July 15, 2024
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Photo Credit: Getty Images
The research paper “Predicting the onset of myopia in children by age, sex, and ethnicity: Results from the CLEERE Study” by Mutti et al. presents a comprehensive study on predicting the onset of myopia in children. The study’s significance lies in providing a model for calculating the probability of myopia onset based on the largest, ethnically diverse study of myopia onset in the United States.
Previous analysis of Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) data provided optimal cutpoints for spherical equivalent refractive error for predicting the onset of myopia. The purpose of the current analysis was to improve risk calculation from CLEERE data by extending those dichotomous results to include specific probabilities of myopia onset year-by-year and cumulatively up to age 14 years using baseline cycloplegic refractive error at 6 to 13 years of age, sex, and race/ethnicity.
The research involved children aged 6 to less than 14 years at baseline from the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study who were nonmyopic and less hyperopic than +3.00D (spherical equivalent). These children were followed up for one to seven years through eighth grade, with annual measurements including cycloplegic autorefraction, keratometry, ultrasound axial dimensions, and parental reports of near work and time spent in outdoor and sports activities. The onset of myopia was defined as the first visit with at least -0.75D of myopia in each principal meridian.
The study’s model of the probability of myopia onset included cycloplegic spherical equivalent refractive error, the horizontal/vertical component of astigmatism (J0), age, sex, and race/ethnicity. The findings showed that the onset of myopia was more likely with lower amounts of hyperopia and less positive/more negative values of J0. Additionally, the research highlighted that younger Asian American females had the highest eventual probability of onset, whereas older White males had the lowest probability. The model’s performance increased with older baseline age, as represented by C statistics ranging from 0.83 at 6 years of age to 0.92 at 13 years.
The paper’s conclusion underlined that the probability of myopia onset can be estimated for children in major racial/ethnic groups within the United States on a year-by-year and cumulative basis up to age 14 years based on a simple set of refractive error and demographic variables. This has significant implications for clinical practice and research in understanding and predicting myopia onset in children.
In summary, Mutti et al.’s study provides valuable insights into predicting the onset of myopia in children, considering age, sex, and ethnicity. The findings contribute to the understanding of myopia development in children and offer a predictive model that could assist clinicians and researchers in identifying children at higher risk of myopia onset. The comprehensive nature of the study, utilizing data from the CLEERE Study, underscores the significance of the research in addressing an increasingly prevalent eye condition, particularly in pediatric populations.
Abstract
Predicting the Onset of Myopia in Children by Age, Sex, and Ethnicity: Results from the CLEERE Study
Donald O. Mutti, Loraine T. Sinnott , Susan A. Cotter , Lisa A. Jones-Jordan , Robert N. Kleinstein , Ruth E. Manny , J. Daniel Twelker , Karla Zadnik
Significance: Clinicians and researchers would benefit from being able to predict the onset of myopia for an individual child. This report provides a model for calculating the probability of myopia onset, year-by-year and cumulatively, based on results from the largest, most ethnically diverse study of myopia onset in the United States.
Purpose: This study aimed to model the probability of the onset of myopia in previously nonmyopic school-aged children.
Methods: Children aged 6 years to less than 14 years of age at baseline participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study who were nonmyopic and less hyperopic than +3.00 D (spherical equivalent) were followed up for 1 to 7 years through eighth grade. Annual measurements included cycloplegic autorefraction, keratometry, ultrasound axial dimensions, and parental reports of their children’s near work and time spent in outdoor and/or sports activities. The onset of myopia was defined as the first visit with at least −0.75 D of myopia in each principal meridian. The predictive model was built using discrete time survival analysis and evaluated with C statistics.
Results: The model of the probability of the onset of myopia included cycloplegic spherical equivalent refractive error, the horizontal/vertical component of astigmatism (J0), age, sex, and race/ethnicity. The onset of myopia was more likely with lower amounts of hyperopia and less positive/more negative values of J0. Younger Asian American females had the highest eventual probability of onset, whereas older White males had the lowest. Model performance increased with older baseline age, with C statistics ranging from 0.83 at 6 years of age to 0.92 at 13 years.
Conclusions: The probability of the onset of myopia can be estimated for children in the major racial/ethnic groups within the United States on a year-by-year and cumulative basis up to age 14 years based on a simple set of refractive error and demographic variables.
Mutti, D. O., Sinnott, L. T., Cotter, S. A., Jones-Jordan, L. A., Kleinstein, R. N., Manny, R. E., … & Zadnik, K. (2024). Predicting the onset of myopia in children by age, sex, and ethnicity: Results from the CLEERE Study. Optometry and Vision Science, 101(4), 179-186.
DOI: https://doi.org/10.1097/opx.0000000000002127
