Age- and Myopia-Related 3-Dimensional Remodeling of Choroidal Thickness in Children.

PURPOSE: To investigate the 3-dimensional (3D) topographic remodeling patterns of choroidal thickness (ChT) in the macular region in children, and their associations with age and myopia related ocular growth. DESIGN: Cross-sectional, population-based study. PARTICIPANTS: A total of 3508 children (mean age 13.6 ± 3.0 years, range 7-18 years, 47.7% male). METHODS: Spectral-domain OCT with a 31-horizontal B-scan protocol was performed on right eyes. Choroidal thickness in each B-scan was automatically segmented and quantified using modified open-source deep learning algorithms (Choroidalyzer). For each eye, a 3D ChT map covering 6 × 6 mm macular region and composed of 12 × 12 grids centered on fovea was generated, and both mean thickness and grid-specific thickness values were calculated. MAIN OUTCOME MEASURES: ChT of each grid, cluster, and macular region; correlation with age, axial length (AL), and sex. RESULTS: The mean ChT was 271.8 ± 56.1 μm, with significant variations across nonmyopia, low, moderate, and high myopia groups (P < 0.001). Age-related ChT changes showed a distinct temporal-nasal asymmetry pattern, with the nasal region showing the strongest negative correlation with age (r = -0.12), the central region demonstrating a weak correlation (r = -0.07, both P < 0.001), whereas the temporal region remained relatively stable (r = -0.02, P = 0.255), resulting in 4.3- and 2.6-fold (95% confidence interval: -0.4 to 8.9; -0.4 to 5.7) greater thinning in the nasal and central choroid than in the temporal region, respectively. Axial length-related ChT changes showed a concentric thinning pattern, characterized by more pronounced foveal thinning (r = -0.51, B = -35.2 μm/mm, both P < 0.001) compared with parafoveal (r = -0.48, B = -28.7 μm/mm, both P < 0.001) and perifoveal changes (r = -0.42, B = -22.3 μm/mm, both P < 0.001), corresponding to 1.6- and 1.3-fold (95% confidence interval: 1.4-1.7; 1.2-1.4) greater thinning in the fovea and parafovea than in the perifovea. CONCLUSIONS: Using 3D topographic mapping, we provide population-based data on ChT in children, and identified 2 major spatial remodeling patterns: temporal-nasal asymmetry with age and concentric thinning with increasing axial length. These spatially and temporally distinct remodeling patterns likely reflect both physiological growth and myopia-related structural change, supporting the potential role of ChT as a biomarker for myopia development and progression. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.