Racial and Ethnic Differences in Pediatric Myopia Progression
abstract
This abstract is available on the publisher's site.
Access this abstract nowPurpose
The purpose of this study was to characterize the differences in myopic progression in children by race/ethnicity and age.
Methods
Patients enrolled in Kaiser Permanente Southern California between 2011 and 2016 and between the ages of 4 and 11 years old with a documented refraction between -6 and -1 diopters (Ds) were included in this retrospective cohort study. Patients with a history of amblyopia, strabismus, retinopathy of prematurity, or prior ocular surgery were excluded from analyses. Patients' race/ethnicity and language information were used to create the following groups for analysis: white, Black, Hispanic, South Asian, East/Southeast Asian, Other Asian, and other/unknown. A growth curve analysis using linear mixed-effects modeling was used to trace longitudinal progression of spherical equivalents over time, modeled by race/ethnicity. Analyses adjusted for potential confounders, including body mass index (BMI), screen time, and physical activity.
Results
There were 11,595 patients who met the inclusion criteria. Patients were 53% girls, 55% Latino, 15% white, 9% black, 9% East/Southeast Asian, and 2% South Asian. Mean age (standard deviation [SD]) at the time of initial refraction was 8.9 years (1.6 years). Patients had an average (SD) of 3.4 (1.5) refractions, including the baseline measurement, during the study period. A three-way interaction model that assessed the effects of age at baseline, time since baseline, and race/ethnicity found that children of East/Southeast Asian descent showed significantly faster myopia progression across time (P < 0.001). East/Southeast Asian patients who presented with myopia between 6 to < 8 years progressed similarly to white patients in the same age group and significantly faster compared with white patients in other age groups.
Conclusions
Myopia progression differed significantly between East/Southeast Asian and white patients depending on the patients' age.
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Additional Info
Disclosure statements are available on the authors' profiles:
Racial and Ethnic Differences in Myopia Progression in a Large, Diverse Cohort of Pediatric Patients
Invest. Ophthalmol. Vis. Sci 2020 Nov 02;61(13)20, TQ Luong, YH Shu, BS Modjtahedi, DS Fong, N Choudry, Y Tanaka, CL NauFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This is a retrospective cohort study of over 11,000 pediatric patients enrolled in the Kaiser Permanente system in Southern California through EHR review of records from 2011 to 2016. The authors focused on children with onset of myopia ranging anywhere from 1 to 6 diopters between the ages of 4 and 11 years old. The first measurement where the refractive error was ≤ −1 diopter defined the baseline measurement. Based on their results, the authors concluded that East and Southeast Asian children warrant special attention as they demonstrate higher progression of myopia than any other race. It is curious that the authors report that cycloplegic refractions were not performed routinely in patients with myopia in this age group in their "real-world setting." They acknowledge that the lack of cycloplegia likely results in overestimation of myopia in young children and their values presented in this paper may therefore may overestimate myopic error. They note that their concern wasn't the absolute amount of myopia, but the rate of progression, and therefore their conclusions are still valid. However, my impression is that cycloplegic refraction in the age group of 4 to 11 years is the norm among pediatric ophthalmologists, who would not view these data as indicative of their "real-world" setting.