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Opt."],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      Examine the association between body mass index (BMI) and astigmatism directionality using vector analysis of refractive and corneal components (\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      ,\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>45<\/jats:sub>\n                      ) in a nationally representative sample of schoolchildren. Refractive and corneal\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      was the primary outcome, with secondary aims to assess whether BMI influences astigmatism severity or other refractive and axial parameters.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This cross-sectional study recruited 1626 schoolchildren aged 6\u20137 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009728) and 12\u201313 years (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009898) from 37 randomly selected schools in Ireland. Cycloplegic autorefraction and ocular biometry were obtained. Height and weight were measured and BMI calculated and analysed as a continuous predictor, with WHO-defined BMI categories used for secondary severity modelling. Refractive and corneal astigmatism were decomposed into vector components (\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      ,\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>45<\/jats:sub>\n                      ). Multivariate linear regression assessed associations between BMI and\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      ,\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>45<\/jats:sub>\n                      , spherical equivalent refraction (SER), axial length (AL) and axial length\/corneal radius (AL\/CR) ratio, adjusted for sex, ethnicity, socioeconomic status and urban\/rural location. Ordinal logistic regression examined associations between BMI category and clinically defined astigmatism severity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Higher BMI was associated with a positive shift in refractive\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      , indicating increased with-the-rule astigmatism. Associations were small but consistent in both age groups: 12\u201313 years (corneal\n                      <jats:italic>J<\/jats:italic>\n                      \u2080\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.03,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; refractive\n                      <jats:italic>J<\/jats:italic>\n                      \u2080\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.02,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and 6\u20137 years (corneal\n                      <jats:italic>J<\/jats:italic>\n                      \u2080\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.03,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008; refractive\n                      <jats:italic>J<\/jats:italic>\n                      \u2080\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.03,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007). Associations with\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>45<\/jats:sub>\n                      were weak and inconsistent. BMI was not associated with SER, AL or the AL\/CR ratio. Compared with non-overweight peers, children with obesity had higher odds of moderate-to-severe astigmatism (6\u20137 years: OR\u2009=\u20095.26, 95% CI: 1.70\u20139.37; 12\u201313 years: OR\u2009=\u20092.50, 95% CI: 1.00\u20134.34).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Higher BMI was independently associated with increased\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      , indicating greater with-the-rule refractive and corneal astigmatism, without evidence of an effect on axial length or overall refractive status. These cross-sectional findings suggest a potential biomechanical influence on corneal toricity, highlighting the need for longitudinal studies to clarify causality and mechanisms.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s44402-026-00032-4","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T07:23:19Z","timestamp":1772436199000},"page":"230-241","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Body Mass Index is Associated With Direction-Specific Increases in With-the-Rule Corneal and Refractive Astigmatism in Schoolchildren"],"prefix":"10.1007","volume":"46","author":[{"given":"Eoin","family":"Kerin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Moore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Loughman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00edofra","family":"Harrington","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"32_CR1","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1097\/OPX.0000000000001998","volume":"100","author":"J Zhang","year":"2023","unstructured":"Zhang J, Wu Y, Sharma B, Gupta R, Jawla S, Bullimore MA. 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