Prediction of Juvenile-Onset Myopia.
Prediction of Juvenile-Onset Myopia.
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DOI：
10.1001/jamaophthalmol.2015.0471
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发表时间：
2015-06
影响因子：
8.1
通讯作者：
Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study Group
中科院分区：
文献类型：
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作者：
Zadnik K;Sinnott LT;Cotter SA;Jones-Jordan LA;Kleinstein RN;Manny RE;Twelker JD;Mutti DO;Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study Group
近视在儿童期发病，影响美国约三分之一的成年人。近视的患病率很高，矫正费用昂贵，并且与青光眼和视网膜脱离等眼部疾病有关。确定学龄儿童近视发病的最佳预测因子。种族和屈光不正协作纵向评估 (CLEERE) 研究是一项关于眼发育和近视发病的观察性队列研究，于 1989 年 9 月 1 日至 2010 年 5 月 22 日在 5 个临床中心进行。数据收集自 4512 名 1 至 8 年级（基线 1 至 6 年级）（6 至 13 岁）的 4512 名不同种族、非近视学龄儿童。 [基线，6 至 11 岁]）。我们评估了 13 个候选风险因素预测近视发病的能力。近视发作定义为右眼每条主子午线的近视度数为-0.75屈光度或以上，在基线后的任何一次就诊时通过散瞳自体验光测量，直至8级（13岁）。我们使用离散时间生存分析的比值比、曲线下面积和交叉验证来评估风险因素。共有 414 名 2 至 8 年级（7 至 13 岁）儿童近视。在评估的 13 个因素中，有 10 个与近视发病风险相关 (P < .05)。在这 10 个因素中，有 8 个在多变量模型中保留了它们的关联：基线时的球面等效屈光不正、父母近视、眼轴长度、角膜屈光力、晶状体屈光力、调节会聚与调节的比率（AC/A 比率）、水平/垂直散光强度和视觉活动。在多变量模型中，远视程度较低/近视程度较高的基线屈光不正始终与近视发病风险相关（比值比为 0.02 至 0.13，P < .001），而工作地点附近、户外时间以及父母近视则不然。等效球面屈光不正是单一的最佳预测因素，与所有 8 个因素一起表现良好，曲线下面积（C 统计量）范围为 0.87 至 0.93（95% CI，0.79-0.99）。通过简单、单一的屈光不正测量，可以预测非近视儿童未来的近视情况。未来预防近视的试验应将低度远视儿童作为高危儿童。
Myopia (nearsightedness) has its onset in childhood and affects about one-third of adults in the United States. Along with its high prevalence, myopia is expensive to correct and is associated with ocular diseases that include glaucoma and retinal detachment. To determine the best set of predictors for myopia onset in school-aged children. The Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study was an observational cohort study of ocular development and myopia onset conducted at 5 clinical sites from September 1, 1989, through May 22, 2010. Data were collected from 4512 ethnically diverse, nonmyopic school-aged children from grades 1 through 8 (baseline grades 1 through 6) (ages 6 through 13 years [baseline, 6 through 11 years]). We evaluated 13 candidate risk factors for their ability to predict the onset of myopia. Myopia onset was defined as −0.75 diopters or more of myopia in each principal meridian in the right eye as measured by cycloplegic autorefraction at any visit after baseline until grade 8 (age 13 years). We evaluated risk factors using odds ratios from discrete time survival analysis, the area under the curve, and cross validation. A total of 414 children became myopic from grades 2 through 8 (ages 7 through 13 years). Of the 13 factors evaluated, 10 were associated with the risk for myopia onset (P < .05). Of these 10 factors, 8 retained their association in multivariate models: spherical equivalent refractive error at baseline, parental myopia, axial length, corneal power, crystalline lens power, ratio of accommodative convergence to accommodation (AC/A ratio), horizontal/vertical astigmatism magnitude, and visual activity. A less hyperopic/more myopic baseline refractive error was consistently associated with risk of myopia onset in multivariate models (odds ratios from 0.02 to 0.13, P < .001), while near work, time outdoors, and having myopic parents were not. Spherical equivalent refractive error was the single best predictive factor that performed as well as all 8 factors together, with an area under the curve (C statistic) ranging from 0.87 to 0.93 (95% CI, 0.79–0.99). Future myopia can be predicted in a nonmyopic child using a simple, single measure of refractive error. Future trials for prevention of myopia should target the child with low hyperopia as the child at risk.