Establishment of Myopia Occurrence Prediction Model in Non-myopic Children Using Cycloplegic Refraction and Prior Axial Length Change

Shengsong Xu; Zhenbang Ruan; Yanbin Wang; Jinyun Jiang; Feng Zhao; Xianghua Tang; Cong Li; Lan Guo; Yin Hu; Ciyong Lu; Xiao Yang

doi:10.1016/j.ophtha.2025.06.010

Establishment of Myopia Occurrence Prediction Model in Non-myopic Children Using Cycloplegic Refraction and Prior Axial Length Change

Ophthalmology. 2025 Jun 12:S0161-6420(25)00359-8. doi: 10.1016/j.ophtha.2025.06.010. Online ahead of print.

Authors

Shengsong Xu¹, Zhenbang Ruan², Yanbin Wang², Jinyun Jiang², Feng Zhao², Xianghua Tang², Cong Li², Lan Guo³, Yin Hu⁴, Ciyong Lu⁵, Xiao Yang⁶

Affiliations

¹ State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China; Shenzhen Eye Hospital, Shenzhen Eye Medical Center, Southern Medical University, Shenzhen, China.
² State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.
³ Department of Medical Statistics and Epidemiology, Sun Yat-Sen University School of Public Health, Guangzhou, China.
⁴ State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China. Electronic address: 18664783831@163.com.
⁵ Department of Medical Statistics and Epidemiology, Sun Yat-Sen University School of Public Health, Guangzhou, China. Electronic address: luciyong@mail.sysu.edu.cn.
⁶ State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China. Electronic address: yangx_zoc@163.com.

PMID: 40516576
DOI: 10.1016/j.ophtha.2025.06.010

Abstract

Objective: Predicting myopia onset is critical for the identification of pre-myopia. This study aimed to develop and validate a myopia occurrence prediction model and further investigated potential pre-myopia criteria.

Design: A 5-year prospective study.

Subjects: 4,437 children aged 6 to 9 years from 12 schools.

Testing: Five valid follow-up visits were completed from 2018 to 2023. At each visit, uncorrected visual acuity was evaluated using the Early Treatment Diabetic Retinopathy Study chart with tumbling E optotypes (Precision Vision). Cycloplegic autorefraction was performed with a desktop autorefractor (KR8800; Topcon Corp). Cycloplegia was induced with three drops of 1% cyclopentolate, instilled 5 minutes apart. Refraction measurements were taken post-complete cycloplegia, which was confirmed by the absence of light reflex and a dilated pupil of at least 6 mm in diameter. Axial length (AL) was measured using noncontact partial-coherence laser interferometry (IOL Master 500; Zeiss).

Main outcome measures: Cycloplegic spherical equivalent refraction (SER) and AL.

Results: Baseline SER and prior AL change showed strong predictive value. Minimal improvement was found using prior 2-year changes, and hence the final model incorporated prior 1-year AL change, baseline SER, sex, and myopic parents. The nomogram exhibited excellent calibration, clinical net benefit, and discrimination, with AUCs of 0.879-0.941 (1- to 4-year prediction) in the primary cohort and 0.877-0.928 (1- to 4-year prediction) in the validation cohort. Calibration plots and DCA showed good consistency (all Brier scores<0.25) and clinical value. Based on the model, SER thresholds under various conditions were established to map the risk of myopia occurrence in the future. The model was integrated into an open-source online risk calculator.

Conclusions: This prospective study combined cycloplegic refraction with prior axial length change to develop and validate a myopia prediction model, establishing potential SER thresholds for pre-myopia definition. Larger-scale studies across diverse populations are warranted to validate these findings.

Trial registration number: ChiCTR1900022236.

Keywords: Myopia; child health (paediatrics); prediction model.