Twelve month refractive and axial length changes in the Israeli refractive error, activity, and devices (iREAD) study

Area of Science:

• Ophthalmology
• Public Health
• Pediatric Eye Care

Background:

• Myopia is a growing global health concern, particularly in children.
• Understanding environmental and genetic risk factors is crucial for myopia prevention and management.
• The Israel Refraction, Environment, and Devices (iREAD) study investigates myopia development in diverse pediatric populations.

Purpose of the Study:

• To assess myopia risk factors and progression in three distinct groups of Israeli boys: Ultra-Orthodox, Religious, and Secular.
• To identify lifestyle, educational, and genetic factors associated with myopia development and progression.
• To compare myopia prevalence and refractive error changes across different socio-cultural groups.

Main Methods:

• A longitudinal study design with 12-month follow-up.
• Recruitment of 135 boys aged 8.6 ± 1.5 years across three groups.
• Ophthalmological examinations including cycloplegic autorefraction and axial length measurements.
• Assessment of ocular history, education, near work, electronic device use, time outdoors, and physical activity.
• Statistical analyses including univariate and multivariate models.

Main Results:

• Myopia prevalence increased from 32% to 40% over 12 months (P=0.02), with no significant group differences in overall prevalence.
• The Ultra-Orthodox group exhibited a more myopic spherical equivalent refraction (SER) at baseline and 12 months, and a greater myopic shift (P<0.05).
• Risk factors associated with greater myopic shift and axial elongation included belonging to the Ultra-Orthodox educational system and having more myopic parents (P<0.05).
• Less time using electronic devices, more time in school, earlier reading age, and higher parental myopia were characteristic of the Ultra-Orthodox group (P<0.01).
• Time outdoors and physical activity levels did not differ significantly between groups.

Conclusions:

• The Ultra-Orthodox educational system and parental myopia are significant risk factors for myopia progression in boys.
• Contrary to some hypotheses, electronic device use was not associated with increased myopia progression in this cohort.
• These findings underscore the complex interplay of genetic predisposition and specific educational/lifestyle factors in pediatric myopia development.