Daily axial length and choroidal thickness variations in young adults: Associations with light exposure and longitudinal axial length and choroid changes

Evidence from animal studies suggests that the eye's natural diurnal rhythms can be disrupted by altering the light/dark cycle or during refractive error development. Although diurnal variations in axial length (AL) and choroidal thickness are well documented in human eyes, the relationship between ambient light exposure, refractive error progression and diurnal AL and choroidal thickness variations is not well understood. Therefore we examined the association between objective ambient light exposure and daily variations in AL and subfoveal choroidal thickness (SFCT), along with longer-term changes in AL and SFCT over 12 months. Thirty-four young adult emmetropes and myopes had their daily variations (measurements ~ every 3 h from 9 a.m. to 9 p.m.) in AL and SFCT assessed on a weekday and weekend in winter and then six months later in summer. Participants then returned six months later for a single measurement session to determine the longer-term change in AL and SFCT. Personal ambient light exposure was captured in winter and summer using wrist-worn light sensors (Actiwatch-2) worn for 14 days over the same period of time when the diurnal measurements were collected. Linear mixed model analyses revealed significant daily variations in AL and SFCT (each p < 0.05). The mean daily peak to trough difference (amplitude) in AL was significantly greater in myopes (0.020 mm; 95% CI: 0.014-0.026 mm) compared to emmetropes (0.010 mm; 95% CI: 0.005-0.015 mm) (p < 0.01), but the SFCT variations were not significantly different between the refractive groups (p = 0.45). Daily variations in AL were negatively associated with the daily SFCT variations (r = -0.603, p < 0.001). Correlation analyses indicated that the amplitude of daily AL variations was negatively associated with the daily time exposed to bright light (r = -0.511, p = 0.002) and positively associated with the longitudinal AL changes over 12 months (r = 0.381, p = 0.04). There was an inverse association between the longer-term changes in AL and SFCT (r = -0.352, p = 0.002). The daily ocular diurnal variations were not significantly different between weekdays and weekends, or between summer and winter (each p > 0.05). In summary, diurnal variations in AL were higher in amplitude in myopes compared to emmetropes and were also associated with longitudinal changes in AL. These findings suggest that diurnal variations may be associated with longer-term axial eye growth. Time spent in bright light also significantly influenced the amplitude of daily AL variations, with more time exposed to bright light associated with a smaller amplitude of diurnal AL change. Choroidal thickness exhibited an inverse association with the AL changes, implying a potential role for the choroid in eye growth.