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Optimising non-cycloplegic screening strategies for early detection of pre-myopia and myopia in young children
Síofra Harrington1,2, Michael Moore1,2, James Loughman1,2
1School of Physics, Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland.
Insights
Early detection of myopia in children is crucial. New non-cycloplegic screening methods combining non-cycloplegic spherical equivalent refraction (SER) and axial length/corneal radius (AL/CR) show promise for identifying pre-myopia and myopia.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Public Health
Background:
- Early detection of myopia is vital for timely intervention to slow progression.
- Pre-myopia, characterized by insufficient hyperopic reserve, significantly increases childhood myopia risk.
- Current screening methods for pre-myopia are limited, necessitating development of practical alternatives.
Purpose of the Study:
- To develop and evaluate practical, non-cycloplegic screening methods for pre-myopia and myopia in 6- to 7-year-old children.
- To identify effective screening strategies that support earlier interventions for myopia.
Main Methods:
- A cross-sectional study involving 621 Irish schoolchildren aged 6-7 years.
- Assessment of uncorrected distance visual acuity (UDVA), non-cycloplegic and cycloplegic spherical equivalent refraction (SER).
- Measurement of axial length (AL), corneal radius (CR), and parental myopia history; analysis using logistic regression and ROC curves.
Main Results:
- Pre-myopia prevalence was 24.3%, and myopia prevalence was 3.3%.
- Combined non-cycloplegic SER and AL/CR ratio showed the best discrimination for pre-myopia (AUC=0.72).
- Combined AL, non-cycloplegic SER, and UDVA provided the best discrimination for myopia (AUC=0.95).
Conclusions:
- UDVA alone is insufficient for pre-myopia screening but acceptable for myopia detection.
- Non-cycloplegic SER combined with AL/CR ratio improves pre-myopia screening effectiveness.
- Combined non-cycloplegic SER, AL, and UDVA offer the most effective approach for myopia screening in young children.
Purpose:
Early detection of myopia is essential to delay its onset and progression. Pre-myopia, defined by an inadequate hyperopic reserve, increases myopia risk in childhood. However, effective screening methods remain limited. This study aimed to develop practical non-cycloplegic screening methods for pre-myopia and myopia in 6- to 7-year-olds to support earlier interventions.
Methods:
This cross-sectional study of 621 Irish schoolchildren (mean age: 7.12 ± 0.45 years; 51.8% boys) assessed uncorrected distance visual acuity (UDVA). Cycloplegic spherical equivalent refraction (SER) classified refractive status (myopia: SER ≤ -0.50D; pre-myopia: SER > -0.50 ≤ 0.75D). Pre- and post-cycloplegic SER were measured using the Welch Allyn Spot Vision Screener and Dong-Yang Rekto-ORK 11, respectively. Axial length (AL) and corneal radius (CR) were measured with the Zeiss IOLMaster and parental myopia history via questionnaire. Logistic regression and ROC curves evaluated non-cycloplegic screening methods.
Results:
Pre-myopia prevalence was 24.3% (95% confidence intervals (CI): 29.3-36.2), and myopia prevalence was 3.3% (CI: 2.5-5.5). UDVA screening had an area under the curve (AUC) (CI) = 0.72 (0.59-0.86) and 0.42 (0.36-0.47) for detecting myopia and pre-myopia, respectively. For pre-myopia discrimination, non-cycloplegic SER, AL, AL/CR and parental myopia had AUCs of 0.67 (0.62-0.72), 0.67 (0.62-0.72), 0.69 (0.64-0.74) and 0.59 (0.53-0.64), respectively. The best method combined non-cycloplegic SER and AL/CR (AUC = 0.72 (0.67-0.76)). Including UDVA or parental myopia did not improve results. For myopia detection, AUCs were non-cycloplegic SER:0.84 (0.72-0.97), AL:0.88 (0.82-0.95), AL/CR:0.84 (0.75-0.94) and parental myopia:0.62 (0.48-0.75). The best method combined AL and non-cycloplegic SER 0.94 (0.90-0.99). Adding parental myopia did not improve the AUC = 0.93 (0.87-0.99) but adding UDVA achieved an AUC = 0.95 (0.90-0.99).
Conclusion:
While UDVA alone provided acceptable discrimination for myopia, it was insufficient for screening pre-myopia. Non-cycloplegic SER alone had relatively poor discrimination for pre-myopia, but its performance improved when combined with the AL/CR ratio. The best results for myopia discrimination were achieved by combining non-cycloplegic SER, axial length and UDVA measures.
