Design and Pilot data of the high myopia registration study: Shanghai Child and Adolescent Large-scale Eye Study (SCALE-HM)

Abstract

Purpose: To describe the methodology and pilot data of the Shanghai Child and Adolescent Large-scale Eye Study (SCALE-HM).

Methods: This is a population-based, prospective, examiner-masked study with annual follow-up. Patients are 4- to 18-year-olds with high myopia. The participants will fill out questionnaires and then undergo visual acuity, axial length (AL), intraocular pressure, ophthalmologist assessment, microperimetry, cycloplegic refraction, Pentacam, wavefront aberration, fundus, blood and saliva examinations. To describe the pilot data, intergroup differences were assessed with t-tests or analysis of variance and a logistic regression model was used to determine the independent factors associated with peripapillary atrophy (PPA).

Results: Overall, 134 eyes of 79 participants met the pilot study recruitment criteria. The mean AL and spherical equivalent were 26.91 ± 1.07 mm and -9.40 ± 1.77 D, respectively. Peripapillary atrophy (PPA) (N = 112) and tessellated fundus (N = 67) were the most common fundus changes. The mean AL was significantly longer in PPA (27.08 ± 0.93 mm) than in non-PPA eyes (26.06 ± 1.31 mm; p < 0.001). Axial length (AL) (p = 0.041) was the only independent factor associated with PPA. Axial length (AL) was significantly longer in eyes with diffuse chorioretinal atrophy (N = 11; 28.02 ± 1.31 mm) than without myopic retinal lesions (N = 56; 26.48 ± 0.91 mm, p < 0.001) or with tessellated fundus (N = 67; 27.09 ± 0.97 mm, p = 0.012). The myopic degree was higher in eyes with diffuse chorioretinal atrophy than without myopic retinal lesions (-10.51 ± 2.76 D versus -9.06 ± 1.58 D, p = 0.039).

Conclusion: Peripapillary atrophy and tessellated fundus were common in children and adolescents with high myopia. Results from this prospective study will help to understand the mechanisms, development and prognosis of these changes and can guide early myopia screening.

Keywords: children; fundus change; high myopia; registration study.

Fig. 1

Flow chart of the examination programme.

Fig. 2

Microperimetry examination results for one participant. The numbers located within 10 degrees of the macula represent the retinal light sensitivity.

Fig. 3

Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) images of one child with high myopia. (A and C) show the OCT and OCTA images, respectively, focused on the fovea, while Fig. 3B,D show the OCT and OCTA images, respectively, focused on the optic disc.

Fig. 4

Fundus photography and ultrawide‐field fundus photography of one of the participating children. (A) Shows the regular fundus image, and B shows the fundus autofluorescence (FAF) image. Each fundus image is focused on the fovea. The exposure intensity was 30 ws for regular fundus photography and 300 ws for FAF. (C) shows the regular pseudocolour image, and (D) Shows the FAF image.