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

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.

Higher order ocular aberrations and their relation to refractive error and ocular biometry in children.

PURPOSE: The interaction between higher order ocular aberrations (HOA) and refractive error is not yet fully understood. This study investigated HOA in relation to refractive error and ocular biometric parameters in a population with a high prevalence of ametropia. METHODS: The HOA were investigated in two cohorts of Caucasian children aged 9 to 10 and 15 to 16 years (n = 313). These aberrations were measured for a 5-mm pupil with the IRX3 aberrometer. Cycloplegic refractive error and ocular biometry measures, including axial length and corneal curvature, also were assessed with the Shin-Nippon SRW-5000 auto-refractor and Zeiss IOLMaster, respectively. Participants were divided into refractive groups for analysis of HOA. RESULTS: The magnitude of total HOA was higher in this population at 0.27 µm (interquartile range [IQR], 0.22-0.32 µm) than other HOA reported in the literature. The profile of HOA was not significantly different across the two age cohorts or across refractive groups, nor did spherical aberration differ significantly with age (Z4° = 0.07 µm for both cohorts). Multivariate linear regression analysis demonstrated spherical aberration was significantly related to axial length (but not refractive grouping), with longer eyes having less positive values of fourth order and root mean square (RMS) spherical aberration. CONCLUSIONS: This study found no significant difference in HOA across refractive groups. The current study also highlights the importance of knowledge of axial length when analyzing HOA.

An investigation into the validity of self-reported classification of refractive error.

PURPOSE: To assess the validity of questionnaire use in the self-identification of refractive status. METHODS: Two hundred and forty adults (21-60 years of age) presenting for a routine eye examination at various optometric practices in Northern Ireland were asked to complete one of two questionnaires. Both questionnaires used identical questions to ascertain age, gender, current spectacle use, age of first spectacle use and level of education. For the identification of refractive status, Questionnaire 1 used layman's terminology whilst Questionnaire 2 combined optometric terminology with descriptive explanations. Current refractive status was identified by the examining optometrist who did not see the completed questionnaire. The spherical equivalent refractive error of the non-cycloplegic subjective refraction was used to categorise myopia as <0D and hyperopia as ≥+1.00D. Astigmatism was defined according to two different criteria: ≥0.50DC and ≥1.00DC. RESULTS: Questionnaire 1 had a sensitivity of 0.63 and a specificity of 0.90 for identifying myopia; a sensitivity of 0.58 and a specificity of 0.71 for identifying hyperopia; a sensitivity of 0.12 and a specificity of 0.98 for identifying astigmatism ≥0.50DC and a sensitivity of 0.19 and a specificity of 0.95 for identifying astigmatism ≥1.00DC. Questionnaire 2 had a sensitivity of 0.83 and a specificity of 0.93 for identifying myopia; a sensitivity of 0.45 and a specificity of 0.86 for identifying hyperopia; a sensitivity of 0.32 and a specificity of 0.88 for identifying astigmatism ≥0.50DC and a sensitivity of 0.50 and a specificity of 0.84 for identifying astigmatism ≥1.00DC. For both questionnaires, altering a positive self-identification of myopia to include only those who had worn spectacles prior to age 30 reduced the sensitivity and increased the specificity slightly. CONCLUSIONS: Questionnaires are a valid tool in self-identification of myopic refractive status. However, they are not an effective way of identifying hyperopia and astigmatism and objective or subjective refraction remains the most appropriate method of identifying such individuals.

A prospective study of spherical refractive error and ocular components among Northern Irish schoolchildren (the NICER study).

PURPOSE: To explore 3-year change in spherical refractive error and ocular components among white Northern Irish schoolchildren. METHODS: Baseline data were collected among 6- to 7-year-old and 12- to 13-year-old children. Three years after baseline, follow-up data were collected. Cycloplegic refractive error and ocular components measurements (axial length [AL], anterior chamber depth [ACD], corneal radius of curvature [CRC]) were determined using binocular open-field autorefraction and ocular biometry. Change in spherical equivalent refractive error (SER) and ocular components were calculated. RESULTS: A statistically significantly greater change in SER was found between 6 to 7 years and 9 to 10 years (younger cohort) compared to between 12 to 13 years and 15 to 16 years (older cohort) (-0.38 diopter [D] and -0.13 D, respectively) (P<0.001). A statistically significantly greater change in AL was found among the younger compared to the older cohort (0.48 mm and 0.14 mm, respectively) (P<0.001). Change in ACD was minimal across both groups (0.12 mm younger and 0.05 mm older cohort) as were changes in CRC. Change in SER was associated with change in AL in both age groups (both P<0.01). CONCLUSIONS: There is a greater change in both spherical refractive error and axial length in younger children when compared with teenagers. Although increase in axial length drives refractive change during childhood and teenage years, lens compensation continues to occur in an attempt to maintain emmetropia. White children living in Northern Europe demonstrate dramatically less change in spherical refractive error over a fixed period of time than their East Asian counterparts. In contrast, they appear to exhibit more rapid myopic progression than UK children studied in the mid-20th century.

The robustness of various forms of perimetry to different levels of induced intraocular stray light.

PURPOSE: To compare directly the robustness of standard automated perimetry (SAP), short-wavelength automated perimetry (SWAP), frequency-doubling perimetry (FDP), and grating-resolution perimetry (GRP) stimuli to different degrees of intraocular stray light induced by commercially available opacity-containing filters. METHODS: Five white opacity filters of increasing density were used to simulate the typical forward light scatter and stray light values associated with age-related lens opacification and significant cataract. The individually induced intraocular stray light value for each filter was quantified with a stray light meter and plotted against individual perimetric thresholds for the right eyes of three normally sighted trained observers for SAP, SWAP, FDP, and GRP. RESULTS: All tests were significantly but differently affected by increasing stray light. Overall average declines over a 1 log unit change in the stray light values were as follows: SAP, 4.85 dB; SWAP, 9.03 dB; FDP, 4.29 dB; and GRP, 1.36 dB. Standardized (z) scores were calculated after normalization to the spread of the normative data values for each instrument. These indicated that the standardized changes from baseline over the range of the five filters per log stray light unit were as follows: SAP, 2.177; SWAP, 1.96; FDP, 1.277; and GRP, 1.04. CONCLUSIONS: The increased stray light values induced by cataract-simulating filters has a significant effect on all tests. However, GRP, which is known to be limited by retinal sampling rather than contrast, remains the most robust of the tests to the effects of intraocular stray light. The degree to which the normative "sensitivity" range for different types of perimetry might incorporate a component caused by individual differences in intraocular stray light is discussed and requires further research.