ORIGINAL RESEARCH article
Front. Med.
Sec. Ophthalmology
Association Between Fundus Tessellated Density and Subfoveal Choroidal Thickness in Children with Different Refractive Statuses
1. Department of Ophthalmology, Affiliated Second Hospital, Chongqing Medical University, Chongqing 400010, China, Chongqing, China
2. Department of Ophthalmology, Affiliated Shapingba Hospital, Chongqing University, Chongqing 400037, China, Chongqing, China
3. EVision technology (Beijing) co. LTD, Beijing, China
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Abstract
Objective: Present study aimed to quantitatively evaluate the association between fundus tessellated density (FTD) and subfoveal choroidal thickness (SFCT) in children with different refractive statuses and to explore the potential of FTD as a non-invasive biomarker for monitoring myopic progression. Methods: A cross-sectional study was conducted involving 619 eyes of 315 children aged 6–12 years. Participants were classified into four refractive groups: hyperopia, pre-myopia, low myopia, and moderate-to-high myopia. FTD was quantitatively assessed using artificial intelligence (AI)-based analysis of color fundus photographs. SFCT and central subfield thickness (CST) were measured using swept-source optical coherence tomography (SS-OCT). Correlation and threshold effect analyses were performed to examine the relationship between FTD and SFCT. Results: SFCT decreased significantly with increasing myopic severity (p < 0.001), while FTD showed a corresponding increase (p < 0.001). A significant negative correlation was observed between FTD and SFCT in pre-myopia (r = –0.183, p = 0.019), low myopia (r = –0.335, p < 0.001), and moderate-to-high myopia (r = –0.222, p = 0.008) groups, but not in hyperopia (p = 0.454). A nonlinear threshold effect was identified: when SFCT decreased below 148.90 µm in the overall cohort, FTD increased markedly, suggesting that this value may serve as a potential reference point for myopia management. This threshold decreased with higher myopic severity. CST did not follow a linear gradient with refraction but was increased in moderate-to-high myopia. Conclusion: FTD and SFCT are significantly associated in a nonlinear manner strongly correlated in myopic children, with a defined threshold effect that varies by refractive status. AI-based FTD measurement offers a reproducible and accessible method for quantifying early structural changes in myopia. The identified nonlinear relationship and threshold suggest that combined assessment of FTD and SFCT may hold promise for improving early detection and monitoring of pediatric myopic progression, warranting further longitudinal validation.
Summary
Keywords
artificial intelligence, biomarker, Fundus tessellated density, Pediatric myopia, Subfoveal choroidal thickness
Received
26 September 2025
Accepted
20 February 2026
Copyright
© 2026 Zhang, Yan, Zhang, Wang, Wang and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Xi Yuan Zhou
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