Zadnik K, Mutti D O, Friedman N E, Qualley P A, Jones L A, Qui P, Kim H S, Hsu J C, Moeschberger M L
The Ohio State University College of Optometry, Columbus 43210-1240, USA.
Invest Ophthalmol Vis Sci. 1999 Aug;40(9):1936-43.
The purpose of this study was to identify reliable predictors of the onset of juvenile myopia.
The data from 554 children enrolled in the Orinda Longitudinal Study of Myopia (OLSM) as nonmyopes with baseline data from the third grade were evaluated to develop a predictive profile for later onset of juvenile myopia. Myopia was defined as at least -0.75 D of myopia in the vertical and horizontal meridians of the right eye as measured by cycloplegic autorefraction (n = 45 children). Chosen predictors were refractive error and the ocular components: corneal power, Gullstrand crystalline lens power, and axial length. Sensitivity and specificity were calculated. Receiver operating characteristic (ROC) curves were generated to evaluate and compare these predictors singly and combined.
Refractive error, axial length, Gullstrand lens and pod corneal power were all significant predictive factors for the onset of juvenile myopia. The best single predictor of future myopia onset in the right eye was the right eye's cycloplegic autorefraction spherical refractive error value (mean sphere across 10 readings) at baseline. For a cut point of less than +0.75 D hyperopia in the third grade, sensitivity was 86.7% and specificity was 73.3%. The area under the ROC curve for this mean sphere was 0.880. Producing a logistic model combining mean sphere, corneal power, Gullstrand lens power, and axial length results in a slight improvement in predictive ability (area under the ROC curve = 0.893).
Onset of juvenile myopia can be predicted with moderate accuracy using the mean cycloplegic, spherical refractive error in the third grade. Measurement of other ocular components at this age improves predictive ability, albeit incrementally. Further improvements in the prediction of myopia onset will require the use of longitudinal data in addition to one-time measurement of refractive error and the ocular components.
本研究旨在确定青少年近视发病的可靠预测因素。
对554名参加奥林达近视纵向研究（OLSM）的儿童数据进行评估，这些儿童在三年级时为非近视且有基线数据，以建立青少年近视发病的预测模型。近视定义为使用睫状肌麻痹验光法测量右眼垂直和水平子午线至少有-0.75 D的近视（n = 45名儿童）。选择的预测因素为屈光不正和眼部成分：角膜屈光力、古尔斯特兰德晶状体屈光力和眼轴长度。计算敏感性和特异性。生成受试者工作特征（ROC）曲线以单独和联合评估及比较这些预测因素。
屈光不正、眼轴长度、古尔斯特兰德晶状体和角膜屈光力均为青少年近视发病的显著预测因素。右眼未来近视发病的最佳单一预测因素是基线时右眼睫状肌麻痹验光的球镜屈光不正值（10次读数的平均球镜）。对于三年级远视低于+0.75 D的切点，敏感性为86.7%，特异性为73.3%。该平均球镜的ROC曲线下面积为0.880。将平均球镜、角膜屈光力、古尔斯特兰德晶状体屈光力和眼轴长度组合生成逻辑模型，预测能力略有提高（ROC曲线下面积 = 0.893）。
使用三年级时的平均睫状肌麻痹球镜屈光不正可对青少年近视发病进行中等准确度的预测。在这个年龄测量其他眼部成分可提高预测能力，尽管提升幅度较小。近视发病预测的进一步改善将需要除屈光不正和眼部成分的一次性测量外，还需使用纵向数据。
