Association Between Pediatric Obesity and Ocular Structural Parameters: A Cross-Sectional Study

Background/Objectives: To explore potential associations between pediatric obesity and retinal and anterior segment ocular structures using OCT and ocular biometry. This study was designed as an exploratory, hypothesis-generating analysis without a pre-specified primary endpoint; all findings should be interpreted accordingly. Methods: This retrospective cross-sectional study included 52 children (104 eyes): 27 obese children (body mass index (BMI) percentile ≥95%) and 25 healthy controls (BMI percentile 5–85%). Optical coherence tomography (OCT) and ocular biometry were used to assess retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), focal loss volume (FLV), global loss volume (GLV), Early Treatment Macular Map 5 (EMM5), corneal parameters, axial length (AL), anterior chamber depth (ACD), and white-to-white corneal diameter (WTOW). Group comparisons and cluster-robust bootstrap regression adjusted for inter-eye dependency, age, and sex; Bonferroni correction was applied. Results: Obese children showed nominally higher GCC average thickness, RNFL, and EMM5 values and shallower ACD; however, no parameter survived Bonferroni correction. ACD showed the most internally consistent exploratory pattern (unadjusted p = 0.006; adjusted p = 0.018; Bonferroni p = 0.249); however, this finding did not survive Bonferroni correction and should not be interpreted as a confirmed association. Other corneal and biometric parameters were not significantly different. Conclusions: Pediatric obesity may be associated with subtle ocular structural variations, but all findings are exploratory and hypothesis-generating. Larger prospective, pre-registered studies are needed to determine whether pediatric obesity is associated with structural ocular changes.