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Published on: March 29, 2022
Longitudinal Changes in Relative Peripheral Refraction During Childhood Myopia Onset: A 3-year Prospective
Runting Ma1, Xiao Wang1, Yin Hu1
1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Insights
Baseline central refractive error is the main predictor of myopia onset in children. Dynamic changes in relative peripheral refraction (RPR) may offer insights into myopia development but have limited added predictive value.
Area of Science:
- Ophthalmology
- Optometry
- Pediatric Vision
Background:
- Myopia progression is a significant concern in pediatric populations.
- Understanding factors influencing myopia development is crucial for early intervention.
Purpose of the Study:
- To investigate 3-year dynamic changes in relative peripheral refraction (RPR) in children.
- To assess the association between RPR changes, axial elongation, and myopia progression stages.
Main Methods:
- A longitudinal observational cohort study involving 564 children in Guangzhou, China (2020-2023).
- Annual assessments included cycloplegic spherical equivalent refraction (SER), axial length (AL), and multispectral refractive topography.
- Relative peripheral refraction (RPR) was calculated, and analysis was stratified by baseline refractive status and 3-year outcomes.
Main Results:
- Baseline RPR differences were observed in non-myopic children a year before myopia onset.
- Longitudinal hyperopic RPR shifts were more pronounced in the peripheral retina (>30°).
- Axial length elongation (ΔAL) was significantly higher in the myopia-onset and established myopia groups compared to the non-myopic group. Baseline SER was the strongest predictor of myopia onset.
Conclusions:
- Baseline central refractive error (SER) is the primary predictor of myopia onset.
- Dynamic RPR changes may be linked to myopia development and ocular remodeling.
- RPR provides complementary information but has limited added predictive value beyond baseline SER for myopia onset.
Purpose:
To investigate 3-year dynamic changes in relative peripheral refraction (RPR) and their association with axial elongation and myopia progression stages in children.
Methods:
A total of 564 children (mean age 9.22 ± 0.59 years; 51.1% female) completed three annual visits in a longitudinal observational cohort study (2020-2023) in Guangzhou, China. Annual assessments included cycloplegic spherical equivalent refraction (SER), axial length (AL) and multispectral refractive topography. RPR was calculated across annular diameters up to 53° and quadrants; the total RPR (TRPR) was the mean across all regions. Analysis was stratified by baseline refractive status (myopia: SER ≤ -0.50 D, non-myopic: SER > -0.50 D) and 3-year outcomes (remained non-myopic, myopia onset or established myopia). Right eye data were included in the analysis.
Results:
In non-myopic children, differences in baseline RPR were observed 1 year before myopia onset. Baseline temporal RPR showed a modest association with myopia onset (odds ratio = 2.24, 95% CI: 1.08-4.66, p = 0.03). Longitudinal hyperopic RPR shifts were more pronounced in the peripheral retina >30°. The 3-year ΔTRPR was higher in the myopia-onset group (0.21 D) and the remaining non-myopic group (0.16 D) than in established myopia (0.06 D). Additionally, significant differences in ΔAL were observed: myopia-onset (+0.91 mm), established myopia (+0.81 mm) and remained non-myopic (+0.45 mm) (p < 0.001). ΔTRPR was correlated with ΔAL in the myopia-onset group (r = 0.32, p < 0.001), but not in established myopia. Baseline SER alone showed strong predictive accuracy for 1-year onset with an area under the curve (AUC) of 0.87, while RPR alone yielded moderate accuracy (AUC = 0.71), outperforming AL alone (AUC = 0.64). Adding RPR to SER did not improve discrimination (AUC = 0.88).
Conclusions:
Baseline central refractive error remains the dominant predictor of myopia onset. Changes in RPR may be associated with myopia development. Dynamic RPR changes may provide complementary information regarding ocular shape remodelling, with limited added predictive value beyond baseline SER.
Clinical Trial Number:
Not applicable.
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