Which children are at risk of developing high myopia in their teenage years?

Title: Rapid Myopic Progression in Early Childhood is Associated with Teenage High Myopia

Authors: Carla Lanca (1), Li Lian Foo (2,5), Marcus Ang (2,4), Chuen Seng Tan (3), Biten Kathrani (6), Hla Myint Htoon (4,5), Donald Tan (2,5), Quan V Hoang (2,4), Noel A. Brennan (6), Seang Mei Saw (1,5), Charumathi Sabanayagam (4,5)

1. Myopia, Singapore Eye Research Institute, Singapore, Singapore
2. Singapore National Eye Centre, Singapore, Singapore
3. National University Singapore Saw Swee Hock School of Public Health, Singapore, Singapore
4. Singapore Eye Research Institute, Singapore, Singapore
5. Duke-NUS Medical School, Singapore, Singapore
6. Johnson and Johnson Services Inc, New Brunswick, New Jersey, United States

Reference:  ARVO 2021 abstract and video presentation

This paper aimed to evaluate the association between early childhood progression of refractive error with high myopia in teenage years. It followed 1051 Singaporean children over a mean of 6.9 years from baseline (6-11 years) until their teenage years (12-19 years old). Cycloplegic autorefraction and axial length measurements were performed yearly. At the conclusion of the study, 20% of children had high myopia (SER≤-5.00D) and 35% had AL≥25mm. Key parameters associated with development of teenage high myopia and/or longer axial length were higher 3-year progression, baseline refraction and parental myopia. 

What does this mean for your clinical practice? These results indicate that children with initial higher myopia and fast myopia progression, especially in combination with parental myopia, require closer monitoring and follow-up as well as proactive clinical interventions to slow myopia progression.

Purpose: To evaluate the association of early childhood progression of spherical equivalent (SE) with high myopia (HM) in teenagers in the Singapore Cohort of Risk factors for Myopia (SCORM).

Methods: We included 1051 SCORM children followed over a mean follow-up of 6.9±1.0 years from baseline (6-11 years-old) until their teenage years (12-19 years-old). Cycloplegic autorefraction and AL measurements were performed yearly. Three-year SE and axial length (AL) progression in childhood, baseline SE and AL, and parental myopia were evaluated using multivariable logistic or linear regression models, with predictive performance of risk factors assessed using the area under the curve (AUC). The outcomes in teenagers were HM (SE≤−5 D), AL≥25 mm, SE and AL.

Results: At the last visit, 20% of teenagers had HM and 35% had AL≥25 mm. In multivariate regression analyses, every -0.3 D/year increase in 3-year initial SE progression and every 0.2 mm/year increase in 3-year initial AL progression were associated with a -1.14 D greater teenage SE and 0.54 mm greater teenage AL (p’s<0.001). The AUC (95% CI) of a combination of 3-year SE progression, baseline SE and parental myopia for teenage HM was 0.98 (0.98-0.99). The AUC for 3-year AL progression, baseline AL and parental myopia for teenage AL≥25 mm was 0.95 (0.94-0.97).

Conclusions: Three-year myopia progression in early childhood combined with baseline SE or AL, and parental myopia, were good predictors of teenage HM. Clinicians may use this combination of factors to guide timing of interventions, potentially reducing the risk of HM later in life.

Layman Abstract: Myopia progression in childhood can lead to severe myopia in teenagers. Severe myopia it is associated with vision related problems in older adults. Myopia control treatment in children may be important to delay progression and reduce the changes of a teenager to develop severe myopia.

Disclosures: Carla Lanca, None; Li Lian Foo, None; Marcus Ang, None; Chuen Seng Tan, None; Biten Kathrani, Johnson & Johnson Vision (Code E (Employment)); Hla Myint Htoon, None; Donald Tan, None; Quan V Hoang, None; Noel A. Brennan, Johnson & Johnson Vision (Code E (Employment)); Seang Mei Saw, None; Charumathi Sabanayagam, None