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Optimizing myopia screening referral guidelines for children aged 4 to 18 based on non-cycloplegic indicators
Pingping Lyu1,2, Jiaojiao Shi2, Jingjing Wang3
1School of Public Health and Management, Jiangsu Vocational College of Medicine, 283 South Jiefang Road, Yancheng, 224005, China.
Insights
Axial length (AL) is a reliable indicator for myopia screening in preschoolers. For older children, uncorrected visual acuity (UCVA) and non-cycloplegic refraction (NCR) are sufficient for myopia prediction, potentially avoiding cycloplegia.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Public Health
Background:
- School vision screenings are crucial for early myopia detection.
- Evaluating the efficacy of different metrics in non-cycloplegic screenings is essential for accurate myopia assessment.
- Uncorrected visual acuity (UCVA), non-cycloplegic refraction (NCR), and axial length (AL) are commonly used indicators.
Purpose of the Study:
- To assess the stability and predictive power of UCVA, NCR, and AL in non-cycloplegic school vision screenings for myopia.
- To compare the effectiveness of these indicators across different age groups.
- To determine the optimal screening strategy for myopia in children.
Main Methods:
- Retrospective cohort study utilizing data from the Shanghai Child and Adolescent Large-scale Eye Study (SCALE).
- Analysis of differences in UCVA, spherical equivalent (SE), and AL between school screenings and hospital re-evaluations for students who failed initial screenings.
- Assessment of UCVA combined with NCR as predictive metrics for myopia referral using decision curve analysis.
Main Results:
- Axial length (AL) demonstrated high reliability (ICC=0.981) as a myopia indicator across all ages, outperforming UCVA (ICC=0.791) and SE (ICC=0.806).
- Myopia prevalence estimated using UCVA and NCR (76.10%) was significantly higher than cycloplegic refraction (58.37%), with high sensitivity (96.93%) but moderate specificity (53.13%).
- Preschoolers showed a substantial decrease in myopia rates post-cycloplegia (50.17% to 19.82%), unlike school-aged children, suggesting AL integration is more beneficial for younger children.
Conclusions:
- Axial length (AL) should be incorporated into myopia screening programs for preschoolers due to significant refractive changes observed post-cycloplegia.
- For school-aged children, the combination of uncorrected visual acuity (UCVA) and non-cycloplegic refraction (NCR) is adequate for myopia prediction, potentially negating the need for cycloplegic eye exams.
- Optimizing school vision screening protocols can improve myopia detection accuracy and efficiency.
Background:
To evaluate the stability and predictive ability of uncorrected visual acuity (UCVA), non-cycloplegic refraction (NCR), and axial length (AL) as indicators in non-cycloplegic school vision screening for myopia.
Methods:
This retrospective cohort study is based on the Shanghai Child and Adolescent Large-scale Eye Study (SCALE). Participants included students who failed school screenings and were referred for follow-up cycloplegic refractions at eye hospitals within three months. We evaluated the differences in UCVA, spherical equivalent (SE), and AL between school screenings and hospital re-evaluations. Furthermore, we assessed the validity of using UCVA in combination with NCR as predictive metrics for myopia referral.
Results:
Among the 8,492 children, 4,357 (51.3%) were boys, with a mean age of 8.26 years (SD = 2.77). AL was identified as a reliable myopia screening indicator across all age groups (ICC = 0.981; 95% CI: 0.978-0.984), outperforming UCVA (ICC = 0.791) and SE (ICC = 0.806). The estimated prevalence of myopia using UCVA and NCR was 76.10%, significantly higher than 58.37% observed with cycloplegic testing. Sensitivity was 96.93% and specificity was 53.13% (Youden index = 0.5). In preschoolers, myopia rates decreased from 50.17% before to 19.82% after cycloplegia, while school-aged children exhibited better consistency. Decision curve analysis showed that the full model incorporating AL did not significantly benefit school-aged children, but may offer greater net benefits for preschoolers.
Conclusions:
AL should be integrated into screening programs for preschoolers. For school-aged children, the combination of UCVA and NCR suffices for myopia prediction, potentially eliminating the need for cycloplegia.
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