Association of tessellation density with progression of axial length and refraction in children: an AI-assisted 4-year study

Abstract Purpose: To investigate fundus tessellation density (TD) and its association with axial length (AL) elongation and spherical equivalent (SE) progression in children. Methods: The school-based prospective cohort study enrolled 1997 individuals aged 7-9 in 11 elementary schools in Mojiang, China. Cycloplegic refraction and biometry were performed at baseline and 4-year visits. The baseline fundus photos were taken, and TD, defined as the percentage of exposed choroidal vessel area in the photos, was quantified using an artificial intelligence-assisted semi-automatic labeling approach. After the exclusion of 330 ineligible participants due to loss to follow-up or ineligible fundus photos, logistic models were employed to assess the association of TD with rapid AL elongation (>0.36mm/year) and SE progression (>1.00D/year). Results: The prevalence of tessellation was 477/1667 (28.6%) and mean TD was 0.008±0.019. The mean AL elongation and SE progression in 4 years were 0.90±0.58mm and -1.09±1.25D. Higher TD was associated with longer baseline AL (beta, 0.030; 95% confidence interval [CI]: 0.015,0.046; p<0.001) and more myopic baseline SE (beta, -0.017; 95%CI: -0.032,-0.002; p=0.029). Higher TD was associated with rapid AL elongation (odds ratio [OR], 1.128; 95%CI: 1.055,1.207; p<0.001) and SE progression (OR, 1.123; 95%CI: 1.020,1.237; p=0.018). Conclusions: TD is a potential indicator of rapid AL elongation and refractive progression in children. TD measurement could be a routine to monitor AL elongation.