Longitudinal changes in peripapillary atrophy and optic disc morphology in preschool children with early-onset high myopia

Purpose: To investigate longitudinal changes in peripapillary atrophy (PPA) and optic disc morphology in preschool children with early-onset high myopia over more than five years and to identify baseline predictors associated with posterior structural changes. Methods: This retrospective study included 100 eyes from children diagnosed with high myopia before the age of six. Participants underwent serial ophthalmologic examinations, including measurements of axial length (AL), cycloplegic refraction, keratometry, and fundus photography. The PPA-to-disc area ratio, optic disc tilt, and torsion were quantitatively assessed using ImageJ. Participants were categorized based on longitudinal changes in PPA-to-disc area ratio. Results: Over a mean follow-up of 6.3 ± 0.8 years, 52% of eyes demonstrated a decrease in the PPA-to-disc area ratio, accompanied by a hyperopic shift in SE (from − 8.35 D to − 7.64 D, p < 0.001) and limited AL elongation (from 25.1 mm to 25.9 mm, p < 0.001). Baseline features associated with PPA regression included male sex (p = 0.025), lower prevalence of binocular high myopia (p = 0.003) and parental high myopia (p < 0.001), and larger initial PPA-to-disc area ratio (p = 0.037), tilt ratio (p = 0.042), and torsion (p = 0.010). Conversely, eyes with a stable or increased PPA-to-disc area ratio exhibited greater axial elongation (p= 0.001) and more pronounced corneal flattening (mean K, p= 0.005; steep K, p= 0.019). Conclusions: A significant proportion of children with early-onset high myopia demonstrated posterior structural regression. Early clinical and structural markers may help predict remodeling potential, supporting personalized, long-term management.