PONE-D-24-41318Physiological growth of axial length among Chinese children and teenagers: A 6-year cohort studyPLOS ONE

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PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This manuscript investigated an important issue related to the physiological growth of axial length among Chinese children and teenagers, providing insights from a 6-year longitudinal cohort study. While the study offers valuable data and perspectives, several aspects require revision for clarity, depth, and rigor.

1. The differences between the two calculation methods for AL growth need better distinction.

2. Please explain the logistic regression models more clearly, especially decision criteria for cutoff points.

3. Authors should discuss the impact of not having lens thickness data on your findings more thoroughly.

4. Please use consistent terminology and clearer subheadings to improve the flow and clarity of the results.

5. It’s important to tie findings more directly to clinical implications for myopia management strategies.

Reviewer #2: The manuscript titled "Physiological growth of axial length among Chinese children and teenagers: A 6-year cohort study" investigates axial length (AL) growth patterns among Chinese youth, aiming to discern physiological from pathological AL elongation associated with myopia progression. Utilizing annual measurements from a cohort of 916 children, the study highlights variations in AL growth across different refractive statuses (emmetropia, incident myopia, persistent myopia) and explores threshold growth rates that may inform myopia control strategies.

1. It is better to mention the ocular (ocular axial length) in the title to indicate the research aim and objectives well.

1. Including "ocular axial length" in the title would enhance clarity, directly aligning the title with the study’s specific aim and objectives, thereby making the research focus immediately apparent.

2. It is recommended to provide detailed follow-up information, including a flowchart illustrating the participant selection process and any losses to follow-up, as this would strengthen the study's transparency and reproducibility.

3. The manuscript should clarify whether potential confounders or covariates were accounted for in the analysis to control their influence on the outcomes, thus reinforcing the robustness of the findings.

4. A comprehensive description of all statistical methods utilized is essential in the Methods section, allowing readers to fully understand and evaluate the analytical approach.

5. Reporting corrected confidence intervals for primary variables and analyses is advised to enhance the precision and interpretability of the results.

6. To improve the figure illustrating axial length (AL) growth, the use of distinct colors for each group would facilitate reader comprehension and improve visual distinction among data categories.

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Reviewer #1: No

Reviewer #2: No

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Physiological growth of axial length among Chinese children and teenagers: A 6-year cohort study

PONE-D-24-41318R1

Dear Dr. Chen,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Clara Martínez Pérez

Academic Editor

PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have done an excellent job revising the manuscript. The improvements and clarifications they’ve made greatly enhance the overall quality and readability of their work.

Reviewer #2: I appreciate the authors' efforts and the revisions they have made. No more comments or revisions are needed

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: No

Reviewer #2: No

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