Ocular Dominance at Near versus Distance: Links to Axial Elongation and Refractive Progression

Objective: To investigate the associations between ocular dominance under near and distance viewing conditions and subsequent axial elongation as well as refractive progression. Methods: A total of 105 children and adolescents aged 6–16 years who attended the Ophthalmology Outpatient Clinic of Hainan General Hospital between September 2024 and September 2025 were enrolled. Ocular dominance was determined using two approaches: near dominance was identified with a modified near-hole-in-the-card test (Group A), while distance dominance was assessed using the conventional hole-in-the-card test (Group B). Consistency between dominance classifications obtained by the two methods was evaluated. Furthermore, axial length elongation and refractive change were compared between dominant and non-dominant eyes as defined by each method. Results: Ocular dominance differed between near and distance testing (McNemar test, P = 0.024). During near viewing, dominant eyes showed greater axial elongation ( P = 0.001) and faster refractive progression ( P = 0.009) than non-dominant eyes; these associations were not observed for distance dominance. Across both testing distances, dominant eyes had lower cylindrical power than nondominant eyes ( P < 0.001). Conclusion: Near and distance ocular dominance are not interchangeable. Near dominant eyes are more prone to accelerated axial growth and myopic progression, and dominance at either distance was associated with lower astigmatism than the non-dominant eye.