Longitudinal changes in corneal curvature and its relationship to axial length in the Correction of Myopia Evaluation Trial (COMET) cohort

PURPOSE: To describe longitudinal changes in corneal curvature (CC) and axial length (AL) over 14 years, and to explore the relationship between AL and CC, and the axial length/corneal radius (AL/CR) ratio. METHODS: In total 469, 6 to <12-year-old, children were enrolled in COMET. Measurements of refractive error, CC (D), CR (mm), and ocular component dimensions including AL were gathered annually. Linear mixed models were used to evaluate longitudinal changes adjusting for covariates (gender, ethnicity, lens type, baseline age and baseline refraction). The Pearson correlation coefficient between AL and CC was computed at each visit. RESULTS: There was a slight but significant (p < 0.0001) flattening in CC over 14 years. At all visits females had significantly steeper CC than males (overall difference = 0.53 D, p < 0.0001). Caucasians had the steepest CC, and Hispanics the flattest (p = 0.001). The correlation between AL and CC was −0.70 (p < 0.0001) at baseline (mean age = 9.3 years) and decreased to −0.53 (p < 0.0001) at the 14-year visit (mean age = 24.1 years). The average AL/CR ratio was 3.15 at baseline and increased to 3.31 at the 14-year visit. The correlation between the magnitude of myopia and AL/CR ratio was significantly higher (p < 0.0001) at each visit than the correlation between myopia and AL alone. CONCLUSIONS: Differences in average corneal curvature by age, gender, and ethnicity observed in early childhood remain consistent as myopia progresses and stabilizes. This study also demonstrates increases in the AL/CR ratio as myopia progresses and then stabilizes, supporting observations from previous cross-sectional data.