Prediction of myopia onset with refractive error measured using non-cycloplegic subjective refraction: the WEPrOM Study

Predicting the onset of myopia in children by age, sex, and ethnicity: Results from the CLEERE Study

SIGNIFICANCE

Clinicians and researchers would benefit from being able to predict the onset of myopia for an individual child. This report provides a model for calculating the probability of myopia onset, year-by-year and cumulatively, based on results from the largest, most ethnically diverse study of myopia onset in the United States.

PURPOSE

This study aimed to model the probability of the onset of myopia in previously nonmyopic school-aged children.

METHODS

Children aged 6 years to less than 14 years of age at baseline participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study who were nonmyopic and less hyperopic than +3.00 D (spherical equivalent) were followed up for 1 to 7 years through eighth grade. Annual measurements included cycloplegic autorefraction, keratometry, ultrasound axial dimensions, and parental report of children's near work and time spent in outdoor and/or sports activities. The onset of myopia was defined as the first visit with at least -0.75 D of myopia in each principal meridian. The predictive model was built using discrete time survival analysis and evaluated with C statistics.

RESULTS

The model of the probability of the onset of myopia included cycloplegic spherical equivalent refractive error, the horizontal/vertical component of astigmatism (J0), age, sex, and race/ethnicity. Onset of myopia was more likely with lower amounts of hyperopia and less positive/more negative values of J0. Younger Asian American females had the highest eventual probability of onset, whereas older White males had the lowest. Model performance increased with older baseline age, with C statistics ranging from 0.83 at 6 years of age to 0.92 at 13 years.

CONCLUSIONS

The probability of the onset of myopia can be estimated for children in the major racial/ethnic groups within the United States on a year-by-year and cumulative basis up to age 14 years based on a simple set of refractive error and demographic variables.

Development of a risk score for myopia: A cohort study conducted among school-aged children in China

PURPOSE

To evaluate the myopia risk in school-aged children one year after lifting a pandemic-related lockdown and develop a tool to identify high-risk groups.

METHODS

In total, 38,079 children without myopia from 38 schools were included. The outcomes were myopia incidence and progression in 1 year after the COVID-19 lockdown was lifted, both obtained by the spherical equivalent refraction (SER). We separated the population into an exploratory (75%) and a validation sample (25%) to construct the risk score model.

RESULTS

In total, 9811 (29.57%) students became myopic, and the overall myopia progression was 0.22 ± 0.62 D. Even less myopia progression was noted in the pre-myopia group at baseline (All: P = 0.045, Boy: P = 0.005). The risk score model included seven predictors: gender, grade, SER at baseline, residence, parental myopia, eye discomfort symptoms, and online courses. The model had a score range of 0-46 and an optimal cutoff of 34. The area under the receiver operating curve of the model was 0.726 (0.719-0.732) for the exploratory sample and 0.731 (0.720-0.742) for the validation sample.

CONCLUSIONS

The risk score can serve as a practical tool for classifying the risk of myopia in school-aged children.

Global risk factor analysis of myopia onset in children: A systematic review and meta-analysis

INTRODUCTION

This work aimed to comprehensively assess the risk factors affecting myopia in children to develop more effective prevention and treatment strategies. To this end, data from database were employed to assess the relationship between the incidence of myopia and its risk factors.

METHODS

We searched eight databases online in June 2022. Cohort studies were included that measured the connection between risk factors and myopia. Eligibility was not restricted by language. The Newcastle-Ottawa Scale (NOS) was used to measure the risk of bias and conducted GRADE evaluation to determine the certainty of evidence. Potential risk factors with positive or negative results were seen. Inplasy Registration: https://inplasy.com/inplasy-2022-4-0109/.

RESULTS

Evidence that risk factors for myopia are mixed, comprising both positive (20) and null (17) findings. In 19 cohort studies on 3578 children, girls were more likely to develop myopia (RR: 1.28 [1.22-1.35]). Myopia can occur at any age, from early childhood to late adulthood. Children whose parents had myopia were more likely to develop myopia. Longer outdoor activities time (RR: 0.97 [0.95-0.98]) and less near-work time (RR: 1.05 [1.02-1.07]) appeared to be significantly decrease the incidence of myopia. Children with lower SE, longer AL, a lower magnitude of positive relative accommodation, worse presenting visual acuity, deeper anterior chamber, and thinner crystalline lens may be related to myopia onset. The burden of myopia in underprivileged countries is higher than in developed countries (RR: 5.28 [2.06-13.48]). The quality of evidence for the evaluated factors was moderate to low or very low.

CONCLUSIONS

Genetic factors, environmental factors (such as excessive use of electronic products, and poor study habits) and lifestyle factors (such as lack of outdoor activities, poor nutrition, etc.) are the main risk factors for myopia in children. Myopia prevention strategies should be designed based on environmental factors, gender, parental myopia and eye indicators in order to explore a lifestyle that is more conducive to the eye health of children.

Progression and incidence of myopia among schoolchildren in the post-COVID-19 pandemic period: a prospective cohort study in Shantou, China

OBJECTIVES

To determine the progression and incidence of myopia in Chinese schoolchildren in the post-COVID-19 pandemic period in Shantou, China.

DESIGN

Prospective cohort study.

SETTING

Shantou Myopia Study, China.

PARTICIPANTS

1-year follow-up data were available for 621 881 schoolchildren (301 999 females). Data on spherical equivalent refraction (SER) were collected.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcomes were myopia progression and incidence. Myopia progression is defined as a change of SER towards the negative direction in the follow-up visit. Incidence is defined as the proportion of schoolchildren who were not myopic but developed myopia in the follow-up study. Age, sex and SER at baseline were evaluated as associated factors for myopia burden, which were defined as the secondary outcomes.

RESULTS

Mean progression of SER was -0.35±0.97 D for the population (ranging from -0.06 D at 18 years of age to -0.46 D at 11 years of age), with a rapid myopic progression for students at the age of 10-12 years (-0.50 D in girls and -0.44 D in boys). A myopic shift greater than -0.50 D/year occurred in 256 299 eyes (41.21%). Myopic progression in refraction was associated with the 10-12 years age groups (OR 1.42; 95% CI 1.39 to 1.45, p<0.001), female sex (OR 1.09; 95% CI 1.08 to 1.10, p<0.001) and higher refractive errors at baseline (OR>1.00, p<0.001). The annual incidence of myopia among schoolchildren was 24.85%, with an incidence of 26.69% in girls and 23.02% in boys.

CONCLUSIONS

Our study revealed an annual myopia progression of -0.35 D and an incidence of 24.85% among schoolchildren in the post-COVID-19 pandemic period. Myopia progressed rapidly at 10-12 years of age, with -0.50 D in girls and -0.44 D in boys. The incidence was higher for children aged 10-11 years and for girls.

Baseline Refractive Error, Habitual Accommodative Tone, and Its Association With Myopia in Children: The Lhasa Childhood Eye Study

PURPOSE

The purpose of this study was to describe the baseline refractive error, habitual accommodative tone (HAT) in Tibetan children and its longitudinal association with incident myopia and myopia progression.

METHODS

This was a prospective cohort study. From 7 elementary schools, 1440 children with mean age of 6.83 ± 0.46 years were included with full noncycloplegic and cycloplegic refraction data at baseline, 1-year and 2-year follow-up in the Lhasa Childhood Eye Study. Noncycloplegic and cycloplegic automated refraction were performed at baseline and annually over the next 2 years. HAT was measured as the difference in spherical equivalent (DSE) between noncycloplegic and cycloplegic refraction.

RESULTS

The mean HAT decreased from a baseline value of 0.92 ± 0.82 diopters (D) to 0.55 ± 0.65 D, P < 0.0001 at 2 years. In multivariable logistic regression models, only baseline spherical equivalent (SE; P < 0.0001) was significantly (negatively) associated with 1- and 2-year incident myopia. Among 1386 children without myopia at baseline, 271 developed myopia over 2 years. For hyperopic children, baseline HAT was significantly associated with the incidence of myopia over 2 years (odds ratio [OR] = 0.43, P < 0.001), and the incidence of myopia was significantly lower with baseline HAT ≥0.5 D, compared to children <0.5 D. For 54 (3.75%) children who were myopic at baseline, SE was significant positively associated with myopic progression in univariable (P = 0.03) and multivariable general mixed linear regression analysis (P = 0.03).

CONCLUSIONS

Baseline SE was an independent influencing factor for the incidence of myopia and its progression. The incidence of myopia was significantly higher with lower baseline HAT among hyperopic children, indicating that lower HAT was potentially associated with myopic development.

Does multidimensional daily information predict the onset of myopia? A 1-year prospective cohort study

PURPOSE

This study aimed to develop an interpretable machine learning model to predict the onset of myopia based on individual daily information.

METHOD

This study was a prospective cohort study. At baseline, non-myopia children aged 6-13 years old were recruited, and individual data were collected through interviewing students and parents. One year after baseline, the incidence of myopia was evaluated based on visual acuity test and cycloplegic refraction measurement. Five algorithms, Random Forest, Support Vector Machines, Gradient Boosting Decision Tree, CatBoost and Logistic Regression were utilized to develop different models and their performance was validated by area under curve (AUC). Shapley Additive exPlanations was applied to interpret the model output on the individual and global level.

RESULT

Of 2221 children, 260 (11.7%) developed myopia in 1 year. In univariable analysis, 26 features were associated with the myopia incidence. Catboost algorithm had the highest AUC of 0.951 in the model validation. The top 3 features for predicting myopia were parental myopia, grade and frequency of eye fatigue. A compact model using only 10 features was validated with an AUC of 0.891.

CONCLUSION

The daily information contributed reliable predictors for childhood's myopia onset. The interpretable Catboost model presented the best prediction performance. Oversampling technology greatly improved model performance. This model could be a tool in myopia preventing and intervention that can help identify children who are at risk of myopia, and provide personalized prevention strategies based on contributions of risk factors to the individual prediction result.

Development and Validation of a Model to Predict Who Will Develop Myopia in the Following Year as a Criterion to Define Premyopia

PURPOSE

To develop and validate models to predict who will develop myopia in the following year based on cycloplegic refraction or ocular biometry and to identify thresholds of premyopia.

METHODS

Prospective longitudinal data of nonmyopic children at baseline from the Guangzhou Twins Eye Study and the Guangzhou Outdoor Activity Longitudinal Study were used as the training set, and the Singapore Cohort Study of the Risk factors for Myopia study formed the external validation set. Age, sex, cycloplegic refraction, ocular biometry, uncorrected visual acuity, and parental myopia were integrated into 3 logistic regression models to predict the onset of myopia in the following year. Premyopia cutoffs and an integer risk score system were derived based on the identified risk.

RESULTS

In total, 2896 subjects with at least 2 visits were included. Cycloplegic refraction at baseline is a better predictor to identify the children with myopia onset [C-statistic=0.91, 95% confidence interval (CI), 0.87-0.94; C-statistic=0.92, 95% CI, 0.92-0.92 for internal and external validation, respectively], comparing to axial length, corneal curvature radius (CR) and anterior chamber depth (C-statistic=0.81, 95% CI, 0.73-0.88; C-statistic=0.80, 95% CI, 0.79-0.80, respectively), and axial length/CR (C-statistic=0.78, 95% CI, 0.71-0.85; C-statistic=0.76, 95% CI, 0.75-0.76). With a risk of >70%, the definitions of premyopia indicating approaching myopia onset were 0.00 D for 6-8 years and -0.25 D for ≥9 years in children with 2 myopic parents.

CONCLUSIONS

Either cycloplegic refraction or ocular biometry can predict 1-year risk of myopia. Premyopia can be successfully defined through risk assessments based on children's age and predict who would require more aggressive myopia prophylaxis.

Correlation Between Increase of Axial Length and Height Growth in Chinese School-Age Children

Purpose

To identify the relationship between the increase in axial length (AL) and height in school-age children and explore the influence of refractive status on such a relationship.

Methods

In this 5-year cohort study, 414 Chinese children (237 boys) aged 6–9 years (mean 7.12) underwent measurements annually. AL was measured using the Lenstar; height with the children standing, without shoes; and refraction using subjective refraction without cycloplegia. Participants were divided according to the refractive status: persistent emmetropia, persistent myopia, and newly developed myopia. The measurement time points of the persistent emmetropia and persistent myopia groups were marked as T₁, T₂, T₃, T₄, and T₅. The time of myopia onset in the newly developed myopia group was marked as t₀; the preceding time points were marked as t₋₁, t₋₂, and so on, and the succeeding as t₁, t₂, and so on. The association between increase in AL and height was analyzed using simple correlation analysis.

Results

The mean changes in AL, height, and refraction were 1.39 mm, 23.60 cm, and −1.69 D, respectively, over 5 years in all children. The increase in AL and height were positively correlated for T₁~T₂, T₁~T₃, T₁~T₄, and T₁~T₅ (r = 0.262, P < 0.001; r = 0.108, P = 0.034; r = 0.165, P = 0.001; r = 0.174, P = 0.001, respectively). The changes in AL and height in the newly developed myopia group were significantly correlated (r = 0.289, P = 0.009) after myopia onset (t₀~t₂).

Conclusion

The increase in AL and height were positively correlated, especially in the newly developed myopia group after myopia onset. Thus, when children grow quickly, AL elongation should be monitored.