Related Experiment Video
Updated: Mar 9, 2026
Subjective Refraction Test Using a Smartphone for Vision Screening
Published on: October 18, 2024
Identifying Children at Risk of High Myopia Using Population Centile Curves of Refraction
Yanxian Chen1, Jian Zhang1, Ian G Morgan2
1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Insights
Reference centile curves for refraction help identify children at risk of high myopia. Lower percentile values in childhood indicate a greater likelihood of developing high myopia by age 15.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Biostatistics
Background:
- Refractive errors are a significant global health concern in children.
- Early identification of children at risk for high myopia is crucial for timely intervention.
- Population-based data are essential for establishing normative references in pediatric eye care.
Purpose of the Study:
- To develop age-specific reference centile curves for refraction in children.
- To assess the efficacy of these curves in identifying children at risk of developing high myopia.
- To establish a severity scale for refractive errors in school-aged populations.
Main Methods:
- Utilized data from 4218 children (aged 5-15) in the Guangzhou Refractive Error Study in Children (RESC).
- Employed a quantile regression model to construct reference centile curves for refraction using cycloplegic refraction data.
- Evaluated the risk prediction of high myopia (≤ -6 diopters) using longitudinal data from 354 first-born twins in the Guangzhou Twin Eye Study (GTES).
Main Results:
- Centile curves showed a decrease in refractive error percentiles with age, from -0.25 D (3rd percentile) at age 5 to -6.00 D at age 15.
- The 5th centile demonstrated high diagnostic value in predicting high myopia onset (sensitivity 92.9%, specificity 97.9%, PPV 65.0%).
- The 5th centile had a Mathew's correlation coefficient of 0.77 for predicting myopia of -6.0D by age 15.
Conclusions:
- Reference centile curves offer an age-specific severity scale for refractive errors in children.
- Children with lower percentile refractive errors at younger ages are more prone to developing high myopia.
- These curves serve as a valuable tool for early risk identification in pediatric populations.
Purpose:
To construct reference centile curves of refraction based on population-based data as an age-specific severity scale to evaluate their efficacy as a tool for identifying children at risk of developing high myopia in a longitudinal study.
Methods:
Data of 4218 children aged 5-15 years from the Guangzhou Refractive Error Study in Children (RESC) study, and 354 first-born twins from the Guangzhou Twin Eye Study (GTES) with annual visit were included in the analysis. Reference centile curves for refraction were constructed using a quantile regression model based on the cycloplegic refraction data from the RESC. The risk of developing high myopia (spherical equivalent ≤ -6 diopters [D]) was evaluated as a diagnostic test using the twin follow-up data.
Results:
The centile curves suggested that the 3rd, 5th, and 10th percentile decreased from -0.25 D, 0.00 D and 0.25 D in 5 year-olds to -6.00 D, -5.65D and -4.63 D in 15 year-olds in the population-based data from RESC. In the GTES cohort, the 5th centile showed the most effective diagnostic value with a sensitivity of 92.9%, a specificity of 97.9% and a positive predictive value (PPV) of 65.0% in predicting high myopia onset (≤-6.00D) before the age of 15 years. The PPV was highest (87.5%) in 3rd centile but with only 50.0% sensitivity. The Mathew's correlation coefficient of 5th centile in predicting myopia of -6.0D/-5.0D/-4.0D by age of 15 was 0.77/0.51/0.30 respectively.
Conclusions:
Reference centile curves provide an age-specific estimation on a severity scale of refractive error in school-aged children. Children located under lower percentiles at young age were more likely to have high myopia at 15 years or probably in adulthood.
