title: Prediction of Juvenile-Onset Myopia.
abstract: OBJECTIVE
  Myopia (nearsightedness) has its onset in childhood and affects about one-third of adults in the United States. Along with its high prevalence, myopia is expensive to correct and is associated with ocular diseases that include glaucoma and retinal detachment.
  
  
  OBJECTIVE
  To determine the best set of predictors for myopia onset in school-aged children.
  
  
  METHODS
  The Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study was an observational cohort study of ocular development and myopia onset conducted at 5 clinical sites from September 1, 1989, through May 22, 2010. Data were collected from 4512 ethnically diverse, nonmyopic school-aged children from grades 1 through 8 (baseline grades 1 through 6) (ages 6 through 13 years [baseline, 6 through 11 years]).
  
  
  METHODS
  We evaluated 13 candidate risk factors for their ability to predict the onset of myopia. Myopia onset was defined as -0.75 diopters or more of myopia in each principal meridian in the right eye as measured by cycloplegic autorefraction at any visit after baseline until grade 8 (age 13 years). We evaluated risk factors using odds ratios from discrete time survival analysis, the area under the curve, and cross validation.
  
  
  RESULTS
  A total of 414 children became myopic from grades 2 through 8 (ages 7 through 13 years). Of the 13 factors evaluated, 10 were associated with the risk for myopia onset (P < .05). Of these 10 factors, 8 retained their association in multivariate models: spherical equivalent refractive error at baseline, parental myopia, axial length, corneal power, crystalline lens power, ratio of accommodative convergence to accommodation (AC/A ratio), horizontal/vertical astigmatism magnitude, and visual activity. A less hyperopic/more myopic baseline refractive error was consistently associated with risk of myopia onset in multivariate models (odds ratios from 0.02 to 0.13, P < .001), while near work, time outdoors, and having myopic parents were not. Spherical equivalent refractive error was the single best predictive factor that performed as well as all 8 factors together, with an area under the curve (C statistic) ranging from 0.87 to 0.93 (95% CI, 0.79-0.99).
  
  
  CONCLUSIONS
  Future myopia can be predicted in a nonmyopic child using a simple, single measure of refractive error. Future trials for prevention of myopia should target the child with low hyperopia as the child at risk.
authors.affiliation: College of Optometry, The Ohio State University, Columbus.
authors.forename: Karla
authors.initials: K
authors.lastname: Zadnik
authors.affiliation: College of Optometry, The Ohio State University, Columbus.
authors.forename: Loraine T
authors.initials: LT
authors.lastname: Sinnott
authors.affiliation: Southern California College of Optometry, Marshall B. Ketchum University, Fullerton.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Cotter
authors.affiliation: College of Optometry, The Ohio State University, Columbus.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Jones-Jordan
authors.affiliation: School of Optometry, University of Alabama at Birmingham.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Kleinstein
authors.affiliation: College of Optometry, University of Houston, Houston, Texas.
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Manny
authors.affiliation: Department of Ophthalmology and Vision Science, University of Arizona, Tucson.
authors.forename: J Daniel
authors.initials: JD
authors.lastname: Twelker
authors.affiliation: College of Optometry, The Ohio State University, Columbus.
authors.forename: Donald O
authors.initials: DO
authors.lastname: Mutti
mesh_terms: D000293:Adolescent; D058452:Axial Length, Eye / Q000473:pathology; D002648:Child; D003315:Cornea / Q000503:physiopathology; D005006:Ethnicity; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000175:diagnosis; D007908:Lens, Crystalline / Q000503:physiopathology; D008297:Male; D009216:Myopia / Q000175:diagnosis* / Q000208:ethnology; D016017:Odds Ratio; D012029:Refraction, Ocular; D012307:Risk Factors
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