The Limited Value of Prior Change in Predicting Future Progression of Juvenile-onset Myopia

Abstract

SIGNIFICANCEIdentifying children at highest risk for rapid myopia progression and/or rapid axial elongation could help prioritize who should receive clinical treatment or be enrolled in randomized clinical trials. Our models suggest that these goals are difficult to accomplish.PURPOSEThis study aimed to develop models predicting future refractive error and axial length using children's baseline data and history of myopia progression and axial elongation.METHODSModels predicting refractive error and axial length were created using randomly assigned training and test data sets from 916 myopic participants in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study. Subjects were 7 to 14 years of age at study entry with three consecutive annual visits that included cycloplegic A-scan ultrasound and autorefraction. The effect of adding prior change in axial length and refractive error was evaluated for each model.RESULTSAge, ethnicity, and greater myopia were significant predictors of future refractive error and axial length, whereas prior progression or elongation, near work, time outdoors, and parental myopia were not. The 95% limits for the difference between actual and predicted change were ±0.22 D and ±0.14 mm without prior change data compared with ±0.26 D and ±0.16 mm with prior change data. Sensitivity and specificity for identifying fast progressors were between 60.8 and 63.2%, respectively, when the cut points were close to the sample average. Positive predictive value and sample yield were even lower when the cut points were more extreme.CONCLUSIONSYoung, more myopic Asian American children in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study were the most likely to progress rapidly. Clinical trials should expect average progression rates that reflect sample demographics and may have difficulty recruiting generalizable samples that progress faster than that average. Knowing progression or elongation history does not seem to help the clinical decision regarding initiating myopia control.

The effects of topical cycloplegics in acute acquired comitant esotropia induced by excessive digital device usage

“…There were significant associations between the pre-and post-treatment stereoacuity. There was a tendency for deterioration in the stereoacuity after a 3-month observation period Changes in the tonus of accommodation and binocular vergence have been reported after near work [17], especially after hours of work with digital devices [18,19]. As compared to that found for ordinary hard copy workers, digital devices workers exhibit a higher ratio of abnormal accommodation and convergence [20].…”

Myopia progression patterns among paediatric patients in a clinical setting

“…The proportion of children that experienced myopic progression increased as a function of the recall interval, but even at a 12‐month interval, 25%–62% of children aged <12 years had myopia progression of <−0.50 D/year, compared to 14% of adolescents aged >13 years. Past myopic progression alone has not been found to correlate well with predicted future progression, 62 so clinicians should consider the individual child and their specific risk factors in totality when determining the appropriate recall period. For those children prescribed a myopia control treatment, it may be expected that myopic progression will reduce; however, 6 monthly recalls may still be warranted to ensure continued progression is not taking place due to treatment non‐compliance or ineffective treatments.…”

Modelling changes in the prevalence of childhood myopia

“…8,25 For example, in a survey among paediatric ophthalmologists around the world, the cut-off criterion for initiation of myopia management was a myopia progression rate of 1.10 D/ year. 27 However, Mutti et al 28 stated that 'knowing progression or elongation history does not seem to help the clinical decision regarding initiating myopia control'.…”