This study identified age and ethnicity as two factors able to help predict myopia progression. Photo: Getty Images.

The degree of refractive error in most myopic children almost always increases for a period of time after initial onset. Identifying those at the highest risk for rapid myopia progression and/or axial elongation could help prioritize who should receive clinical treatment. To accomplish this, researchers recently developed models predicting future refractive error and axial length using children’s baseline data and prior history of myopia progression and axial elongation.

These models were created using randomly assigned training and test datasets from 916 myopic participants ages seven to 14 in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) study. Each participant had three consecutive annual visits that included cycloplegic A-scan ultrasound and autorefraction, and the effect of adding prior change in axial length and refractive error was evaluated.

Age, ethnicity and greater myopia were significant predictors of future refractive error and axial length, while prior progression or elongation, near work, time outdoors and parental myopia were not. Female sex was a significant factor for a more myopic refractive error at the third visit, but not for a longer axial length. Young, more myopic Asian-American children were the most likely to progress rapidly.

“While demographic factors were expected to be related to the rate of change, more surprising was how little meaningful information about the past contributed to model predictions about the future,” the authors explained. “Axial elongation between visits one and two was not significantly correlated with elongation between visits two and three. The prior year’s myopia progression was correlated with the next year’s progression but weakly with a low R2 of 0.015. The poor performance for axial elongation may be due in part to the imprecision of measurement in the CLEERE study.”

Sensitivity and specificity for identifying fast progressors were between 60.8% and 63.2%, respectively, when the cutoff points were close to the sample average.

The authors explained that one goal of predicting the rate of change is for the clinician treating myopic children and the researcher planning a clinical study to prioritize the fast progressor.

“Sample enrichment seems most efficient when the data predict a high average progression rate, i.e., when roughly a 50-50 split will occur around that desired high average rate of progression,” they noted.

The study concluded that associations between prior year and future year myopia progression or axial elongation were too weak to provide useful predictive information.

Mutti DO, Sinnott LT, Brennan NA, et al. The limited value of prior change in predicting future progression of juvenile-onset myopia. Optom Vis Sci. February 22, 2022. [Epub ahead of print].