This retrospective longitudinal analysis aimed to investigate the association between ocular higherorder aberrations (HOAs) and axial eye growth in Hong Kong children. Measures of axial length and ocular HOAs under cycloplegia were obtained annually over a two-year period from 137 subjects aged 8.8 ± 1.4 years with mean spherical equivalent refraction of-2.04 ± 2.38 D. A significant negative association was observed between the RMS of total HOAs and axial eye growth (P = 0.03), after adjusting for other significant predictors of axial length including age, sex and refractive error. Similar negative associations with axial elongation were found for the RMS of spherical aberrations (Z40and Z60combined) (P = 0.037). Another linear mixed model also showed that greater levels of vertical trefoil (Z3 )-3 , primary spherical aberration (Z )40and negative oblique trefoil (·) Z33were associated with slower axial elongation and longer axial length (all P < 0.05). These findings support the potential role of HOAs, image quality and a vision-dependent mechanism in childhood eye growth.
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