Predicting the progression of myopia in children

Abstract

Purpose : Predicting the progression of myopia in children based on clinical features could allow identification of those requiring intervention and an earlier initiation of myopia management and hence a reduction to the risk of developing high myopia. We aimed to assess if optic disc and posterior segment features have the potential to predict a myopic shift in refractive error in children with myopia.

Methods : The study was approved by the AIER Institutional Ethics committee and parents/carers provided consent. Baseline fundus images of 56 (eyes) of 28 Chinese children with myopia who attended baseline and 12 months visit were analyzed. Fundus images were obtained using KOWA VX-10 alpha retinal camera. The fundus images were analysed using custom-coded Matlab software. Features assessed were optic disc tilt, rotation and asphericity, fovea-to-disc distance, superior and inferior ophthalmic retinal artery and vein angles at the disc, the presence of tessellations (quadrant wise),extend of temporal crescent at the optic disc.. The association of these features to the progression of spherical equivalent (SE) and axial length (AL) at 12 months was determined using the general linear model.

Results : Annual change in axial length was associated with disc tilt (p=0.017) and temporal crescent (p=0.002, model r²=0.18). Greater extent of temporal crescent, graded as 0 (absent), 1(< 90⁰), 2(90⁰-180⁰), 3(180⁰) and 4(>180⁰) correlated with lower AL progression. Similarly, there was an inverse relation with disc tilt, i.e. lower AL progression correlated with greater disc tilt, measured as the angle formed by global vertical and long axis of the optic disc. After adjusting for age, optic disc features remained significant (disc tilt p=0.043; temporal crescent p=0.018). Annual progression of SE followed a similar model with disc tilt (p=0.005) and temporal crescent (p=0.026, model r²=0.15).

Conclusions : In this small sample of myopic children, there was an association between the presence of temporal crescent at the disc and disc tilt with the progression of axial length and spherical equivalent. The results have to be confirmed using a larger sample.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.