What the Fundus

A standard warning in investing is that prior performance does not predict future results. Can the same thing be said about myopia progression? The article The Limited Value of Prior Change in Predicting Future Progression of Juvenile-Onset Myopia: Optometry and Vision Science published in the May 2022 edition of Optometry and Vision Science purports that is the case.

The data for this article was extracted from the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study which evaluated the myopia progression of 916 children 7 to 14 years of age over a two-year period.

This study evaluated the amount of change between the baseline visit and the second visit one year later and tried to predict what the level of myopia would be at the third visit in one more year.

Age, ethnicity, and greater myopia were significant predictors of future refractive error and axial length, whereas prior progression or elongation, near work, time outdoors, and parental myopia were not.

Interesting.

If you ask most people in the myopia control field, this is counter to what we believe. I routinely ask parents about their level of myopia, how much time the child spends outside, and how much time they spend doing near work. We just recorded a podcast discussing a study on how much outside time affects myopia progression.

Neither near work nor time outdoors has factored significantly or consistently into models of eventual amounts of myopia or rate of progression

I’m not going to change my thinking. This study was not out to disprove that outdoor time and near work aren’t important in myopia progression, only that it cannot necessarily be used to predict how fast the child will progress.

Parental history of myopia and environmental variables such as near work and time outdoors did not add to the accuracy of predictions of future change

So, you can still consider these factors when thinking when to trying to figure out when to start myopia control therapy. You may not want to use previous changes to predict where they will end up.

These findings suggest that it is inadvisable to delay myopia control to establish a high rate of pre-treatment progression. Initiation of myopia control should not depend on history of progression.

I tend to rely on age normals to decide when to start myopia control. I have those somewhere from a talk I gave. When I come across them, I’ll post them.