Global Axial Length Centile Charts

Importance: Myopia is increasingly common worldwide and poses major public health challenges because axial elongation drives sight-threatening complications. Because axial length (AL) is the primary target for myopia management, population-specific AL reference charts are needed. Objective: To generate region- and sex-specific reference centile charts for AL in children and adolescents. Design, Setting, and Participants: This was a pooled cohort analysis using individual-participant data from population- and school-based studies conducted in East Asia, Europe, and Australia contributing to the CREAM-Kids Consortium. A total of 147 404 children and adolescents contributing 559 799 AL measurements were included. Most participants were from East Asia (84%; ages 6-18 years), followed by Europe (12%; ages 6-21 years) and Australia (4%; ages 6-21 years). After assessment of comparability, European and Australian datasets were combined. Data were included from 1999 to 2024, with the analysis taking place from December 2024 to May 2026. Exposures: AL, age, sex, and geographic region. Main Outcomes and Measures: Region- and sex-specific AL centiles across age and agreement between modeled centiles and empirical values. Results: AL distributions among the 147 404 included individuals varied by sex and region. In female individuals, the 50th centile AL at age 7 years was 22.35 mm in Europe and Australia and 22.67 mm in East Asia; by age 18 years, the 50th centile ALs were 23.31 mm and 24.36 mm, respectively. Regional differences were larger at higher centiles: for female individuals at age 7 years, East Asia vs Europe and Australia differences were 0.33 mm at the 3rd centile and 0.50 mm at the 97th centile; at age 18 years, differences were 0.73 mm and 1.27 mm, respectively. Modeled centile curves closely matched empirical values (intraclass correlations >0.99) with minimal bias across sex and region subgroups (-0.08 mm to 0.04 mm). Conclusions and Relevance: While not based solely on population-based cohorts, the region- and sex-specific AL centile charts developed in this pooled cohort study provide reference values for childhood and adolescence that may be used to support clinical and research applications, including identifying atypical axial elongation and informing targeted strategies for myopia prevention and management.

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Journal
JAMA Ophthalmology
Published
2026-07-16
DOI
https://doi.org/10.1001/jamaophthalmol.2026.2539
Primary Topic
Ophthalmology and Visual Impairment Studies
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article
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article

Global Axial Length Centile Charts

Rigmor C. Baraas, Sander C. M. Kneepkens, Gareth Lingham, Caroline C. W. Klaver et al.
JAMA Ophthalmology
Ophthalmology and Visual Impairment Studies
article

Global Axial Length Centile Charts

Rigmor C. Baraas, Sander C. M. Kneepkens, Gareth Lingham, Caroline C. W. Klaver, Peilun Dai, Wei Pan, Ellen Svarverud, Niall C. Strang, Cécile Delcourt, Jan Roelof Polling, Núria Vila‐Vidal, Li Lian Foo, Klaus Nordhausen, Kathryn J. Saunders, Valldeflors Viñuela-Navarro, Trine Langaas, Mariam El Gharbi, Joan Pérez-Corral, Stuart J. Gilson, Olavi Pärssinen, Laura Guisasola, Micheal Moore, Yong Li, Yuzhou Zhang, Marja-Liisa Franssila, Christopher Hammond, Tina R. Johansen, G. Horgen, D.I. Flitcroft, Xiangui He, Seang Mei Saw, Jason C. Yam, Daniel Ting, Cathy Williams, Katie Williams, Jeremy A. Guggenheim, Wan-Ting Loke, Kathryn Rose, Amanda French, Lene A. Hagen, Chi Pui  Pang, Jun Chen, Cecilie O. Bjørset, Hilde R. Pedersen, Virginie Verhoeven, Weizhong Z. Lan, J. Willem L.  Tideman, Sara McCullough, James Loughman, Marcus Ang, David A. Mackey, Yih Chung Tham, Wu Fan, Jun Zhou, Jani Moilanen, Siofra C. Harrington, Alba Galdón, Fabian Yii, Niko Setälä, Hanne-Mari S. Thorud, Samantha Lee, Xun Xu, Dirk J. van Hemert
article en

Abstract

Importance: Myopia is increasingly common worldwide and poses major public health challenges because axial elongation drives sight-threatening complications. Because axial length (AL) is the primary target for myopia management, population-specific AL reference charts are needed. Objective: To generate region- and sex-specific reference centile charts for AL in children and adolescents. Design, Setting, and Participants: This was a pooled cohort analysis using individual-participant data from population- and school-based studies conducted in East Asia, Europe, and Australia contributing to the CREAM-Kids Consortium. A total of 147 404 children and adolescents contributing 559 799 AL measurements were included. Most participants were from East Asia (84%; ages 6-18 years), followed by Europe (12%; ages 6-21 years) and Australia (4%; ages 6-21 years). After assessment of comparability, European and Australian datasets were combined. Data were included from 1999 to 2024, with the analysis taking place from December 2024 to May 2026. Exposures: AL, age, sex, and geographic region. Main Outcomes and Measures: Region- and sex-specific AL centiles across age and agreement between modeled centiles and empirical values. Results: AL distributions among the 147 404 included individuals varied by sex and region. In female individuals, the 50th centile AL at age 7 years was 22.35 mm in Europe and Australia and 22.67 mm in East Asia; by age 18 years, the 50th centile ALs were 23.31 mm and 24.36 mm, respectively. Regional differences were larger at higher centiles: for female individuals at age 7 years, East Asia vs Europe and Australia differences were 0.33 mm at the 3rd centile and 0.50 mm at the 97th centile; at age 18 years, differences were 0.73 mm and 1.27 mm, respectively. Modeled centile curves closely matched empirical values (intraclass correlations >0.99) with minimal bias across sex and region subgroups (-0.08 mm to 0.04 mm). Conclusions and Relevance: While not based solely on population-based cohorts, the region- and sex-specific AL centile charts developed in this pooled cohort study provide reference values for childhood and adolescence that may be used to support clinical and research applications, including identifying atypical axial elongation and informing targeted strategies for myopia prevention and management.

JAMA Ophthalmology
Lions Eye Institute (AU), University of Technology Sydney (AU), Tongji University (CN), University of Ulster (GB), Central South University (CN), Radboud University Nijmegen (NL), National University of Singapore (SG), Chinese University of Hong Kong (HK), The University of Western Australia (AU), Glasgow Caledonian University (GB), Singapore National Eye Center (SG), Hong Kong Eye Hospital (CN), University of South-Eastern Norway (NO), Erasmus MC (NL), Radboud University Medical Center (NL), Mater Misericordiae University Hospital (IE), Shanghai Eye Disease Prevention & Treatment Center (CN), Hubei University of Science and Technology (CN), Centre for Eye Research Australia (AU), New Mexico Consortium (US), Singapore Eye Research Institute (SG), Duke-NUS Medical School (SG), Central Finland Health Care District (FI), Technological University Dublin (IE), National University Health System (SG), Institute of Molecular and Clinical Ophthalmology Basel (CH), Cardiff University (GB), University of Jyväskylä (FI), Universitat Politècnica de Catalunya (ES)
Good health and well-being
Openalex Percentile: Top 9%
Ophthalmology and Visual Impairment Studies
DOISourceOpenAlex
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