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Relative Peripheral Refraction Predicts Myopia Progression in Children

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Children with faster myopia progression have higher axial length, lower spherical equivalent, higher horizontal and vertical relative peripheral refraction

By Elana Gotkine HealthDay Reporter

TUESDAY, June 24, 2025 (HealthDay News) — Vertical and horizontal relative peripheral refraction (RPR) are associated with faster axial length progression and higher risk of incident myopia, according to a study published online June 16 in the American Journal of Ophthalmology.

Sander C.M. Kneepkens, M.D., from the Erasmus University Medical Center in Rotterdam, Netherlands, and colleagues used subject-specific ray tracing with magnetic resonance imaging (MRI) to examine the relationship between RPR and myopia in children. Ophthalmological examinations were conducted at age 9 and 13 years, and participants underwent a brain MRI scan at age 9.

The analysis included 1,635 participants, with a distribution of refractive error of 8, 77, and 16 percent for hyperopia, emmetropia, and myopia, respectively. The researchers found that RPR was more hyperopic in those with myopia, with similar results seen for both horizontal and vertical RPR. Both horizontal and vertical RPR were significantly associated with axial length, birth weight, and horizontal retinal radius of curvature, in multivariate linear regression analysis. However, vertical retinal radius of curvature was only associated with vertical RPR. Individuals with faster myopia progression had a higher axial length, lower spherical equivalent, and higher horizontal and vertical RPR. For each diopter increase in horizontal and vertical RPR, the risk of incident myopia increased significantly (odds ratios, 1.40 and 1.29, respectively) after adjustment for covariates including axial length.

“We found that higher RPR is strongly associated with both faster axial length growth and increased risk of developing myopia,” the authors write. “Our findings affirm the relevance of RPR in predicting myopia progression and can guide future efforts in developing targeted therapies.”


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