The predictive accuracy of axial length to corneal curvature radius ratio for myopia in children and adolescents

Purpose To analyze the association of axial length to corneal curvature radius ratio (AL/CR) and other ocular biometric parameters with myopia in children and adolescents. Methods A cross-sectional study was conducted among children and adolescents aged 6 to 12 years without ocular diseases who attended the optometry clinic of the Yantai Aier Ophthalmology Hospital from February 2022 to February 2024. The visual acuity, ocular biometry, and automatic refraction under cycloplegia were measured. The axial length, corneal curvature radius, and AL/CR were compared across different age groups. Pearson correlation and linear regression were performed to analyze the effects of correlated factors on spherical equivalent. Receiver operating characteristic curves were constructed to evaluate the diagnostic efficacy in detecting myopia. Results A total of 2,760 eyes (right eye) of 2,760 children and adolescents were included. Both axial length and AL/CR increased with age in children and adolescents aged 6 to 12 years, while spherical equivalent decreased with age. Corneal curvature radius did not exhibit significant changes with age. The correlation coefficients between AL/CR, axial length, and spherical equivalent are −0.865 and −0.747, respectively, whereas axial length shows no significant correlation ( r = −0.083). Upon stratification by age, the correlation between AL/CR and spherical equivalent remains stronger than that between axial length and spherical equivalent. The linear regression models for predicting spherical equivalent based on AL/CR, axial length, and age are as follows: spherical equivalent = 36.463–12.278 * AL/CR and spherical equivalent = 28.835–1.260 * axial length. The area under the receiver operating characteristic curve for the AL/CR is 0.938, which surpasses that of axial length at 0.87. The AL/CR cutoff point was 3.026, and the sensitivity and specificity were 0.898 and 0.826, respectively. Conclusion The correlation between AL/CR and spherical equivalent (SE) is stronger than that between AL and SE in children and adolescents. AL/CR can independently reflect dynamic changes in SE during myopia progression, without relying solely on optometric data.