Background: Relative peripheral retinal defocus has been implicated in refractive development, but multispectral refractive topography (MRT) patterns in early school-aged children remain incompletely characterized. This study evaluated MRT-derived relative peripheral retinal defocus patterns and their associations with myopia-related ocular parameters. Materials and Methods: This study included 115 children, aged 5-8 years, who underwent cycloplegic autorefraction, optical biometry, and MRT between July and November 2024. Right-eye data were analyzed. Spherical equivalent (SE), axial length (AL), mean keratometry (Km), and the axial length/corneal radius ratio (AL/CR) were calculated. Relative peripheral retinal defocus parameters were measured within a 53°retinal field and classified into volcanic mouth, hemiolateral upturned, saddle, and relatively flat patterns. Correlations and between-group differences were analyzed. Results: Diopter sphere (DS) was negatively correlated with total retinal defocus value (TRDV), 0-30°defocus (RDV-30), 0-45°defocus (RDV-45), 15-30°defocus (RDV-15-30), 30-45°defocus (RDV-30-45), and inferior defocus value (RDV-I) (all P<0.05). SE was negatively correlated with RDV-30, RDV-45, RDV-15-30, RDV-30-45, and RDV-I (all P<0.05). The hemiolateral upturned pattern was the most frequent pattern (31.30%), followed by the volcanic mouth (26.09%), saddle (22.61%), and relatively flat (20.00%) patterns. SE, DS, AL, AL/CR, and regional defocus parameters differed significantly among patterns (P<0.05). Conclusion: MRT-derived relative peripheral retinal defocus patterns were associated with refractive status and ocular biometry in early school-aged children. The volcanic mouth pattern was linked to a more myopic ocular profile, whereas the relatively flat pattern was linked to a more hyperopic profile. |