Abstract
Aims To investigate the prevalence and severity of adult myopia progression among highly myopic individuals aged 18–25 years, identify its associated factors and evaluate its association with pathologic myopia (PM).
Methods We retrospectively included participants aged 18–25 years with consecutive follow-ups from the Shanghai Child and Adolescent Large-scale Eye Study database. Annual changes of cycloplegic spherical equivalent (ΔSE) and axial length (ΔAL) were calculated. Adult myopia progression is defined as ΔSE ≤−0.50 D/year or ΔAL≥0.10 mm/year. PM was diagnosed based on META-Analysis for Pathologic Myopia criteria (category≥2) and optical coherence tomography (OCT) images.
Results Among all included 345 eyes, the mean ΔSE was −0.28 D/year (95% CI −0.31 to −0.20; p<0.001) and 64 (18.6%) were classified as having adult myopia progression. The mean ΔAL was 0.09 mm/year (95% CI 0.09 to 0.10; p<0.001), with axial elongation observed in 138 (40.0%) eyes. Both age (ΔSE: β=0.045, p=0.005; ΔAL: β=−0.015, p<0.001) and baseline AL (ΔSE: β=−0.044, p=0.028; ΔAL: β=0.020, p<0.001) were identified as factors associated with ΔSE and ΔAL. No differences in ΔSE (95% CI –0.08 to 0.11; p=0.759) or ΔAL (95% CI –0.04 to 0.01; p=0.190) were found between PM and non-PM groups, and neither metric improved PM discrimination.
Conclusions Among high myopic individuals aged 18–25 years, 18.6% exhibited adult myopia progression and 40.0% showed axial elongation. Age and baseline AL were associated with adult myopia progression, but no clear link was found between adult myopia progression and the development of PM.
Data availability statement
Data are available upon reasonable request. Data are available upon reasonable request. Following publication, study protocols, statistical code and de-identified participant data may be made available to qualified investigators upon approval by the Shanghai Eye Disease Prevention and Treatment Center.
https://creativecommons.org/licenses/by-nc/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/. https://doi.org/10.1136/bjo-2025-328046
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WHAT IS ALREADY KNOWN ON THIS TOPIC
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Myopic progression typically occurs during childhood and adolescence, but may persist into adulthood. Individuals with high myopia are more susceptible to adult myopia progression, which may further elevate their long-term risk of myopia-related complications.
WHAT THIS STUDY ADDS
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This retrospective analysis of a population-based cohort examined annual changes in cycloplegic spherical equivalent (SE) and axial length (AL) among 182 high myopes (345 eyes) aged 18–25 years. Adult myopia progression (ΔSE≤–0.50 D/year) was observed in 18.6% of eyes and axial elongation (ΔAL≥0.10 mm/year) in 40.1%. Age and baseline AL were identified as factors associated with myopia progression, with both the rates of myopic shift and axial elongation declining rapidly with age. No clear link was found between myopia progression in this age group and the development of pathologic myopia.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
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A notable proportion of highly myopic adults aged 18–25 years continue to experience myopic shift and axial elongation. The persistence of myopia progression in this age group supports ongoing monitoring and management for individuals with documented changes. Given the variability in adult myopia progression, personalised strategies may help reduce the long-term risk of myopia-related complications. Further evidence is needed to improve understanding of adult myopia progression and guide more effective control approaches.
