The PreMO (Predicting Myopia Onset and progression) risk indicator reliably predicts future myopia in East Asian and UK children.

Abstract

Purpose : The Predicting Myopia Onset and Progression Risk Indicator (PreMO) provides evidence-based risk stratification and management guidance for childhood myopia. It was derived from a UK population-based study of white children (the ‘NICER’ study) and utilises cycloplegic spherical equivalent refraction (SER), axial length (AL) and parental myopia to stratify future risk of myopia. The present study evaluated the PreMO’s performance using prospective data from independent samples of children in the UK (Birmingham, ethnically diverse sample) and East Asia (Hong Kong [HK]).

Methods : PreMO risk scores for future myopia were generated for all non-myopic (SER>-0.50D) participants aged 6-8 and/or 9-10 years using SER, AL, and parental myopia (0=no risk, 1-3=low risk, 4-6=moderate risk, 7-9=high risk). Table 1 describes participant demographics. SER at >15 years of age was used to define outcomes as ‘myopic’ (SER≤-0.50D) or ‘not myopic’.

PreMO performance in correctly predicting future myopia was evaluated by Receiver Operator Characteristic curve analysis. Youden’s J Index was used to identify optimal risk scores for prediction. Sensitivity, specificity, and area under the curve (AUC) were also derived for previously identified, singular predictors for future myopia; SER <+0.75DS and AL ≥23.07mm (75^th centile of NICER growth chart) at 6-8 years.

Results : Using ocular metrics and parental history data collected at 6-8 years, a PreMO risk score ≥4 was highly sensitive (0.97 UK, 0.94 HK) in predicting future myopia. A score ≥4 was highly specific (0.96) for future myopia in UK children but less so for East Asian children in HK (0.64). PreMO risk scores obtained at 9-10 years achieved both high sensitivity (0.80) and specificity (0.90) for future myopia in HK children. Use of singular predictors demonstrated lower sensitivity than the PreMO framework in HK children and lower specificity for UK children (Table 2).

Conclusions : The PreMO can be applied to both UK and East Asian children to stratify risk for future myopia. A risk score ≥4 is strongly indicative of future myopia.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Table 1: Mean ± Standard Deviation of Birmingham, UK and Hong Kong data set demographics and ocular characteristics.

 

Table 2: Sensitivity and specificity of the PreMO Risk Indicator and alternative prediction strategies in predicting future myopia.