Centile curves of refraction in children and adolescents aged 5–18 in Hubei Province: a study based on GAMLSS to predict refraction development

To establish percentile curves of refractive development for children and adolescents aged 5–18y in Hubei Province.

A cross-sectional study was conducted in 103 county-level administrative districts of Hubei Province via a multistage stratified cluster sampling strategy. Participants underwent non-cycloplegic autorefraction, and spherical equivalent refraction (SER) of the right eye was calculated. Generalized additive models for location, scale, and shape (GAMLSS) were applied to construct age-specific standard SER percentile curves stratified by gender and region. Moreover, age-related curves of annual refractive progression rate at each percentile were plotted.

A total of 1255454 participants (673341 boys and 582113 girls) aged 5–18y (mean age: 11.13±3.59y) were enrolled. An overall myopic shift trend was observed with advancing age. The median SER was +0.25 diopters (D) at 5 years of age and decreased to -0.50 D at 9 years of age. From 5 to 18 years of age, the refractive progression was -6.63 D at the 3rd percentile, while the values were -3.25 D and -1.00 D at the 50^th and 97^th percentiles, respectively. Girls and rural children presented higher myopic degrees. The annual age-dependent refractive progression rate curve showed a U-shaped pattern, with greater annual refractive changes in lower percentiles and peak refractive progression occurring at younger ages.

Children in lower SER percentiles suffer from more severe myopia and faster refractive progression. Therefore, earlier and targeted intensive myopia interventions are warranted for children with SER below the 50^th percentile.