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Published on: April 3, 2016
Short-Term Axial Length Changes Predict Progression of Myopic Maculopathy in Pediatric High Myopia
Feng Jiang1, Lili Wang1, Xiaohu Ding1
1From the State Key Laboratory of Ophthalmology (F.J., L.W., X.D., J.Z., Z.L.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
Objective:
To characterize changes in long-term myopic maculopathy (MM) progression and to investigate short-term axial length (AL) and spherical equivalent (SE) changes as predictors for long-term MM progression in highly myopic children and adolescents.
Design:
Prospective cohort study.
Participants:
A total of 310 eyes from 155 highly myopic individuals aged 7 to 17 years with an 8-year follow-up.
Methods:
Ocular examinations were performed every two years. MM was classified according to the Meta-PM system. Logistic regression models with generalized estimating equations were used to identify predictors of MM progression. Internal validation was performed using bootstrap resamples.
Main Outcome Measures:
Two-year changes of AL and SE to predict 8-year MM progression.
Results:
Over 8 years, 31.29% of eyes showed MM progression. A total of 97 participants demonstrated 112 lesion changes, with the most common being the new appearance of tessellated fundus (44.64%). Multivariable models demonstrated that combination of baseline AL (odds ratio [OR] = 1.62; 95% confidence interval [CI]: 1.15-2.28, P = .005) and 2-year AL change rate (OR = 1.62; 95% CI: 1.27-2.07, P < .001) provided superior predictive performance for long-term MM progression compared to baseline AL alone (OR = 1.52, 95% CI: 1.13-2.05, P = .006), after adjustment for age and pathologic myopia (PM). The area under the receiver operating characteristic curve (AUC) values were 0.829 (combined model) and 0.772 (baseline AL-only model), respectively (P = .013). Similarly, the model incorporating baseline SE (OR = 0.83; 95% CI, 0.73-0.96; P = .011) and 2-year SE change rate (OR = 0.44; 95% CI, 0.22-0.88; P = .020) achieved a higher AUC (0.793) than the baseline SE model (AUC = 0.764; P = .039) following adjustment for age and PM. The predictive model demonstrated an optimism-corrected AUC of 0.821 based on bootstrap internal validation. The optimal cut-off value for the 2-year AL change rate, determined by maximizing Youden's Index, was 0.325 mm/year.
Conclusions:
Nearly one-third of pediatric high myopes experienced MM progression over 8 years. Short-term changes in AL could predict MM progression with high accuracy, highlighting the importance of early risk identification and timely intervention in high-risk children.
