An international research collaboration has produced a comprehensive refractive error reference chart, revealing striking differences in myopia development between East Asian and Western children and adolescents. The new centile curves, published in Investigative Ophthalmology & Visual Science, aim to transform how clinicians assess and manage childhood myopia worldwide. 

The large individual-level meta-analysis pooled refractive data from 70,022 eyes of participants aged 6 to 20 years, drawn from nine population-based studies across Europe, North America, Australia, and East Asia. Using both cycloplegic (considered the clinical gold standard) and non-cycloplegic refraction methods, researchers developed age-, sex-, and region-specific centile curves that describe how refractive errors vary across childhood and adolescence in different populations. 

The study identified significant regional differences in refractive development:

  • East Asian children showed more myopic centile distributions compared with their Western counterparts after age 8

  • Differences in the 50th, 75th, and 90th myopia centiles widened with age and stabilized by the late teens, particularly among females

  • Higher centiles—indicating more severe degrees of myopia—remained elevated longer in male subjects

These patterns mirror global epidemiological trends: East Asia has some of the highest rates of childhood myopia in the world, a public health issue linked with increased risk of sight-threatening conditions later in life. 

Like pediatric height and weight charts, refractive error centile curves allow eye care professionals to track an individual’s visual development over time and estimate their risk of developing high myopia. Such curves are valuable for early detection and intervention when lifestyle changes or clinical treatments might slow progression. The researchers also devised a new statistical method to align cycloplegic and non-cycloplegic measurements, making it easier to combine large datasets that use different clinical protocols. 

According to the reserchers, by accounting for age, sex, and regional differences, the new centile curves offer a more nuanced and clinically useful benchmark than previous refractive reference charts. They not only reflect natural variation in eye growth across populations but also offer a standardized baseline for evaluating the effectiveness of myopia control strategies—from spectacle lenses and contact lenses to pharmacologic interventions.

Reference

Tideman, JWL., Polling, JR, Jaddoe, VWV, Klaver, CCW, & International Refractive Error Study Consortium. (2025). Refractive error centile curves for Asian and Western children and adolescents. Investigative Ophthalmology & Visual Science, 66(15), Article 30.
https://doi.org/10.1167/iovs.66.15.30