February 1, 2026
By Kevin Chan, OD, MS, FAAO, IACMM
Photo Credit: Getty Images
The soaring trend of prevalence of myopia among children is no longer about optical inconvenience, but has inevitably grown as a public health concern due to the rapid axial length elongation of young eyes and the associated risks of vision-threatening ocular complications. Effective myopia control strategies, including optical and pharmaceutical interventions, have continued to demonstrate sound clinical efficacy in effort to slow myopia progression, particularly for at-risk children.
Despite a myriad of targeted interventions, however, the underlying risk factors of driving the development or progression of myopia remain elusive and controversial. In particular, some are keen to believe that history of myopia progression is likely associated with, or even predictive of, future progression. The study by Wesley T. Beaulieu et al. conducted a post hoc analysis of data and aimed to evaluate the relationship between prior refractive myopia progression and axial length elongation and future myopia progression and ocular changes.
Research Design
The study was a multicentered, randomized controlled trial conducted by the Pediatric Eye Disease Investigator Group (PEDIG) across 12 clinical centers in the U.S between 2018 and 2022. Children of five to 12 years of age were included. The spherical equivalent refraction (SER) -1.00 to -6.00D were randomized 2:1 to 0.01% atropine or placebo eye drops. Children with prior myopia control treatment were excluded. They were followed up at an interval of six,12, 18, 24 months upon randomization. SER was assessed using standardized cycloplegic autorefraction and axial length (AL) data. Analyses included only participants with complete data at 12 and 24 months, classifying them as “progressors” or “non-progressors” based on the predetermined change thresholds, defined as ≤−0.50D change in SER or ≥0.25 mm change in AL.
In this study, as part of the key measuring criteria, predictive metrics and agreement between progression classifications were evaluated. In addition, multivariable regression models were used to assess the relationship between past and future myopia changes while controlling potential confounders, such as age, sex and baseline refractive error. Sensitivity analyses that were restricted to the placebo group were conducted to minimize or rule out the pharmacologic effect of atropine.
Key Research Findings
- Of the 187 randomized subjects, 136 (73%) met the inclusion criteria.
- Mean ± SD age at 12 months: 10.2 ± 1.8 years
- Patient demographics: 75 female (55%), 86 White (63%) and 20 Hispanic or Latino (15%)
- Mean changes in SER: −0.40 ± 0.35D in the first 12 months and −0.35 ± 0.38D in the second 12 months (difference = −0.05 D; 95% CI, −0.13 to 0.02)
- Mean changes in AL: 0.23 ± 0.17 mm in the first and 0.18 ± 0.16 mm in the second 12 months (difference = 0.05 mm; 95% CI, 0.03–0.08)
- Correlations between changes in SER and AL: −0.87 (95% CI, −0.90 to −0.82) in the first 12 months and −0.90 (95% CI, −0.92 to −0.86) in the second 12 months
- Positive predictive value 42% (19/45; 95% CI, 29%–57%)
- Using the median 12-month change in SER (-0.32D) as the threshold value, the positive predictive value was found to be 56% (38/68; 95% CI, 44%–67%).
- Only a modest correlation was found between past and future myopia progression; high individual variabilities were observed despite correlation.
- The reported predictive value was shown to diminish over time during the course of the study period.
Study Strengths and Limitations
The study demonstrated robust post hoc analyses for the presumed associations and predictive merits on the prior and future projected rates of myopia progression. Nevertheless, limitations include, yet not limited to:
- Data on the treatment group (0.01% atropine) and the placebo group were aggregated for analysis, subject to skewed trends and outcomes.
- Selection biases: Homogeneous patient demographic of predominately white population, which might limit the generalizability of the result for diverse ethnic populations.
- Missing data of 12 months related to the COVID-19 pandemic
Clinical Significance and Application
The findings of Beaulieu et al. have key and profound implications for clinical practice. While historical progression rates may inform risk stratification to a certain degree, the modest correlation found in this study failed to support the predictive merits in serving as a sole and reliable basis for risk analyses or patient education. Indeed, using past refractive and/or axial length changes as prognostic barometers in case history may be considered as poor predictors for which should probe further scrutiny and assessment. This underscores the importance of comprehensive and personalized assessment, taking both the inherent individual variability and lifestyle considerations into account, so that clinicians can provide an objective risk evaluation and prediction for clinical decisions for myopia management.
Abstract
Does Past Myopia Progression Predict Future Progression?
Wesley T. Beaulieu; Michael X. Repka; Stacy L. Pineles; Danielle L. Chandler; Yi Pang; Lori Ann F. Kehler; Catherine O. Jordan; Katherine A. Lee; David B. Petersen; Sarah R. Hatt; Susan A. Cotter; Raymond T. Kraker; Katherine K. Weise; Jonathan M. Holmes; on behalf of the Pediatric Eye Disease Investigator Group
Purpose
To quantify the value of using prior changes in spherical equivalent refractive error (SER) and axial length (AL) to predict future myopia progression.
Methods
For this post hoc analysis of a randomized controlled trial, we used data from children ages 5 to 12 years with SER −1.00 to −6.00 D who had been randomized 2:1 to 0.01% atropine or placebo eye drops for 24 months. Multivariable linear regression evaluated the association of baseline-to-12-month change in SER and AL versus 12-to-24-month change while controlling for age and SER or AL at 12 months. Treatment groups were pooled for analyses; sensitivity analyses were conducted using only the placebo group.
Results
Among 187 children, 136 (73%) with complete data were included. For predicting a 0.50-D-or-more SER increase of myopia in the second 12 months based on observing a 0.50-D-or-more increase of myopia in the first 12 months, the positive predictive value was 42% (19 of 45; 95% confidence interval [CI], 29%–57%). Greater baseline-to-12-month SER change was weakly associated with greater 12-to-24-month SER change (0.20 D per additional 1.00 D; 95% CI, 0.02 to 0.39; P = 0.03; partial R2 = 0.03). The 95% prediction interval half-width for 12-to-24-month change was ±0.66 D with prior change versus ±0.67 D without (difference = 0.01 D; 95% CI, −0.05 to 0.07). Analyses of AL and sensitivity analyses limited to the placebo group were qualitatively similar.
Conclusions
Changes in SER and AL of children in the prior 12 months were poor predictors of future myopia progression, limiting their usefulness for clinical decision-making or selecting participants for clinical trials.
DOI: https://doi.org/10.1167/iovs.67.1.38
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