Higher-Order Aberrations Linked With Axial Length in Children With High Myopia

Teen girl wearing glasses, portrait.
An association between comatic aberration and axial length was established in patients with high myopia, but not in those with moderate myopia, a study shows.

Ocular higher-order aberrations may be negatively associated with longer axial length in children and adolescents with high myopia, according to an investigation published in the British Journal of Ophthalmology. 

Researchers conducted a retrospective cohort study that included 458 participants with high myopia (mean age: 13.51±2.48, 209 boys, 249 girls). They determined baseline cycloplegic ocular and corneal higher order aberrations (HOA), axial length (AL), spherical equivalent (SE), astigmatism, and interpupillary distance (IPD) for the right eye of all participants (SE ≤-5.0D). The investigators compared HOA between 3 age groups (≤12 years, 13–15 years and 16–18 years). In total, 99 participants completed the 1-year follow-up. The team used a linear mixed model to establish an association between HOA components, axial growth, and other confounding factors such as age, gender, SE, astigmatism, and IPD. They also compared data with a previous study of patients with moderate myopia.  

The researchers found that most of the ocular HOAs and few corneal HOAs showed significant differences between the 3 age groups (all P <.05). After 1 year, only ocular HOA components such as secondary horizontal comatic aberration (P =.019), primary spherical aberration (P <.001) and spherical HOA (P =.026) showed a significant negative association with a longer AL. Comatic aberration with AL growth also revealed an association with high myopia when compared with data from the moderate myopia study. 

“Higher levels of ocular secondary horizontal comatic aberrations were the most relevant factor correlated with faster axial elongation in high myopia after adjusting for confounders, such as age, refraction and IPD,” according to the researchers. “Changes in ocular HOAs, notably horizontal comatic aberrations, besides spherical aberrations may take part in refractive development of high myopia.”

Study limitations include a relatively small sample size, a retrospective design, failure to assess accommodative response or habitual correction, and possible confounding due to genetic factors and participant living conditions.  


Xu Y, Deng J, Zhang B, et al. Higher-order aberrations and their association with axial elongation in highly myopic children and adolescents. Br J Ophthalmol. Published online January 13, 2022. doi:10.1136/bjophthalmol-2021-319769