<p><strong>Background: </strong>Axial length is key in determining the underlying cause of refractive errors, including myopia. It is essential for assessing myopic progression or risk in patients.<br /><strong>Aim: </strong>To systematically evaluate associations between ocular axial length and various ocular biometric, demographic, and anthropometric parameters.<br /><strong>Method: </strong>A systematic review was conducted on studies highlighting the significance of axial length and its associations with anthropometric factors including height, and body mass index, ocular biometry factors including refractive error, corneal thickness and radius, crystalline lens, anterior chamber depth, vitreous chamber depth, retinal, choroidal, and scleral thicknesses, and demographic factors including age, ethnicity, race and gender. The review includes studies demonstrating the impact of axial length changes on the eye's refractive status.<br /><strong>Results: </strong>Axial length is associated with anthropometric, ocular biometric, and demographic metrics, suggesting a complex interplay of factors. Increased axial length is linked to increased anterior chamber depth, vitreous chamber depth, body height, and myopia. Axial length is negatively associated with spherical equivalent refractive error, lens and choroidal thickness.<br /><strong>Conclusion: </strong>The interplay of age, gender, ethnicity, and environmental factors complicates the generalization of axial length measurements. The strength and direction of these associations vary across studies, indicating complex relationships between factors. Tailored axial length norms based on individual characteristics are necessary, highlighting the need for population-based studies to minimize the generalization of ocular biometry in clinical practice.<br /><strong>Contribution: </strong>This review emphasizes the need for population-specific norms in ocular biometry, considering factors like age, gender, ethnicity, and stature to enhance the precision and applicability of axial length measurements in clinical practice. The scarcity of instruments to measure axial length in primary and community eye care settings may hinder myopia control treatments.</p>