Abstract
Purpose :
With increasing interest in slowing myopia progression, normative data for progression in myopic children provide a valuable clinical reference. Growth curves have been presented but are specific to population and usually include both myopes and non-myopes, limiting their application to myopia control. We conducted a meta-analysis to model refractive error change in myopic children with emphasis on the influence of age and race.
Methods :
A comprehensive electronic systematic search was performed using Ovid Medline, EMBASE, Cochrane Central Register of Controlled Trials. To achieve maximum sensitivity of the search strategy, the following terms were used: “myopia” or “myopic” and “child” or “children” and “progression” or “longitudinal” or “follow-up” or “shift” and “refractive error”. There were 106 studies with 165 subpopulations and 359 evaluations of the mean refractive error from baseline that met our inclusion criteria. Mean rate of change in refractive error was analyzed using a multivariate linear mixed effects meta-analysis model. All collected covariates were tested for significance (age, race [east Asian or not], and baseline refractive error selected). The model included three levels of random effects to account for all variability. Prediction intervals were calculated to show likely variability across a population.
Results :
Only data without missing significant covariates were included in the final model (127 evaluations). The figure shows instantaneous myopia progression (in D/year) as a function of age and race. Mean refractive error progression decreases as age increases (9.7% decrease per year, 95% CI 5.4%-13.9%, P <0.0001) and is greater in Asian children (by 42.2%, 95% CI 18.3%-70.0%, P <0.0001) compared to non-Asians. The estimated prediction intervals show the broad range of progression rates.
Conclusions :
To our knowledge, this is the first weighted random effects meta-analysis of refractive error change in myopic children. Interpretation of the data is limited due to the use of aggregated data rather than individual subject data. This analysis sets benchmark values and estimates of the spread of refractive error change for monitoring myopia progression and treatment efficacy.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.