Advanced Imaging and Optical Strategies in Predicting Myopia Progression

A recent longitudinal study published June 16, 2025, in the American Journal of Ophthalmology offers new insights into how peripheral vision may influence the development of myopia in children. Researchers from the Erasmus University Medical Center in Rotterdam, Netherlands, found that both vertical and horizontal relative peripheral refraction (RPR) are significantly associated with faster axial elongation and increased risk of incident myopia.

Led by Dr. Sander C.M. Kneepkens, the study employed subject-specific ray tracing based on brain magnetic resonance imaging (MRI) to examine the relationship between RPR and refractive development in a cohort of 1,635 children. Participants underwent MRI at age 9 and ophthalmologic exams at ages 9 and 13. At baseline, 8% were hyperopic, 77% emmetropic, and 16% myopic.

The findings revealed that children with myopia had more hyperopic RPR in both vertical and horizontal dimensions. Multivariate analyses showed that both types of RPR were significantly associated with longer axial length, lower birth weight, and a flatter horizontal retinal curvature. Vertical RPR was also specifically associated with vertical retinal curvature.

Crucially, the study found that children with higher RPR values experienced faster axial growth and a greater likelihood of developing myopia. After adjusting for baseline axial length and other variables, each diopter increase in horizontal and vertical RPR was associated with a 1.29-fold and 1.40-fold increase in the odds of incident myopia, respectively.

While the study stops short of validating RPR as a predictive model for clinical use, the authors note that the findings affirm the relevance of peripheral optical signals in refractive eye growth. “Our findings affirm the relevance of RPR in predicting myopia progression and can guide future efforts in developing targeted therapies,” the researchers wrote.

These results reinforce the idea that myopia control strategies may benefit from addressing not just central refraction but also the peripheral optical environment. Though further research is needed to establish clinical applications, these data may eventually inform the design of new interventions, such as customized optical treatments targeting peripheral hyperopia.

As childhood myopia rates continue to rise globally, understanding the biomechanical and optical factors contributing to its progression is increasingly important. This study adds to the growing body of evidence suggesting that how the eye processes peripheral light may influence its overall growth—a finding with potential implications for future therapeutic approaches.