Exploration of visual perception metrics as indicators for myopia screening

This study aims to develop and validate a low-cost, easy-to-use myopia screening model by integrating visual perception indicators with biometric indicators, to provide a feasible strategy for identifying children at risk of myopia in large-scale screenings.

A group comprising of 180 third-grade students aged 8-10 years in Shenzhen underwent myopia screening in 2023, accompanied by assessments of ocular biometrics and visual perception. Vision examination was conducted using the YYK-900 intelligent self-serving vision tester, with measurements of uncorrected visual acuity (UCVA) taken at a distance equivalent to the standard 5 m. Binocular visual perception examinations were conducted using a visual perception examination system. Predictive models for myopia were formulated using the axial length/corneal radius ratio (AL/CR) along with visual perception metrics. The diagnostic efficacy of each model was then assessed through receiver operating characteristic (ROC) curve analysis.

The maximum Perceptual Eye Positioning - Digital Localization in Horizontal Direction value between both eyes (PEP-DL (max)), the 0.8mE optotype, and the 1.5mE optotype, indicating statistically significant differences between emmetropia and the screening myopia groups. Prediction models were subsequently developed using AL/CR (max) along with visual perception indicators. Model 1 was constructed exclusively on AL/CR (max), with an area under the ROC curve (AUC) of 0.779 (95%CI 0.686 to 0.872). Meanwhile, Model 2 was solely based on visual perception indicators, resulting in an AUC of 0.709 (95%CI 0.614 to 0.804). Model 3 was a combination of both AL/CR (max) and visual perception indicators, which are PEP-DL (max) and E 0.8 m, achieving an AUC of 0.794 (95%CI 0.702 to 0.886).

The diagnostic effectiveness of visual perception indicators and AL/CR (max) in myopia screening demonstrated comparable outcomes. Furthermore, the integration of visual perception indicators with AL/CR (max) substantially enhances the diagnostic capacity of myopia screening, thereby enhancing both the precision and dependability of myopia screening initiatives conducted within schools.