Age-indexed cumulative risk of high myopia estimated from axial length and early axial elongation: a 7-year school-based longitudinal cohort study.
- 1Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China.
Abstract
Purpose
To develop and validate age-indexed models estimating the cumulative risk of high myopia, defined as axial length (AL) ≥ 26.0 mm, using routinely collected ocular biometry, and to evaluate their potential for clinical risk stratification.Methods
This 7-year school-based longitudinal cohort included 7,052 Chinese children aged 6-16 years at baseline who participated in a school-based screening program in Tianjin, China, from 2018 to 2024. Discrete-time survival models with age as the timescale estimated cumulative risk from ages 9 to 18 years. Two models were tested: baseline AL plus sex and baseline AL plus first-year axial elongation (ΔAL) plus sex. Performance was assessed in a participant-level temporal holdout test set using iAUC, iBrier, calibration, and decision-curve analysis, and by school-level internal-external cross-validation using iAUC and iBrier.Results
Overall, 577 participants (8.2%) developed high myopia. In the temporal holdout test set (n = 5,245), the AL + ΔAL model outperformed the AL-only model, with higher discrimination [iAUC, 0.919 [95% CI, 0.902-0.933] vs. 0.851 [95% CI, 0.833-0.869]] and lower prediction error [iBrier, 0.074 [95% CI, 0.068-0.081] vs. 0.087 [95% CI, 0.080-0.095]]. Calibration was close to ideal, decision-curve analysis showed clinical net benefit, and school-level validation confirmed stable performance.Conclusions
Routine AL measurement, particularly when combined with early axial elongation, enables accurate age-specific risk estimation of AL-defined high myopia and provides a transparent basis for timely and proportionate myopia-control decisions.
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BibTeX
@article{yang2026ageindexed,
title = {{Age-indexed cumulative risk of high myopia estimated from axial length and early axial elongation: a 7-year school-based longitudinal cohort study.}},
author = {Jing Yang and Hui Li and Bei Du and Desheng Song and Nan Jin and Ruihua Wei},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1939322},
url = {https://europepmc.org/article/MED/42898192},
note = {CC BY},
}
RIS
TY - JOUR
TI - Age-indexed cumulative risk of high myopia estimated from axial length and early axial elongation: a 7-year school-based longitudinal cohort study.
AU - Jing Yang
AU - Hui Li
AU - Bei Du
AU - Desheng Song
AU - Nan Jin
AU - Ruihua Wei
PY - 2026
DA - 2026/10/05
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1939322
UR - https://europepmc.org/article/MED/42898192
AB - Purpose To develop and validate age-indexed models estimating the cumulative risk of high myopia, defined as axial length (AL) ≥ 26.0 mm, using routinely collected ocular biometry, and to evaluate their potential for clinical risk stratification.Methods This 7-year school-based longitudinal cohort included 7,052 Chinese children aged 6-16 years at baseline who participated in a school-based screening program in Tianjin, China, from 2018 to 2024. Discrete-time survival models with age as the timescale estimated cumulative risk from ages 9 to 18 years. Two models were tested: baseline AL plus sex and baseline AL plus first-year axial elongation (ΔAL) plus sex. Performance was assessed in a participant-level temporal holdout test set using iAUC, iBrier, calibration, and decision-curve analysis, and by school-level internal-external cross-validation using iAUC and iBrier.Results Overall, 577 participants (8.2%) developed high myopia. In the temporal holdout test set (n = 5,245), the AL + ΔAL model outperformed the AL-only model, with higher discrimination [iAUC, 0.919 [95% CI, 0.902-0.933] vs. 0.851 [95% CI, 0.833-0.869]] and lower prediction error [iBrier, 0.074 [95% CI, 0.068-0.081] vs. 0.087 [95% CI, 0.080-0.095]]. Calibration was close to ideal, decision-curve analysis showed clinical net benefit, and school-level validation confirmed stable performance.Conclusions Routine AL measurement, particularly when combined with early axial elongation, enables accurate age-specific risk estimation of AL-defined high myopia and provides a transparent basis for timely and proportionate myopia-control decisions.
SN - 2296-858X
ER -