ArticleOphthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)2026
Axial Length to Corneal Curvature Ratio is Insufficient for Detecting Pseudomyopia in Children: A Multi-Cohort Study.
Article in Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 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
purposePseudomyopia is an accommodative disorder that can be identified by the difference between pre- and post-cycloplegic refractive error. The current study aimed to evaluate whether the axial length to corneal curvature (AL/CR) ratio, in conjunction with non-cycloplegic refractive error, can reliably identify pseudomyopia in children, thus avoiding the need for cycloplegia.
methodsRefractive error and biometry data from longitudinal studies based in Denmark (n = 645; age 7-17 years) and China (Anyang Childhood Eye Study; n = 2487; age 6-13 years) were used to train separate linear mixed models for children of European or East Asian ancestry, respectively, with AL/CR ratio as outcome and cycloplegic spherical equivalent refractive error (SER), age and sex as predictors. The models could be used to calculate the AL/CR 95% prediction interval in a child of known age, sex and non-cycloplegic SER; if the child's AL/CR fell below the lower limit of the AL/CR 95% prediction interval, then the child was classified as pseudomyopic. The European and East Asian models were externally validated using data from participants of the Ireland Eye Study (IES; n = 92) and Sydney Myopia Study (SMS; n = 686) cohorts, and the Hong Kong Children Eye Study (HKCES; n = 9519) and Vietnam (n = 1165) cohorts, respectively.
resultsThe European model demonstrated moderate detection accuracy for pseudomyopia: sensitivity = 0.82 (IES) and 0.81 (SMS); specificity = 0.75 in both cohorts. By contrast, the East Asian model performed poorly: sensitivity = 0.22 (HKCES) and 0.13 (Vietnam); specificity = 0.99 in both cohorts.
conclusionsDespite moderate diagnostic performance in European samples, the current AL/CR-based models lacked sufficient accuracy for screening and performed poorly in East Asian children, suggesting that AL/CR is not a reliable non-cycloplegic marker of pseudomyopia. Further studies incorporating additional ocular biometric parameters and employing a more rigorous definition of pseudomyopia may build on these initial findings.
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