Interocular Posterior Retinal Curvature Asymmetry and Its Relationship With Myopic Differences in Anisometropic Children.

Purpose: To investigate interocular differences in posterior retinal curvature in anisometropic children and their association with interocular differences in myopia. Methods: Forty-two non-highly myopic children underwent ultra-widefield swept-source optical coherence tomography for 24-mm × 20-mm macular-centered retinal imaging. Gaussian curvature measurements were derived from corrected three-dimensional retinal reconstructions, based on Bruch's membrane segmentation. The retina was divided into six regions (I-VI) with diameters of 1, 3, 6, 9, 12, and 15 mm according to the Early Treatment of Diabetic Retinopathy Study grid standard. Regions I to III were classified as the macular zone, while regions IV to VI constituted the peripheral zone. Results: The mean difference in spherical equivalent between the more myopic and less myopic eyes was 1.42 ± 0.51 diopters, while the difference in axial length (AL) was 0.58 ± 0.32 mm. The average retinal curvature in the macular zone was significantly steeper in the more myopic eyes (0.55 ± 0.15 × 10⁻² mm⁻²) compared to the less myopic eyes (0.46 ± 0.11 × 10⁻² mm⁻²; P < 0.001). Retinal curvature was significantly higher in regions I to IV of the more myopic eyes but lower in region VI (all P < 0.001). Furthermore, positive correlation was observed between macular retinal curvature disparities and AL differences (R = 0.340, P = 0.028), while peripheral retinal curvature disparities were negatively correlated with AL differences (R = -0.374, P = 0.015). Conclusions: Axial elongation drives region-specific posterior retinal remodeling in anisometropic children, steepening the macula and flattening the periphery. Translational Relevance: By investigating retinal curvature in anisometropic children, we provide morphologic insights that establish a basis for strategies to prevent and manage pediatric myopia.