Choroidal Changes Could Help in Predicting Future Myopia in Children, reports research

A new study published in the British Journal of Ophthalmology explored how short-term changes in the choroid may help predict the onset of myopia (nearsightedness) in children. Myopia is a common refractive error which has become increasingly prevalent among young people and early identification of children at risk could be critical for implementing preventive measures.

The research followed a total of 577 eyes from 289 primary school children over a period of 2 years. The study determined whether short-term choroidal changes could predict future myopic shifts which is defined as a significant refractive change of at least −0.50 diopter per year. At baseline, none of the children were classified as having myopia, and their eye measurements were recorded using optical coherence tomography (OCT). The measurements included cycloplegic refractions (used to measure refractive errors) at baseline, one year, and two years. Also, the study analyzed the choroidal thickness (ChT), luminal area (LA), stromal area (SA), and total choroidal area (TCA) at baseline and 3 months.

By the end of the two-year follow-up, a total of 228 children (455 eyes) completed the study. Among initially non-myopic eyes, 37.6% underwent a myopic shift. In contrast, 73.6% of initially myopic eyes showed a progression towards increased myopia. The study found significant differences in the choroidal changes between children who developed a myopic shift and the children who did not, particularly in initially myopic eyes. After 3 months, children who experienced a myopic shift expressed greater reductions in ChT, LA, SA, and TCA when compared to the children without a myopic shift. These choroidal changes were not significantly different between non-myopic eyes, regardless of whether a myopic shift occurred or not.

The multivariable analyses of this study revealed that each percentage increase in ChT, LA, SA, and TCA was associated with a decreased risk of myopic shift (all p<0.001) for initially myopic eyes. While similar patterns were observed in non-myopic eyes, the associations were weaker in comparison.

One of the most significant findings was that adding the 3-month percentage change in choroidal parameters to a predictive model (which already included age, gender, parental myopia, and baseline refraction) significantly improved the ability of the model to predict future myopic shifts in initially myopic eyes. The area under the receiver operating characteristic (ROC) curve, a measure of predictive accuracy, increased from 0.650 to approximately 0.800 (all p<0.05). However, this improvement was not seen in non-myopic eyes. Overall, this study suggests that short-term changes in the choroid may serve as early indicators of future myopic shifts in children who are already myopic.

Reference:

Wu, H., Liu, M., Wang, Y., Li, X., Zhou, W., Li, H., Xie, Z., Wang, P., Zhang, T., Qu, W., Huang, J., Zhao, Y., Wang, J., Zhang, S., Qu, J., Ye, C., & Zhou, X. (2024). Short-term choroidal changes as early indicators for future myopic shift in primary school children: results of a 2-year cohort study. In British Journal of Ophthalmology (p. bjo-2024-325871). BMJ. https://doi.org/10.1136/bjo-2024-325871