Clinical

Influences on Myopia Progression

October 1, 2021

By Dwight Akerman, OD, MBA, FAAO, FBCLA

Many studies have reported rates of myopia progression, which are most frequently based on data for the single-vision spectacle or placebo group in clinical trials evaluating interventions for myopia control. The purpose of this study was to model juvenile-onset myopia progression as a function of race/ethnicity, age, sex, parental history of myopia, and time spent reading or in outdoor/sports activity.

Subjects in this investigation were 594 children in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study with at least three study visits: one visit with a spherical equivalent (SPHEQ) less myopic/more hyperopic than -0.75 diopter (D), the first visit with a SPHEQ of -0.75D or more myopia (onset visit), and another after myopia onset. Myopia progression from the time of onset was modeled using cubic models as a function of age, race/ethnicity, and other covariates.

It was found that younger children had faster myopia progression; for example, the model estimated 3-year progression in an Asian American child was -1.93D when onset was at age 7 years compared with -1.43D when onset was at age 10 years. Annual myopia progression for girls was 0.093D faster than for boys. Asian American children experienced statistically significantly faster myopia progression compared with Hispanic (estimated 3-year difference of -0.46D), Black children (-0.88D), and Native American children (-0.48D), but with similar progression compared with White children (-0.19D). Parental history of myopia, time spent reading, and time spent in outdoor/sports activity were not statistically significant factors in multivariate models.

Although several of the factors that can specifically be used to predict those children whose myopia is most likely to progress have been considered previously, no study to date has had the diverse sample and longitudinal data to evaluate multiple groups at one time. This analysis confirmed and quantified the amount that myopia progression differed by sex, age at first myopic visit, and race/ethnicity.

The researchers concluded that Asian American children exhibited faster myopic progression than Black, Hispanic, and Native American children, and myopic progression was faster at younger ages and among girls across all racial/ethnic groups. These predictions may help identify those myopic children who would most benefit from treatments that slow the progression of myopia. Interestingly, the number of myopic parents or the amount of time spent in outdoor/sports activity did not significantly improve the ability of the multivariate model to predict myopia progression. 

Abstract

Myopia Progression as a Function of Sex, Age, and Ethnicity

Lisa A Jones-Jordan, Loraine T Sinnott, Raymond H Chu, Susan A Cotter, Robert N Kleinstein, Ruth E Manny, Donald O Mutti, J Daniel Twelker, Karla Zadnik, CLEERE Study Group

Purpose: To model juvenile-onset myopia progression as a function of race/ethnicity, age, sex, parental history of myopia, and time spent reading or in outdoor/sports activity. 

Methods: Subjects were 594 children in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study with at least three study visits: one visit with a spherical equivalent (SPHEQ) less myopic/more hyperopic than -0.75 diopter (D), the first visit with a SPHEQ of -0.75D or more myopia (onset visit), and another after myopia onset. Myopia progression from the time of onset was modeled using cubic models as a function of age, race/ethnicity, and other covariates. 

Results: Younger children had faster progression of myopia; for example, the model-estimated 3-year progression in an Asian American child was -1.93D when onset was at age 7 years compared with -1.43D when onset was at age 10 years. Annual progression for girls was 0.093D faster than for boys. Asian American children experienced statistically significantly faster myopia progression compared with Hispanic (estimated 3-year difference of -0.46D), Black children (-0.88D), and Native American children (-0.48D), but with similar progression compared with White children (-0.19D). Parental history of myopia, time spent reading, and time spent in outdoor/sports activity were not statistically significant factors in multivariate models. 

Conclusions: Younger age, female sex, and racial/ethnic group were the factors associated with faster myopic progression. This multivariate model can facilitate the planning of clinical trials for myopia control interventions by informing the prediction of myopia progression rates. 

Jones-Jordan, L. A., Sinnott, L. T., Chu, R. H., Cotter, S. A., Kleinstein, R. N., Manny, R. E., … & CLEERE Study Group. (2021). Myopia Progression as a Function of Sex, Age, and Ethnicity. Investigative Ophthalmology & Visual Science, 62(10), 36-36.

DOI: 10.1167/iovs.62.10.36

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