ArticleFrontiers in medicine2026
Hyperopic reserve insufficiency and myopic pre-disposition in pre-school children aged 3-6 years: a large-scale cross-sectional survey.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To estimate the prevalence of hyperopic reserve insufficiency (HRI) and examine its associated factors among pre-school children aged 3-6 years in Ganzhou, China. Methods: This cross-sectional study included 3,360 pre-school children aged 3-6 years. All participants underwent cycloplegic autorefraction and axial length (AL) measurement. HRI was defined using age-specific spherical equivalent refraction (SER) thresholds. SER was also used to describe age-specific refractive status and to conduct a sensitivity analysis using the International Myopia Institute (IMI) pre-myopia criterion (-0.50 D < SER ≤ +0.75 D). Guardian-completed Questionnaires assessed paternal/maternal high myopia, outdoor time, near-work, and residence. Multivariable logistic regression was performed with HRI coded as 1 and sufficient hyperopic reserve coded as 0. Results: HRI was identified in 380 children (11.3%, 95% CI: 10.3-12.4%). Age-specific HRI prevalence increased from 4.1% (95% CI: 2.8-6.0%) at age 3 to 27.5% (95% CI: 23.9-31.5%) at age six. Mean SER declined from +2.35 ± 0.37 D at age 3 to +1.05 ± 0.54 D at age 6. IMI-defined pre-myopia was found in 179 (5.3%). In multivariable analysis, older age (OR = 1.86), longer AL (OR = 1.70), paternal (OR = 1.28) and maternal (OR = 1.31) high myopia, near-work (OR = 1.06), and urban residence (OR = 1.40) were associated with higher HRI odds. Male sex was protective (OR = 0.75, 95% CI: 0.60-0.94). Outdoor time showed lower odds but was non-significant (OR = 0.93, 95% CI: 0.85-1.01). IMI sensitivity analysis showed consistent directions. Conclusions: HRI was detectable in a notable proportion of pre-schoolers and was accompanied by an age-related decline in SER. HRI was associated with age, AL, parental myopia, residence, and early-life visual behaviors. Due to the cross-sectional design, findings are associational, not causal.
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