Astigmatism and myopia in Tohono O'odham Native American children

Abstract

Purpose: To describe change in spherical equivalent (M) in a longitudinal sample of Tohono O'odham students ages 3 to 18 years and to test the hypothesis that astigmatism creates complex cues to emmetropization, resulting in increased change in M in the direction of increasing myopia and increased occurrence of myopia.

Methods: Subjects were 777 Tohono O'odham Native American children on whom cycloplegic right eye autorefraction was measured on at least two study encounters between ages 3 and 18 years (first encounter prior to age 5.5 years, final encounter ≥3 years later). Regression lines were fit to individual subjects' longitudinal M data to estimate rate of change in M (regression slope, D/yr). Regression was also used to predict if a subject would be myopic (≤-0.75 D M) by age 18 years. Analysis of covariance was used to assess the relation between M slope and magnitude of baseline M and astigmatism. Chi-square analyses were used to assess the relation between predicted myopia onset and magnitude of baseline M and astigmatism.

Results: Mean M slope was significantly more negative for hyperopes (M ≥ +2.00) than for myopes (M ≤ -0.75) or for subjects neither hyperopic nor myopic (NHM, M > -0.75 and < +2.00), but there was no significant difference between the myopic and NHM groups. Chi-square analysis indicated that final myopia status varied across level of baseline astigmatism. Subjects with high astigmatism were more likely to be predicted to have significant myopia by age 18 years.

Conclusions: The association between greater shift in M towards myopia with age in subjects who were hyperopic at baseline is consistent with continued emmetropization in the school years. Results regarding predicted myopia development imply that degradation of image quality due to refractive astigmatism creates complex cues to emmetropization, resulting in increased occurrence of myopia.

Figure 1

Scatterplot of the longitudinal spherical equivalent (M) data across age with the best-fit line. The inflection point occurs at age 5.5 years.

Figure 2

Scatterplot of M Slope by Baseline M. Dashed line represents the regression line.

Figure 3

Scatterplot of M Slope by Refractive Astigmatism, (A) with outliers and (B) with outliers removed.