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Opt."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Pseudomyopia is an accommodative disorder that can be identified by the difference between pre- and post-cycloplegic refractive error. The current study aimed to evaluate whether the axial length to corneal curvature (AL\/CR) ratio, in conjunction with non-cycloplegic refractive error, can reliably identify pseudomyopia in children, thus avoiding the need for cycloplegia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Refractive error and biometry data from longitudinal studies based in Denmark (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009645; age 7\u201317 years) and China (Anyang Childhood Eye Study;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092487; age 6\u201313 years) were used to train separate linear mixed models for children of European or East Asian ancestry, respectively, with AL\/CR ratio as outcome and cycloplegic spherical equivalent refractive error (SER), age and sex as predictors. The models could be used to calculate the AL\/CR 95% prediction interval in a child of known age, sex and\n                      <jats:italic>non-cycloplegic<\/jats:italic>\n                      SER; if the child\u2019s AL\/CR fell below the lower limit of the AL\/CR 95% prediction interval, then the child was classified as pseudomyopic. The European and East Asian models were externally validated using data from participants of the Ireland Eye Study (IES;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200992) and Sydney Myopia Study (SMS;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009686) cohorts, and the Hong Kong Children Eye Study (HKCES;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20099519) and Vietnam (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091165) cohorts, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The European model demonstrated moderate detection accuracy for pseudomyopia: sensitivity\u2009=\u20090.82 (IES) and 0.81 (SMS); specificity\u2009=\u20090.75 in both cohorts. By contrast, the East Asian model performed poorly: sensitivity\u2009=\u20090.22 (HKCES) and 0.13 (Vietnam); specificity\u2009=\u20090.99 in both cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite moderate diagnostic performance in European samples, the current AL\/CR-based models lacked sufficient accuracy for screening and performed poorly in East Asian children, suggesting that AL\/CR is not a reliable non-cycloplegic marker of pseudomyopia. Further studies incorporating additional ocular biometric parameters and employing a more rigorous definition of pseudomyopia may build on these initial findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s44402-026-00185-2","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:11:05Z","timestamp":1789726265000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Axial Length to Corneal Curvature Ratio is Insufficient for Detecting Pseudomyopia in Children: A Multi-Cohort Study"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0733-5281","authenticated-orcid":false,"given":"Huyen T.","family":"Bui","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8744-684X","authenticated-orcid":false,"given":"Dirk J.","family":"van Hemert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5798-4843","authenticated-orcid":false,"given":"Tianli","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhui","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8985-5520","authenticated-orcid":false,"given":"Hai-Yen T.","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8309-8063","authenticated-orcid":false,"given":"Hannah","family":"Noor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2667-1796","authenticated-orcid":false,"given":"Siofra C.","family":"Harrington","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2689-5896","authenticated-orcid":false,"given":"Sander C. 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