Differential posterior pole morphology in pediatric myopia in Chinese children: An ultra-widefield OCT analysis of retinal curvature

PURPOSE: To characterize the spatial distribution of retinal curvature (RC) and its determinants in Chinese children across various refractive states, and to explore the morphological remodeling patterns associated with early myopic progression. METHODS: This cross-sectional study included 155 eyes from 155 participants (aged 5 to 18 years), categorized into emmetropia (n = 52) and low/moderate myopia (n = 103) groups. RC was measured in seven concentric zones (RC Ⅰ - Ⅶ, 1-18 mm diameter) using ultra-widefield swept-source optical coherence tomography. Ocular parameters including axial length (AL), spherical equivalent (SE), and retinal and choroidal thickness were analyzed. Data were analyzed using SPSS version 24.0. RESULTS: Myopic eyes exhibited a distinct central steepening and peripheral flattening pattern compared to emmetropic eyes. RC was significantly higher (steeper) in central zones (RC Ⅰ - Ⅳ) but lower (flatter) in peripheral zones (RC Ⅵ - Ⅶ) (all p < 0.001), with RC Ⅴ (12 mm) serving as a morphological inflection point. Multivariable linear regression indicated that central foveal curvature was independently associated with older age, more myopic SE, longer AL, and thinner inner retinal and subfoveal choroidal thickness (Adjusted R² = 0.389). Notably, peripheral RC showed a stronger correlation with AL elongation than central RC. CONCLUSIONS: Pediatric myopia is characterized by a non-uniform posterior pole remodeling. The observed differential changes in RC, particularly the stable flattening of the peripheral retina, may provide more sensitive quantitative biomarkers than traditional central metrics for monitoring the biomechanical impact of axial elongation.