Researchers Consider Virtues of AL vs. SER to Monitor Ocular Risks in Myopic Children

These researchers favored spherical equivalent refraction for monitoring the progression of myopia in adolescent patients but noted that axial length metrics are useful when monitoring the progression of myopia in adult patients, as well as retinal pathology associated with high myopia. Photo: Getty Images. Click image to enlarge. A quick glance at the extensive literature on myopia reveals a bias towards axial length (AL) as the principal measurement for the assessment of nearsightedness. However, a recent analysis suggests that spherical equivalent (SE) refraction measurements are significantly more optimal than AL when examining children.A study published in American Journal of Ophthalmology from researchers in California and Hawaii compared AL to SE for the monitoring of children with myopia. Additionally, they assessed what myopia-related diseases could be ascertained by these metrics. Results were gathered using records from observational studies available on PubMed and Embase databases.Although their initial search yielded 2,432 publications, the researchers included 70 studies in their final result. As long as a study observed a minimum of 200 eyes, reported AL and SE metrics and was published between 1990 and 2025, it was included for analysis.Regardless of age, sex, height and ethnicity, SE measurements remained sufficient throughout the analysis. AL measurements, however, varied strongly across each demographic. One observed result in favor of the AL metric was the odds ratio (OR) for retinal disease risk; longer AL eyes corresponded with a higher risk for retinal diseases (OR 3.9 per +1mm) compared to SE (OR ~1.5 to 1.8 per -1D and OR 2 to 12 for high myopia [approximately -3 to -6 D]).Inversely, SE metrics showed more prominence in the assessment of cataract and primary open-angle glaucoma (POAG) prevalence compared to AL. For cataracts, researchers observed an OR of 3.1 for nuclear cataracts and 4.6 for posterior subcapsular cataracts after analyzing SE measurements. AL data was insufficient, with reported results being “null or modest.” For POAG, SE metrics resulted in an OR of 3, while AL had an OR of 1.4 per +1 mm.“Absolute AL thresholds are useful for identifying a small group of very long eyes at high retinal risk, but SE better captures cataract and glaucoma risk gradients across the refractive range most myopic children will reach,” concluded the researchers in their paper. “A pragmatic approach is SE‐first monitoring for most children, with selective AL tracking (ideally percentile‐based) to detect excessive axial elongation and to guide retinal‐risk staging and follow‐up.”Click here for the journal source. Clark RA, Wong RK. Spherical equivalent refraction versus axial length for monitoring childhood myopia and estimating disease risk: A systematic review and meta-analysis. Am J Ophthalmol. March 11, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.