-026-05140-w
UR - https://doi.org/10.1186/s12886-026-05140-w
AB - Background: To investigate the impact of spectacle correction on visual development and axial length (AL) in children with moderate to high astigmatism. Methods: A nested cohort study analyzed 82 first-grade students (age: 7.13 ± 0.36 years) with cylindrical power ≥ 1.25 diopters (D) and best corrected visual acuity (BCVA) ≤ 0.1 (logMAR) from the Anyang Childhood Eye Study. Uncorrected visual acuity (UCVA), BCVA, cycloplegic autorefraction and AL were measured at baseline, 1-year and 2-year follow-up. Based on whether parents provided spectacle correction for their children, children were categorized into the spectacles group (n = 17) and non-spectacles group (n = 65), which was stratified into tertiles by cylindrical power (C): 1.25 D ≤ C < 1.50 D (n = 18), 1.50 D ≤ C < 1.75 D (n = 21), C ≥ 1.75 D (n = 26). Results: Compared to the non-spectacles group, the spectacles group exhibited a significantly greater myopic shift in spherical equivalent refraction (P = 0.006) and longer AL (P < 0.05) by the 2-year follow-up. Conversely, the non-spectacles group demonstrated a significant reduction in cylindrical power (P < 0.001) and improvement in UCVA (P = 0.013). Longitudinal analysis of the non-spectacles subgroups revealed a significant emmetropization in SER and axial elongation over the 2-year period (all P < 0.05), with no significant inter-group deviations among the three subgroups (P > 0.05). However, higher baseline astigmatism was significantly associated with worse BCVA at the 2-year follow-up (P = 0.014). Conclusions: For school-aged children with moderate to high astigmatism and normal baseline BCVA (≤ 0.1 logMAR), the absence of spectacle correction may not impede visual development or accelerate axial elongation. Clinical decision-making should prioritize individualized assessment of visual demands and symptoms, rather than relying solely on cylindrical power.
SN - 1471-2415
ER -