The progression of myopia in school age children: data from the Columbia Medical Plan.

The purpose of this study was to characterize the clinical course of myopia in a selected pediatric population. The computerized records of a health maintenance organization provided longitudinal data on 501 children aged 5 to 15 years. We examined the influence of age at diagnosis, gender, race, and initial refraction on progression of myopia. Mean follow-up was 34 months, with 75% of children having follow-up longer than 16 months. The mean rate of myopic progression was greater for children whose myopia was diagnosed at a younger age (5-7 years, -0.56 diopters/year versus 11-15 years, -0.28 diopters/year; p < 0.0001). Children with more than one diopter of myopia at first diagnosis progressed faster than children with less than or equal to one diopter of myopia (mean rate -0.48 diopter/year versus -0.41 diopter/year; p = 0.05). Cumulative event rate curves suggest a gender effect in the prepuberty years of 8 to 10, with myopia progressing faster in girls than boys (p = 0.003). Progression of myopia did not differ between white and non-white children. More rapidly progression of myopia is associated with younger age at initial diagnosis and greater severity of initial myopic refraction.

Accommodative amplitudes in the Early Treatment Diabetic Retinopathy Study.

PURPOSE: Accommodative amplitude in persons with diabetes was investigated using data collected as part of the Early Treatment Diabetic Retinopathy Study. METHODS: Accommodative amplitude was measured at the baseline visit in 1,058 patients who had good visual acuity and who were less than 46 years old. Risk factors for low accommodative amplitude at baseline were evaluated using multivariable linear regression. Change in accommodative amplitude after photocoagulation was evaluated using paired t tests and repeated measures analysis of variance for the 578 patients who underwent follow-up measurements at the 4-month visit. RESULTS: Accommodative amplitudes in Early Treatment Diabetic Retinopathy Study patients were lower than normal accommodative amplitudes. Older age (P < 0.001) and increased duration of diabetes (P < 0.01) were risk factors associated with low amplitudes of accommodation in the Early Treatment Diabetic Retinopathy Study. Full scatter photocoagulation was associated with an apparently transient additional reduction in accommodative amplitude; a one third diopter loss in accommodative amplitude was demonstrated only at the 4-month visit (P < 0.001). CONCLUSION: This study demonstrates that diabetes and duration of diabetes, along with age, are important risk factors for reduced accommodative amplitude. These factors along with an apparently transient decrease in accommodative amplitude following scatter photocoagulation should be considered when assessing the accommodative needs of patients with diabetes and when discussing side effects of full scatter photocoagulation.