Myopia progression from wearing first glasses to adult age: the DREAM Study

Abstract

Purpose: Data on myopia progression during its entire course are scarce. The aim of this study is to investigate myopia progression in Europeans as a function of age and degree of myopia from first prescription to final refractive error.

Methods: The Drentse Refractive Error and Myopia Study assessed data from a branch of opticians in the Netherlands from 1985 onwards in a retrospective study. First pair of glasses prescribed was defined as a spherical equivalent of refraction (SER) ≤-0.5 D to ≥-3.0 D. Subjects with prescriptions at an interval of at least 1 year were included in the analysis.

Results: A total of 2555 persons (57.3% female) met the inclusion criteria. Those with first prescription before the age of 10 years showed the strongest progression (-0.50 D; IQR: -0.75 to -0.19) and a significantly (p<0.001) more negative median final SER (-4.48 D; IQR: -5.37 to -3.42). All children who developed SER ≤-3 D at 10 years were highly myopic (SER ≤-6D) as adults, children who had SER between -1.5 D and -3 D at 10 years had 46.0% risk of high myopia, and children with SER between -0.5 D and -1.5 D had 32.6% risk of high myopia. Myopia progression diminished with age; all refractive categories stabilised after age 15 years except for SER ≤-5 D who progressed up to -0.25 D annually until age 21 years.

Conclusion: Our trajectories of the natural course of myopia progression may serve as a guide for myopia management in European children. SER at 10 years is an important prognostic indicator and will help determine treatment intensity.

Keywords: epidemiology; public health.

Figure 1

Median spherical equivalent of refraction in diopters in children from first prescription of myopia and adult myopia obtained at the age of 22–25.

Figure 2

Boxplots of median annual progression of spherical equivalent of refraction in diopters for boys (blue) and girls (red) per age group. Lower and upper box boundaries 25th and 75th percentiles and lower and upper error lines 2.5th and 97.5th percentiles. Tested with non-parametric Mann-Whitney U test.

Figure 3

Progression curves in percentiles representing annual progression rate of spherical equivalent in diopters as a function of age for European myopic subjects. Percentiles were calculated per age group and are connected by dashed lines.

Figure 4

Boxplots of median annual progression in diopter spherical equivalent per adult degree of myopia category obtained at the age of 22–25. Lower and upper box boundaries 25th and 75th percentiles and lower and upper error lines 2.5th and 97.5th percentiles. SER, spherical equivalent of refraction.

Figure 5

(A–C) Cumulative risk of high myopia (≤−6 D) according to spherical equivalent of refraction in diopters category by age. (A) For subjects with myopia onset younger than 10 years of age. (B) For subjects with myopia onset 10–12 years of age. (C) For subjects with a myopia onset 13–15 years of age. SER, spherical equivalent of refraction.