Assessing the value of prior myopia progression data

Paper title: Does Past Myopia Progression Predict Future Progression?

Authors: Beaulieu WT (1), Repka MX (2), Pineles SL (3), Chandler DL (1), Pang Y (4), Kehler LAF (5), Jordan CO (6), Lee KA (7), Petersen DB (8), Hatt SR (9), Cotter SA (10), Kraker RT (1), Weise KK (11), Holmes JM (12)

1. Jaeb Center for Health Research, Tampa, Florida, United States
2. Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, United States
3. Jules Stein Institute at the University of California, Los Angeles, Los Angeles, California, United States
4. Illinois College of Optometry, Chicago, Illinois, United States
5. Vanderbilt University Medical Center, Nashville, Tennessee, United States
6. Nationwide Children's Hospital, Columbus, Ohio, United States
7. St. Luke's Children's Ophthalmology, Boise, Idaho, United States
8. Rocky Mountain Eye Care Associates, Salt Lake City, Utah, United States
9. Mayo Clinic, Rochester, Minnesota, United States
10. Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California, United States
11. Birmingham School of Optometry, University of Alabama, Birmingham, Alabama, United States
12. University of Arizona, Tucson, Arizona, United States

Date: Published online January 5, 2026

Reference: Beaulieu WT, Repka MX, Pineles SL, Chandler DL, Pang Y, Kehler LAF, Jordan CO, Lee KA, Petersen DB, Hatt SR, Cotter SA, Kraker RT, Weise KK, Holmes JM; Pediatric Eye Disease Investigator Group. Does Past Myopia Progression Predict Future Progression? Invest Ophthalmol Vis Sci. 2026 Jan 5;67(1):38.

[Link to open access paper]

Identifying predictive factors for future myopia progression would be valuable both for clinicians managing individual patients and for researchers designing clinical trials. In clinical practice, some practitioners have used prior changes in refractive error or axial length to guide treatment decisions, under the assumption that children who have progressed rapidly will continue to do so.1  However, this assumption has been challenged by research suggesting that past progression may not consistently reflect future risk, due in part to year-to-year variability in progression and the typical age-related slowing of myopia.2  This study aimed to evaluate whether changes in spherical equivalent refractive error (SER) and axial length (AL) over one year could meaningfully predict changes over the following year in a cohort of children with mild to moderate myopia.

Key points were as follows:

• The study analysed data from 136 children with mild to moderate myopia enrolled in a 2-year randomized controlled trial of 0.01% atropine versus placebo (PEDIG study).
• Weak associations were found between prior and subsequent 12-month changes in both SER (0.20 D per additional 1.00 D) and AL (0.28 mm per additional 1.00 mm).
• Including prior progression in predictive models resulted in minimal improvements in prediction interval width (e.g., ±0.66 D vs ±0.67 D for SER).
• Sensitivity analyses limited to the placebo group yielded similar results.
• The findings indicate that prior myopia progression offers limited value in predicting future progression for individual patients.

 This study found that prior 12-month changes in refractive error or axial length are poor predictors of future myopia progression in individual children. While it may be tempting to classify patients as “fast” or “slow” progressors based on their previous year’s data, this approach showed little value in forecasting outcomes over the subsequent 12 months. In this study, the positive predictive value of ≥0.50 D myopia progression in year one predicting the same in year two was just 42%. For axial length, the corresponding value was 46% for ≥0.25 mm of growth. This means a less than 50/50 chance of the prediction being useful. Prediction intervals for future change were almost identical regardless of whether prior progression was included, showing that past data did not meaningfully improve predictability.

In clinical settings, this suggests that relying on the previous year’s myopia progression to guide treatment decisions — such as initiating or intensifying myopia control — may not be a robust strategy. Instead, clinicians should continue to take a holistic view of the child’s age, baseline refraction, family history, and lifestyle risk factors when making management decisions. These findings reinforce the importance of early intervention rather than waiting to confirm “fast progression” before initiating treatment.

This study shows that refractive error and axial length changes over the previous 12 months provide limited predictive value for future myopia progression. Even when included in multivariable models, prior progression did not meaningfully improve prediction. However, several limitations must be considered. Only 73% of the original cohort were included due to missing mid-study data during the COVID-19 pandemic. .The prediction window was limited to a single 12-month period, which may be too short to capture more meaningful trends. These factors may limit the generalisability of findings, particularly in treated populations or different age and ethnic groups.

While there is some correlation between past and future change, this and other studies suggest the relationship is too weak to guide treatment decisions in isolation. Using data from the SCORM study, a retrospective cohort study in 981 Singaporean children aged 7 to 9 years found moderate associations between one-year and subsequent two-year progression, particularly in younger children and those with higher baseline myopia. In contrast, using data from the CLEERE study, a predictive modelling study of over 900 American children aged 7 to 14 years found that prior progression added little to predictive performance, with age, ethnicity, and baseline refractive error being more reliable indicators. Future studies could explore longer-term progression patterns across diverse populations, using consistent measurement methods and multifactorial models to improve individual-level prediction and guide treatment decisions.

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.

[Link to open access paper]