May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Relative Peripheral Refractive Error and the Risk of Juvenile-Onset Myopia
Author Affiliations & Notes
  • D. O. Mutti
    College of Optometry, Ohio State University, Columbus, Ohio
  • L. T. Sinnott
    College of Optometry, Ohio State University, Columbus, Ohio
  • L. A. Jones
    College of Optometry, Ohio State University, Columbus, Ohio
  • S. A. Cotter
    Southern California College of Optometry, Fullerton, California
  • R. N. Kleinstein
    School of Optometry, University of Alabama, Birmingham, Alabama
  • R. E. Manny
    College of Optometry, University of Houston, Houston, Texas
  • J. D. Twelker
    Department of Ophthalmology, University of Arizona, Tucson, Arizona
  • K. Zadnik
    College of Optometry, Ohio State University, Columbus, Ohio
  • The CLEERE Study Group
    College of Optometry, Ohio State University, Columbus, Ohio
  • Footnotes
    Commercial Relationships  D.O. Mutti, None; L.T. Sinnott, None; L.A. Jones, None; S.A. Cotter, None; R.N. Kleinstein, None; R.E. Manny, None; J.D. Twelker, None; K. Zadnik, None.
  • Footnotes
    Support  NIH/NEI grants U10-EY08893 and R24-EY014792, the Ohio Lions Eye Research Foundation, and the EF Wildermuth Foundation.
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 5426. doi:https://doi.org/
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      D. O. Mutti, L. T. Sinnott, L. A. Jones, S. A. Cotter, R. N. Kleinstein, R. E. Manny, J. D. Twelker, K. Zadnik, The CLEERE Study Group; Relative Peripheral Refractive Error and the Risk of Juvenile-Onset Myopia. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5426. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : Peripheral hyperopic defocus may accelerate the overall growth of the eye, often resulting in a myopic foveal refractive state (Smith et al., ARVO 2007). We investigated whether relative peripheral refractive error is related to the risk of myopia onset in children.

Methods: : Subjects were 1,981 participants in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study who were not myopic in the third grade and who returned for at least one subsequent annual visit. Examinations included autorefraction (Canon R-1, Grand Seiko WR-5100K) under cycloplegia (tropicamide or tropicamide plus cyclopentolate) in primary gaze and in 30 degrees temporal gaze. Relative peripheral refractive error (RPR) was defined as peripheral spherical equivalent minus central spherical equivalent refractive error. Central and RPR refractions were dichotomized into risk factors (cut points <+0.75 D or ≥+0.75 D centrally; any relative peripheral hyperopia or not for RPR). Risk of myopia onset (more than -0.75 D of myopia in each meridian) was analyzed using a discrete time survival analysis model.

Results: : Children with a central refractive error ≥+0.75 D had a low risk of myopia onset regardless of whether RPR was hyperopic or non-hyperopic (probability of no myopia by grade 8 = 0.98 and 0.99, respectively). Children with a central refractive error <+0.75 D had a higher risk of myopia onset that depended on whether RPR was hyperopic or non-hyperopic (probability of no myopia by grade 8 = 0.60 and 0.70, respectively). In a multivariate model, the hazard probability odds ratio for central refractive error <+0.75 D was 28.7 (95% CI = 14.1-58.6) and 1.46 for hyperopic RPR (95% CI = 1.14-1.87).

Conclusions: : Relative peripheral hyperopia is a risk factor for myopia onset independent of central refractive error. Central refractive error <+0.75 D seems to be the much stronger predictive factor, however. Possible mechanisms for RPR’s influence include defocus-driven eye growth or mechanical or physiologic restriction to equatorial expansion. Clinical trials of correction of peripheral defocus in children at risk for myopia onset using corneal reshaping or bifocal contact lenses may be justifiable but may also require a large sample considering the estimated size of RPR’s effect.

Keywords: myopia • clinical (human) or epidemiologic studies: risk factor assessment • refractive error development 
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