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The Limited Value of Prior Change in Predicting Future Progression of Juvenile-onset Myopia
Donald O Mutti, Loraine T Sinnott1, Noel A Brennan2
1The Ohio State University College of Optometry, Columbus, Ohio.
Insights
Predicting rapid myopia progression in children is challenging. Young, myopic Asian children are at highest risk, but historical data offers limited predictive value for myopia control decisions.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Myopia Research
Background:
- Accurate prediction of myopia progression and axial elongation in children is crucial for timely clinical intervention and clinical trial enrollment.
- Current models face challenges in reliably identifying children at highest risk for rapid progression.
Purpose of the Study:
- To develop predictive models for refractive error and axial length in children using baseline data and myopia progression history.
- To assess the impact of incorporating prior changes in axial length and refractive error on model accuracy.
Main Methods:
- Utilized data from 916 myopic children (ages 7-14) in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study.
- Employed randomly assigned training and testing datasets with cycloplegic A-scan ultrasound and autorefraction over three annual visits.
- Evaluated the predictive performance of models with and without the inclusion of prior progression or elongation data.
Main Results:
- Age, ethnicity, and baseline myopia severity were significant predictors of future refractive error and axial length.
- Prior progression, near work, outdoor time, and parental myopia were not significant predictors.
- Models incorporating prior change data showed only marginal improvements in prediction accuracy (±0.26 D, ±0.16 mm) compared to those without (±0.22 D, ±0.14 mm).
- Sensitivity and specificity for identifying rapid progressors were moderate (60.8-63.2%), with lower positive predictive values for extreme progression rates.
Conclusions:
- Younger, more myopic Asian American children demonstrated the highest risk for rapid myopia progression.
- Clinical trials may struggle to recruit generalizable samples with faster-than-average progression rates.
- Historical progression or elongation data provided limited utility in guiding clinical decisions for myopia control initiation.
Significance:
Identifying 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.
Purpose:
This 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.
Methods:
Models 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.
Results:
Age, 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.
Conclusions:
Young, 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.
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