Crystalline Lens Tilts Less With Higher Myopia in Children With Limited Age-Related Effect.

PURPOSE: To evaluate tilted crystalline lens morphology in children across different orientations and their correlations with age and spherical equivalent (SE). METHODS: This cross-sectional study encompassed 966 eyes of 493 children (5-15 years; SE, -6.00 to +3.00 diopters [D]). The binocular crystalline lens biometrics in 16 orientations were measured using swept-source anterior segment optical coherence tomography. Parameters included the anterior radius of the lens (LAR), posterior radius of the lens (LPR), thickness, and diameter, as well as lens tilt and decentration. Group comparisons were performed among non-, low-, and moderate-myopic eyes. RESULTS: Lens tilt and decentration demonstrated semi-periodic variations (R2 = 0.984 and R2 = 0.789, respectively). Lenses predominantly tilted temporal-inferiorly, with corresponding temporal decentration. The non-myopia group had significantly higher LAR and LPR (more curved) than the low- and moderate-myopia groups (all P < 0.001). As myopia increased, lens tilt consistently decreased across all refractive subgroups (all P < 0.001), whereas other parameters either reached a turning point at approximately -4.00 D or showed no linearity. Age-stratified polynomial analysis revealed that the positive correlation between lens tilt and SE remained strong within the range of -4.18 D to +3.00 D. CONCLUSIONS: Although the lens maintains a greater tilt toward the temporal and inferior regions, it exhibits less tilt and becomes more orthotopic in eyes with higher myopia across different age groups in children. TRANSLATIONAL RELEVANCE: This study established crystalline lens tilt as a robust, less age-dependent biomarker that could enhance the prediction of myopia progression and facilitate individualized risk assessment in pediatric refractive development.