Reduction of hyperopia and accelerated myopia progression in preschool children: A four-year longitudinal study
Huaying Xu1, Chenxi Zong1, Jianing Pu2
1Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China.
Insights
Reduced hyperopia in preschoolers, particularly 5- and 6-year-olds, is linked to faster myopia progression. Early monitoring and interventions are crucial to prevent excessive hyperopia loss and slow myopia development.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Myopia Research
Background:
- Myopia onset and progression are significant concerns in pediatric eye care.
- Understanding the role of refractive status in early childhood is key to myopia prevention.
- The Beijing Hyperopia Reserve Research (BHRR) cohort provides valuable longitudinal data.
Purpose of the Study:
- To investigate the association between reduced hyperopia and increased risk of myopia onset in preschool children aged 3-6 years.
- To identify optimal refractive error thresholds for predicting myopia development in young children.
- To analyze age-specific changes in ocular biometry related to refractive status.
Main Methods:
- Prospective cohort study (BHRR) with 941 children aged 3-6 years and 3-year follow-up.
- Cross-sectional and longitudinal analyses comparing ocular biometry (SER, AL, ACD, CR) between pre-myopia and hyperopia groups.
- Receiver operating characteristic (ROC) analysis to determine the predictive value of spherical equivalent refraction (SER) for myopia onset.
Main Results:
- Children with lower hyperopia (pre-myopia group) had significantly longer axial length (AL) at baseline.
- Over 3 years, both groups showed decreasing SER and increasing AL, with faster changes in the pre-myopia group for 5- and 6-year-olds.
- The optimal SER cutoff for predicting myopia onset was +0.90 D, decreasing with age.
Conclusions:
- Preschoolers with less hyperopia, especially older ones, experience a higher rate of myopic drift and AL growth.
- Early detection of reduced hyperopia is critical for timely intervention.
- Preventing excessive loss of hyperopia may mitigate myopia acceleration in children.
Purpose:
To investigate the association between reduced hyperopia and the increased risk of myopia onset in preschool children aged 3-6 years.
Methods:
This study utilized data from the Beijing Hyperopia Reserve Research (BHRR) prospective cohort, including 941 children aged 3-6 years who completed baseline and 3-year follow-up assessments (2021-2024). Cross-sectional analyses compared ocular biometry among children with different baseline refractive statuses, followed by longitudinal analyses evaluating the relationship between reduced hyperopia and myopia onset. Children were categorized into pre-myopia and hyperopia groups based on spherical equivalent refraction (SER). The predictive ability of SER for myopia onset was evaluated using receiver operating characteristic analysis, with optimal cutoffs determined by the Youden index. Age-stratified (3-6 years) analyses identified age-specific SER thresholds.
Results:
The baseline cross-sectional analysis revealed that there were no significant differences in anterior chamber depth (ACD) or corneal radius (CR) in the pre-myopia group compared to the hyperopia group despite having a significantly lower SER (p < 0.001) and longer AL (p < 0.001). Over 3 years, both groups showed decreasing SER, increasing AL, and deepening anterior chambers (all p < 0.05). Furthermore, in the 5- and 6-year-old groups, the pre-myopia group demonstrated significantly higher rates of change in SER and AL compared to the hyperopia group (all p < 0.05). The optimal SER cut-off value for predicting myopia onset in preschool children was +0.90 D. This cut-off value showed a decreasing trend with age, corresponding to +1.04 D, +0.95 D, +0.87 D, and +0.82 D for children aged 3, 4, 5, and 6 years, respectively.
Conclusions:
Preschool children with lower levels of hyperopia, especially those aged 5 and 6, show a significantly higher rate of myopic drift, and AL growth compared to those with greater hyperopia. Enhanced early monitoring and interventions are essential to prevent excessive loss of hyperopia that may accelerate myopia development.
Trial Registration:
The registration database and the registration number: Chinese Clinical Trial Registry: ChiCTR2000031142.
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