Associations of optic nerve head morphology and peripapillary retinal nerve fibre layer thickness with myopic severity and treatment in children

Purpose: This study aimed to investigate the longitudinal associations between myopic optic disc features and optical coherence tomography (OCT) measurements of peripapillary retinal nerve fibre layer (RNFL) thickness in young myopic children in Singapore.

Methods: A prospective, single-site cohort study was conducted, involving children aged 7-16 years who participated in the PROM-Kids clinical cohort study from 2019 to 2022. Participants underwent annual assessments, including cycloplegic refraction, axial length measurements, fundus photography, and OCT imaging, with ocular magnification correction. Children were classified into low (LM, 0 to -3D), moderate (MM, -3.01 to -6D), and high (HM, > -6D) myopia, with or without treatment.

Results: Data from 1000 children (right eye) were analyzed, including 521 with 2-year follow-up. At baseline, the mean age was 10.2 ± 1.6 years, with 46.4 % male and 90.7 % ethnic Chinese. HM children were older and exhibited greater optic disc tilt (ODT, 92 % vs. 80 %) and more peripapillary atrophy (PPA, 94 % vs. 73 %) compared to LM children. RNFL thickness decreased in the superior, inferior, and nasal quadrants but increased in the temporal quadrant with higher myopia. In the follow-up cohort, myopia progression was associated with thicker temporal quadrant and average RNFL, particularly in younger children. Prior treatment with myopia-control lenses was also associated with increased RNFL thickness in the superior quadrant.

Conclusion: Optic disc changes occur early in life, even in low myopia. Increasing myopia is linked to varying RNFL thickness across quadrants and may be influenced by age and myopia treatment.