Factors Influencing Refractive Severity and Visual Improvement in Pediatric Unilateral High Myopia With Myelinated Retinal Nerve Fibers

OBJECTIVES: To investigate factors influencing refractive error severity and visual improvement in children with unilateral high myopia and myelinated retinal nerve fibers (MRNF). METHODS: Thirty-six children (12 years and younger) with unilateral high myopia (spherical equivalent [SE] ≤ -6.0 D) and MRNF were prospectively enrolled. Twenty-two received rigid gas-permeable (RGP) contact lenses and 14 spectacles; all underwent occlusion therapy. Myelinated retinal nerve fiber features-including optic disc quadrant involvement, myelin-over-disc ratio, MRNF area, and fovea-to-myelination distance (Df-m)-were evaluated from fundus images. Best-corrected visual acuity (BCVA) change at one year was assessed. RESULTS: Mean age was 5.2±2.4 years. Affected eyes had a mean SE of -10.01±2.80 D and baseline BCVA of 1.33±0.35 logMAR. Spherical equivalent severity correlated negatively with myelin-over-disc ratio, MRNF area, and Df-m (P<0.05). Mean BCVA improvement at 1 year was 0.65±0.32 logMAR, positively correlated with baseline SE and final BCVA, and negatively with optic disc quadrant involvement, myelin-over-disc ratio, MRNF area, and Df-m. Patients fitted with RGP lenses achieved significantly greater visual improvement than those with spectacles (P<0.001). CONCLUSION: Extensive MRNF involvement predicted more severe myopia and poorer recovery. Early amblyopia therapy, particularly with RGP lenses, achieved significant visual benefits.