Abstract

Background/Objectives: Progressive axial elongation is a key structural indicator of myopia progression. In school-based screening, repeated ocular biometry may not always be feasible; routinely collected visual-acuity information may support follow-up prioritization. This study examined the association between stable habitual spectacle-corrected distance visual-acuity profiles and annualized axial length growth. Methods: This retrospective real-world cohort study used the Chengdu school-based myopia screening database. Children aged 7.0–9.9 years with screening—defined as low-to-moderate myopia and three consecutive screening visits—were classified as adequately corrected (ACG), functionally under-corrected (UCG), or uncorrected myopia (UMG) according to stable spectacle-wearing and visual-acuity profiles. The primary outcome was annualized axial length growth from baseline to the second follow-up (ΔAL). The primary analysis used 1:1 propensity-score matching; robustness was assessed using interval-specific outcomes, alternative caliper widths, and full-cohort multivariable regression. Results: The final cohort included 4152 children: 391 ACG, 551 UCG, and 3210 UMG. Matching retained 313 ACG–UCG pairs and 387 UCG–UMG pairs. ΔAL was lower in the ACG than in the UCG groups (0.224 vs. 0.362 mm/year; mean difference, −0.139; 95% CI, −0.165 to −0.112; p < 0.001). No statistically significant ΔAL difference was detected between the UCG and UMG (p = 0.412). Sensitivity analyses yielded consistent findings. Conclusions: Stable habitual spectacle-corrected distance visual-acuity profiles were associated with annualized axial length growth. Achieved visual acuity under habitual spectacle-wearing conditions may provide information beyond spectacle-wearing status alone; however, these observational findings do not establish equivalence, predictive utility, or causality.

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