October 15, 2024
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
The study “Influence of age and race on axial elongation in myopic children: A systematic review and meta-regression” by Brennan, N. A., Shamp, W., Maynes, E., Cheng, X., & Bullimore, M. A. (2024), published in Optometry and Vision Science, delves into the factors influencing axial elongation in myopic children. The purpose of the study was to conduct a meta-regression to model axial elongation and its associated factors in children with low to moderate myopia.
The researchers performed a comprehensive electronic systematic search using Ovid Medline, EMBASE, and Cochrane Central Register of Controlled Trials of studies conducted up until October 2021. The mean rate of axial elongation was analyzed using a multivariate linear mixed-effects meta-regression model, with backward stepwise elimination of nonsignificant covariates. The model included three levels of random effects, allowing both prediction and confidence intervals to be estimated.
The study encompassed a total of 64 studies with 83 subpopulations and 142 evaluations of mean axial change from baseline that met the inclusion criteria and had no missing significant covariates in the final model. Additionally, a separate analysis including all populations with axial length data (202 evaluations) but missing variance or covariate data produced a similar model to that of the analysis with complete data.
The study’s results revealed compelling insights. The mean axial elongation was found to be 38% greater in Asian children compared with non-Asians, with significant implications for addressing myopia in different racial groups. Furthermore, it was observed that both Asian and non-Asian children show a 15% decline per year as age increases. The report emphasized the substantial variability around the axial elongation estimates, as indicated by the broad prediction intervals, highlighting the challenge of managing individual children based on aggregate data.
The study draws attention to the clinical significance of these findings in terms of evaluating the efficacy of myopia control. The mean values of axial elongation provide valuable insights for monitoring the progression of myopia. However, it is vital to consider the broad prediction intervals, which indicate the large range of individual axial elongation rates in the population. This underscores the complexity and variability in managing myopia in individual children and calls for a more personalized approach.
It should be noted that the interpretation of the analysis may be limited by the use of aggregated data rather than individual subject data, which could affect the generalizability of the findings to individual cases. Additionally, the study’s findings contribute to the existing body of knowledge on myopia, offering valuable insights for future research and clinical practice. The insights gained from this study could potentially guide the development of more targeted and effective strategies for managing myopia in children, taking into account age and race-specific factors that influence axial elongation.
In conclusion, the systematic review and meta-regression presented in this study shed light on the influence of age and race on axial elongation in myopic children. The findings provide valuable information for clinicians and researchers involved in myopia management, emphasizing the need for a nuanced and individualized approach considering the variability of axial elongation rates in different racial groups and age brackets. This study offers a foundation for further exploration of personalized myopia management strategies and underscores the importance of accounting for demographic factors in addressing myopia among children with low to moderate myopia.
Abstract
Influence of Age and Race on Axial Elongation in Myopic Children: A Systematic Review and Meta-Regression
Noel A Brennan, Wright Shamp, Elizabeth Maynes, Xu Cheng, Mark A Bullimore
Purpose: Axial elongation is the basis of progression in primary myopia and the preferred metric to monitor its evolution. We conducted a meta-regression to model axial elongation and its associated factors in children with low to moderate myopia.
Methods: A comprehensive electronic systematic search was performed using Ovid Medline, EMBASE, and Cochrane Central Register of Controlled Trials of studies conducted up until October 2021. The mean rate of axial elongation was analyzed using a multivariate linear mixed-effects meta-regression model, with backward stepwise elimination of nonsignificant covariates. The model included three levels of random effects, allowing both prediction and confidence intervals to be estimated.
Results: A total of 64 studies with 83 subpopulations and 142 evaluations of mean axial change from baseline met our inclusion criteria and had no missing significant covariates in the final model. A separate analysis including all populations with axial length data (202 evaluations) but missing variance or covariate data produced a similar model to that for the analysis with complete data. The mean axial elongation is 38% greater in Asian children (95% confidence interval, 19 to 61%; p<0.01) compared with non-Asians, but both groups show a 15% decline per year as age increases (95% confidence interval, 12 to 17% p<0.0001). Prediction intervals indicate substantial variability around the axial elongation estimates.
Conclusions: This analysis provides mean values of axial elongation for evaluation of the efficacy of myopia control. The broad prediction intervals emphasize the large range of individual axial elongation rates in the population, illustrating the challenge of managing individual children. Interpretation of the analysis is limited by the use of aggregated data rather than individual subject data.
Brennan, N. A., Shamp, W., Maynes, E., Cheng, X., & Bullimore, M. A. (2024). Influence of age and race on axial elongation in myopic children: A systematic review and meta-regression. Optometry and Vision Science, 101(8), 497-507.
DOI: 10.1097/OPX.0000000000002176