This pooled cohort analysis used individual-participant data from 147,404 children and adolescents (ages 6–21 years) across East Asia, Europe, and Australia (CREAM-Kids Consortium, 1999–2024) to generate region- and sex-specific axial length (AL) centile reference charts.
East Asian children had longer AL than European/Australian peers at all ages; in females, the 50th centile AL at age 18 was 24.36 mm (East Asia) vs. 23.31 mm (Europe/Australia). Regional differences widened at higher centiles and older ages (up to 1.27 mm difference at the 97th centile, age 18, females). Modeled centiles matched empirical values with intraclass correlations >0.99 and bias of only −0.08 to 0.04 mm.
Not derived solely from population-based cohorts (school-based studies included), which may introduce selection bias. European and Australian datasets were combined due to comparability, limiting region-specific granularity. Data span 1999–2024, so secular trends in AL may not be fully captured.
Clinicians managing myopia in children should use region- and sex-specific AL centile charts rather than universal norms — an AL at the 97th centile carries different risk depending on whether the child is in East Asia or Europe/Australia. These charts can flag atypical axial elongation early and help target myopia prevention or treatment interventions.
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