Axial growth and refractive change in white European children and young adults: predictive factors for myopia

Abstract

This report describes development of spherical equivalent refraction (SER) and axial length (AL) in two population-based cohorts of white, European children. Predictive factors for myopic growth were explored. Participants were aged 6–7- (n = 390) and 12–13-years (n = 657) at baseline. SER and AL were assessed at baseline and 3, 6 and 9 years prospectively. Between 6 and 16 years: latent growth mixture modelling identified four SER classes (Persistent Emmetropes-PEMM, Persistent Moderate Hyperopes-PMHYP, Persistent High Hyperopes-PHHYP and Emerging Myopes-EMYO) as optimal to characterise refractive progression and two classes to characterise AL. Between 12 and 22-years: five SER classes (PHHYP, PMHYP, PEMM, Low Progressing Myopes-LPMYO and High Progressing Myopes-HPMYO) and four AL classes were identified. EMYO had significantly longer baseline AL (≥ 23.19 mm) (OR 2.5, CI 1.05–5.97) and at least one myopic parent (OR 6.28, CI 1.01–38.93). More myopic SER at 6–7 years (≤ + 0.19D) signalled risk for earlier myopia onset by 10-years in comparison to baseline SER of those who became myopic by 13 or 16 years (p ≤ 0.02). SER and AL progressed more slowly in myopes aged 12–22-years (− 0.16D, 0.15 mm) compared to 6–16-years (− 0.41D, 0.30 mm). These growth trajectories and risk criteria allow prediction of abnormal myopigenic growth and constitute an important resource for developing and testing anti-myopia interventions.

Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute

“…The presence of +0.75 D or less of hyperopia at the age of 6 years indicates that myopia is likely to develop in the near future. 334,336,338 In prospective data from White European children, McCullough et al demonstrated that children presenting with a refractive error of <+0.63 D at 6-7 years and with at least one myopic parent were likely to develop myopia by age 13 years and those with no myopic parents were likely to develop myopia by 16 years. 338 Other work suggests that premyopes may also show specific binocular vision disorders.…”

“…334,336,338 In prospective data from White European children, McCullough et al demonstrated that children presenting with a refractive error of <+0.63 D at 6-7 years and with at least one myopic parent were likely to develop myopia by age 13 years and those with no myopic parents were likely to develop myopia by 16 years. 338 Other work suggests that premyopes may also show specific binocular vision disorders. 136 Since the visual profile of the myopic child is characterized by higher accommodative lag, 26,27 high AC/A ratio (esophoria at near) 135,139 and reduced accommodative flexibility, 26,27 it would be important to include tests that evaluate the binocular vision and not only refraction.…”

“…Where axial biometry measures are available, these can also be informative in identifying children at risk for myopia who should be provided behavioural advice and monitored closely for the onset of myopia in order that anti-myopia therapies can be applied. 93,337,338 Percentile growth curves for White European children are available for axial length in childhood and can be used to identify patients whose eye size puts them at increased risk for future myopia. 93,337,338 In addition to identifying risk for future myopia, these centiles can be used after the onset of myopia to monitor growth trajectories with/without anti-myopia intervention.…”

“…Axial length is the most important metric to monitor in pre-myopic and myopic children. 93,285,334,337,338 Myopia generally progresses most rapidly during preteenager years (7-12 years), subsequently slowing through adolescence and adulthood. 67,91,354 The mean age of myopia stabilization is around 15.6 years of age, and 95% of myopes stabilize by age of 24 years.…”

Ocular biometric features of pediatric patients with fibroblast growth factor receptor-related syndromic craniosynostosis

“…However, the age at examination and definition of significant refractive error (hypermetropia, myopia, and astigmatism) differ between studies. Moreover, prior studies were not controlled for environmental factors and ethnic differences, which can affect refractive error 11 – 13 . Thus, the impact of syndromic and non-syndromic craniosynostosis on refractive error remains to be elucidated.…”