Association between intraocular pressure and myopia in healthy children and adolescents: a systematic review and meta-analysis

Myopia is a major cause of visual impairment worldwide, and intraocular pressure (IOP) is now known as a promising associated factor in myopia progression. While some studies suggest that IOP correlates with spherical equivalent (SE) and axial length (AL), findings across the literature remain inconsistent. This systematic review and meta-analysis quantitatively evaluated the association between IOP and refractive status in pediatric populations. PubMed, Embase, Cochrane Library, Web of Science Core Collection, Ovid, CNKI, and Wanfang database were searched from inception to March 3, 2026, for observational studies reporting the correlation between IOP and refractive parameters. Evidence certainty was assessed using the GRADE approach. Random-effects models were employed to pool correlation coefficients ( r ). Nineteen observational studies comprising 13,451 children and adolescents were included. The pooled negative correlation between IOP and SE was statistically significant but became non-significant after trim-and-fill adjustment for small-study effects. No significant correlations were found between IOP and axial length or SE progression. Subgroup analyses indicated that clinical setting and sample size were significant sources of heterogeneity in the IOP–SE correlation. IOP levels in healthy children and adolescents showed a weak negative association with SE, and no significant association with AL. The IOP-SE association was not robust in a trim-and-fill sensitivity analysis for potential small-study effects.