The Gompertz function provides estimates of the age and the amount of myopia at stabilization in an ethnically diverse cohort. These findings should provide guidance on the time course of myopia and on decisions regarding the type and timing of interventions.

Our findings highlight the importance of intangible factors such as staff attributes and participants' study commitment in maintaining high retention rates, and the usefulness of surveying both families and staff.

Purpose To examine the relationship of choroidal thickness with axial length (AL) and myopia in young adult eyes in the ethnically diverse Correction of Myopia Evaluation Trial (COMET) cohort. Design Cross-sectional, multi-center, study Methods In addition to measures of myopia by cycloplegic autorefraction and AL by A-scan ultrasonography, participants underwent optical coherence tomography imaging of the choroid (RTVue) in both eyes at their last visit (14 years after baseline). Using digital calipers, two independent readers measured choroidal thickness in the right eye (left eye if poor quality; n=37) at seven locations: fovea and 750, 1500, 2250μm nasal (N) and temporal (T) to the fovea. Results Choroidal thickness measurements were available from 294/346 (85%) of imaged participants (mean age: 24.3±1.4 years; 44.9% male) with mean myopia of -5.3±2.0D and mean AL of 25.5±1.0mm. Overall, choroidal thickness varied by location (p<0.0001) and was thickest at the fovea (273.8±70.9 μm) and thinnest nasally (N2250,191.5±69.3 μm). Multivariable analyses showed significantly thinner choroids in eyes with more myopia and longer AL at all locations except T2250 (p≤0.001) and presence of peri-papillary crescent at all locations except T1500 and T2250 (p≤0.0001). Choroidal thickness varied by ethnicity at N2250 (p<0.0001), with Asians having the thinnest and African Americans the thickest choroids. Conclusion Choroids are thinner in longer, more myopic young adult eyes. The thinning was most prominent nasally and in eyes with a crescent. In the furthest nasal location, ethnicity was associated with choroidal thickness. The findings suggest that choroidal thickness should be evaluated, especially in the nasal regions where myopic degenerations are most commonly seen clinically.

Purpose: To evaluate the association between outdoor and nearwork activities at baseline and myopia stabilisation by age 15 in the Correction of Myopia Evaluation Trial (COMET). Methods: Correction of Myopia Evaluation Trial enrolled 469 children (ages: 6-11 years) with spherical equivalent myopia between À1.25 and À4.50 D, who were randomised to progressive addition or single vision lenses and followed for 5 years in their original lenses. At baseline, families recorded the child's outdoor and nearwork activities for 3 days within a week. Weekly hours spent in nearwork and outdoor activities were calculated for each participant. Refractions collected over 11 years were fit using the Gompertz function to determine each participant's myopia stabilisation age. Myopia for each child was then categorized as stable/not stable by age 15. Results: Half (233/469) of participants had usable baseline activity diaries and refraction data that could be fit with the Gompertz function, 59.7% (139/233) had stable myopia by age 15 and 40.3% had myopia that was not yet stable. The frequency of stable myopia was similar for the two categories (median split) of outdoor activities: 60% (71/118) for ≤9.0 hours/week À1 and 59% (68/115) for >9.0 hours/week À1 . 56% (64/114) of children reporting >21.0 h of baseline weekly nearwork activity had stable myopia by age 15 compared to 63% (75/119) with ≤21.0 h of near work (adjusted OR = 0.74; 95% CI: 0.43-1.29). Using baseline nearwork as a continuous variable, the multivariable odds ratio for the association between baseline nearwork hours and stabilisation by age 15 is 0.98: 95% CI: 0.96-1.00, a result trending towards significance. Conclusion: While time spent in outdoor activities in childhood does not appear to be related to myopia stabilisation by age 15, less near work activity might potentially be associated with myopia stabilisation by that age.

Purpose To investigate myopia progression in Correction of Myopia Evaluation Trial (COMET) participants who switched to soft contact lenses (CLs) versus remained in spectacles after the clinical trial ended. Methods 469 ethnically diverse, 6–11 year old myopic children were randomly assigned to wear single vision lenses (SVLs) or progressive addition spectacle lenses (PALs) for 5 years as part of COMET. Afterwards they could choose another lens type, including CLs. Data in this paper are from 286 participants who wore their original spectacle lenses for 6 years (n =199) or wore CLs most or all of the time between the 5- and 6-year visits (n =87). Refractive error and axial length (AL) were measured after cycloplegia with 1% Tropicamide. The primary outcome was myopia progression between the 5- and 6-year visits. Two-year myopia progression was evaluated in a subset of 183 participants who wore the same lens type for an additional year. Myopia progression and AL were compared between the two lens groups using multiple linear regression. Results Participants in the two groups were similar with respect to age, ethnicity, myopia at 5-years, accommodation and phoria, but more girls switched to CLs than remained in spectacles (p<0.0001). Mean (± SD) myopia progression was higher (p=0.003) after one year in the CL group (−0.28 ± 0.33D) than the spectacle group (−0.14 ± 0.36D), and remained higher after two years in the 2-year subset (− 0.52 ± 0.46D versus −0.25 ± 0.39D, p<0.0001). Results were similar after adjustment for related factors. No significant differences in AL were found between groups after adjustment. Corneal curvature remained unchanged in both groups. Conclusions COMET children switching from glasses to contact lenses experienced a small, statistically significant but clinically inconsequential increase in myopia progression.

Baseline self-esteem is associated with visual symptoms, age, gender, and ethnicity, but not with magnitude of refractive error. Follow-up reports will assess whether there are changes in self-esteem associated with myopia progression and lens assignment.

Purpose To investigate refractive error, especially myopia, in parents of myopic children and its association with education and occupation. Methods Six hundred and twenty seven parents (n = 375 mothers and 252 fathers) of the 469 myopic 6 to <12 year-old children enrolled in COMET provided refraction data as well as answered questions about their education and occupation. Eighty-five percent of the refractions were obtained by non-cycloplegic autorefraction (Nidek ARK 700A) and 15% were obtained from the most recent prescription. Results The mean age ± SD of the parents was 44.26 ± 5.81 years, and their mean spherical equivalent refraction (SER) was −2.34 ± 2.94 D. Parents with higher education (college degree or greater) had significantly more myopia (−2.97 ± 2.98 D) than parents with lower education (−1.72 ± 2.76 D). The odds of being myopic was significantly higher in the higher education group (multivariate OR = 2.12, 95% CI = 1.41, 3.19). Mean myopia also differed significantly by occupation, with parents in white collar jobs (−2.87 ± 3.10 D) significantly more myopic than those in blue collar jobs (−1.21 ± 2.02 D) by 1.66 D (p < 0.001). The odds of being myopic between the two occupation groups was of borderline significance (multivariate OR=1.61, 95% CI= 0.999, 2.60). Conclusions The parents of myopic children participating in a clinical trial of lenses to slow the progression of myopia had a high prevalence of myopia that was associated with their level of education and to a lesser extent with their choice of occupation. To our knowledge, this is the first account of refractive errors, education, and occupation in parents of a large group of myopic children.

Lens assignment and myopia progression were not associated with self-esteem in the COMET cohort. These children had high levels of self-esteem, suggesting that having myopia does not negatively impact self-esteem. Follow-up reports will monitor self-esteem and related factors in this cohort of myopic children over the course of adolescence and early adulthood.