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  • Myopia Progression in Children: Racial and Ethnic Differences

    By Lynda Seminara
    Selected By: Prem S. Subramanian, MD, PhD
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    Journal Highlights

    Investigative Ophthalmology & Visual Science
    2020;61(13):20

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    Studies of myopia usually involve ethnically homogeneous cohorts. The minimal research in diverse popula­tions has revealed little about the role of race in the development or pro­gression of myopia or the subsets of children at greatest risk for advanced disease. To shed light on these issues, Luong et al. looked at myopia progres­sion in a large, racially diverse popu­lation of children who had early onset myopia. They found that race/ethnicity was a major predictor of myopic pro­gression and that meaningful differ­ences exist between Whites and East/Southeast Asians based on age at onset.

    For this retrospective study, the au­thors reviewed medical records of patients aged 4 to 11 years, whose documented refraction ranged from ‒6 to ‒1 D.

    Excluded from the study were children with a history of ambly­opia, strabismus, retinopathy of prematurity, or ocular surgery. The authors used growth-curve and linear mixed-effects modeling to track spherical equivalents (SEs) over time, modeled by race/ethnicity. They also adjusted for potential confound­ers, including body mass index, screen time, and physical activity.

    Overall, 11,595 patients met the inclusion criteria. The mean age at initial refraction was 8.9 years, and 53% were female. The racial/ethnic break­down was 55% Latino, 15% White, 9% Black, 9% East/Southeast Asian, and 2% South Asian. The average follow-up time was 3.1 years (range, 1.8-5.9 years).

    The mean number of refractions during the study period was 3.4, including the baseline assessment. In mixed-effects models, no significant differences were noted for screen time or level of physical activity. A three-way interaction model to explore the effects of age at baseline, time since baseline, and race/ethnicity showed that myopia progressed fastest in children of East/Southeast Asian descent (p < .001) and that trajectories varied significantly by age at onset. SE declines were steeper in East/Southeast Asians than in Whites in all age groups except those with onset at 6 or 7 years of age, for whom the progression rate was similar.

    Based on these real-world findings in a large study population, the authors proposed that race and ethnicity be considered in future myopia clinical tri­als and prevention programs. They not­ed that children of East and Southeast Asian descent require special attention because of their high risk of rapid pro­gression. They also recommend more refined studies of the effects of screen time and physical activity on myopia progression.

    The original article can be found here.