Distribution of pupil diameter and its association with myopia in school-age children

GONG Yizhuo; YU Junli; YAO Xianwei; HUO Huanhuan; MA Xiaohui; LIU Guoyong; XU Qian; HU Yuanyuan; BI Hongsheng

doi:10.16835/j.cnki.1000-9817.2025233

Volume 46 Issue 8

Aug. 2025

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Article Navigation > CHINESE JOURNAL OF SCHOOL HEALTH > 2025 > 46(8): 1194-1197

GONG Yizhuo, YU Junli, YAO Xianwei, HUO Huanhuan, MA Xiaohui, LIU Guoyong, XU Qian, HU Yuanyuan, BI Hongsheng. Distribution of pupil diameter and its association with myopia in school-age children[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(8): 1194-1197. doi: 10.16835/j.cnki.1000-9817.2025233

Citation:

GONG Yizhuo, YU Junli, YAO Xianwei, HUO Huanhuan, MA Xiaohui, LIU Guoyong, XU Qian, HU Yuanyuan, BI Hongsheng. Distribution of pupil diameter and its association with myopia in school-age children[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(8): 1194-1197. doi: 10.16835/j.cnki.1000-9817.2025233

Citation:

GONG Yizhuo, YU Junli, YAO Xianwei, HUO Huanhuan, MA Xiaohui, LIU Guoyong, XU Qian, HU Yuanyuan, BI Hongsheng. Distribution of pupil diameter and its association with myopia in school-age children[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2025, 46(8): 1194-1197. doi: 10.16835/j.cnki.1000-9817.2025233

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Distribution of pupil diameter and its association with myopia in school-age children

doi: 10.16835/j.cnki.1000-9817.2025233

1.
Ophthalmology and Optometry Medical School, Shandong University of Traditional Chinese Medicine, Jinan 250014, Shandong Province, China

Received Date: 2024-12-30
Rev Recd Date: 2025-04-03

Available Online: 2025-08-30

Publish Date: 2025-08-25

Abstract

Abstract

Objective To investigate the distribution of pupil diameter and its association with myopia in school-age children, providing ideas into the mechanisms of the role of pupil diameter in the onset and development of myopia. Methods Adopting a combination of stratified cluster random sampling and convenience sampling method, 3 839 children from six schools in Shandong Province were included in September 2021. Pupil diameters distribution was analyzed by age, sex, and myopic status. Pearson correlation analysis was used to assess the relationship between pupil diameter and cycloplegic spherical equivalent (SE), as well as axial length (AL) and other variables. Propensity score matching (PSM) was applied to match myopic and non-myopic children at a 1∶1 ratio based on age and sex. A generalized linear model (GLM) was constructed with pupil diameter as the dependent variable to identify independent factors influencing pupil size and its association with myopia. Results The mean pupil diameter of school-age children was (5.77±0.80)mm. Pupil diameter exhibited a significant increasing trend with age (F=49.34, P_trend < 0.01). Myopic children had a significantly larger mean pupil diameter compared to non-myopic children with a statistically significant difference(t=18.10, P < 0.01). Multivariable GLM analysis, adjusted for age, amplitude of accommodation, and uncorrected visual acuity, revealed a negative correlation between pupil diameter and cycloplegic SE (before PSM: β=-0.089, after PSM: β=-0.063, both P < 0.01). Conclusions Myopic school-age children exhibite larger pupil diameters than their non-myopic counterparts. Pupil diameter may serve as a potential indicator for monitoring myopia development in school-age children.
- Pupil,
- Myopia,
- Child,
- Adolescent

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References(25)

References

[1]	MORGAN I G, FRENCH A N, ASHBY R S, et al. The epidemics of myopia: aetiology and prevention[J]. Prog Retin Eye Res, 2018, 62(1): 134-149.
[2]	LANCA C, SUN C H, CHONG R, et al. Visual field defects and myopic macular degeneration in Singapore adults with high myopia[J]. Br J Ophthalmol, 2022, 106(10): 1423-1428. doi: 10.1136/bjophthalmol-2020-318674
[3]	NITZAN I, SHMUELI O, SAFIR M. Association of myopia with anxiety and mood disorders in adolescents[J]. Eye (Lond), 2024, 38(15): 3016-3018. doi: 10.1038/s41433-024-03170-6
[4]	HYSI P G, CHOQUET H, KHAWAJA A P, et al. Meta-analysis of 542 934 subjects of European ancestry identifies new genes and mechanisms predisposing to refractive error and myopia[J]. Nat Genet, 2020, 52(4): 401-407. doi: 10.1038/s41588-020-0599-0
[5]	WANG Q, BI H Y, WANG C F, et al. Familial aggregation and heritability of myopia: a local population survey in Shanxi, China[J]. Trop Med, 2021, 2021: 4847112.
[6]	LI X, LI L, QIN W, et al. Urban living environment and myopia in children[J]. JAMA Netw Open, 2023, 6(12): e2346999. doi: 10.1001/jamanetworkopen.2023.46999
[7]	ZADNIK K, MUTTI D O. Outdoor activity protects against childhood myopia: let the sun shine in[J]. JAMA Pediatr, 2019, 173(5): 415-416. doi: 10.1001/jamapediatrics.2019.0278
[8]	DOLGIN E. The myopia boom[J]. Nature, 2015, 519(7543): 276-278. doi: 10.1038/519276a
[9]	RICHTER G M, WANG M, JIANG X, et al. Ocular determinants of refractive error and its age- and sex-related variations in the Chinese American eye study[J]. JAMA Ophthalmol, 2017, 135(7): 724-732. doi: 10.1001/jamaophthalmol.2017.1176
[10]	CHEN J, LIU S, ZHU Z, et al. Axial length changes in progressive and non-progressive myopic children in China[J]. Graefes Arch Clin Exp Ophthalmol, 2022, 261(5): 1493-1501.
[11]	HAN X, XIONG R, JIN L, et al. Longitudinal changes in lens thickness and lens power among persistent non-myopic and myopic children[J]. Invest Ophthalmol Vis Sci, 2022, 63(10): 10. doi: 10.1167/iovs.63.10.10
[12]	CHEN Z, NIU L, XUE F, et al. Impact of pupil diameter on axial growth in orthokeratology[J]. Optom Vis Sci, 2012, 89(11): 1636-1640. doi: 10.1097/OPX.0b013e31826c1831
[13]	FU A, STAPLETON F, WEI L, et al. Effect of low-dose atropine on myopia progression, pupil diameter and accommodative amplitude: low-dose atropine and myopia progression[J]. Br J Ophthalmol, 2020, 104(11): 1535-1541.
[14]	FLITCROFT D I, HE M, JONAS J B, et al. IMI-defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies[J]. Invest Ophthalmol Vis Sci, 2019, 60(3): M20-M30. doi: 10.1167/iovs.18-25957
[15]	DHARANI R, LEE C F, THENG Z X, et al. Comparison of measurements of time outdoors and light levels as risk factors for myopia in young Singapore children[J]. Eye, 2012, 26(7): 911-918. doi: 10.1038/eye.2012.49
[16]	MCADAMS H, IGDALOVA A, SPITSCHAN M, et al. Pulses of melanopsin-directed contrast produce highly reproducible pupil responses that are insensitive to a change in background radiance[J]. Invest Ophthalmol Vis Sci, 2018, 59(13): 5615-5626. doi: 10.1167/iovs.18-25219
[17]	HSU T Y, WANG H Y, CHEN J T, et al. Investigating the role of human frontal eye field in the pupil light reflex modulation by saccade planning and working memory[J]. Front Hum Neurosci, 2022, 16(1): 1044893.
[18]	ZHU M J, DU L L, CHEN J, et al. Photopic pupil size change in myopic orthokeratology and its influence on axial length elongation[J]. Int J Ophthalmol, 2022, 15(8): 1322-1330. doi: 10.18240/ijo.2022.08.15
[19]	LIU S, HE X, WANG J, et al. Association between axial length elongation and spherical equivalent progression in Chinese children and adolescents[J]. Ophthalmic Physiol Opt, 2022, 42(5): 1133-1140. doi: 10.1111/opo.13023
[20]	HUANG Z, SONG D, TIAN Z, et al. Prevalence and associated factors of myopia among adolescents aged 12-15 in Shandong Province, China: a cross-sectional study[J]. Sci Rep, 2024, 14(1): 19520. doi: 10.1038/s41598-024-70361-2
[21]	LIN T, HU J, LIN J, et al. Epidemiological investigation of the status of myopia in children and adolescents in Fujian Province in 2020[J]. Jpn J Ophthalmol, 2023, 67(3): 335-345.
[22]	高其乐, 周晓东, 戚慧荭, 等. 上海市金山区小学生5年屈光发育状况[J]. 中国学校卫生, 2019, 40(2): 268-269. doi: 10.16835/j.cnki.1000-9817.2019.02.030 GAO Q L, ZHOU X D, QI H H, et al. Refractive development during the past 5 years among primary school students in Jinshan District of Shanghai[J]. Chin J Sch Health, 2019, 40(2): 268-269. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2019.02.030
[23]	LINKE S J, BAVIERA J, MUNZER G A F, et al. Mesopic pupil size in a refractive surgery population (13 959 eyes)[J]. Optom Vis Sci, 2012, 89(8): 1156-1164.
[24]	CHARMAN W N. Aberrations and myopia[J]. Ophthalm Physiol Opt, 2005, 25(4): 285-301.
[25]	BERNAL-MOLINA P, MONTÉS-MICÓ R, LEGRAS R, et al. Depth-of-field of the accommodating eye[J]. Optom Vis Sci, 2014, 91(10): 1208-1214.