Latent growth modelling of refractive error development in white children & young adults

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Aim: Population-based data on children’s eye growth are rare. This prospective study modelled the developmental trajectory of spherical equivalent refraction (SER) and axial length (AL) in a white population to identify the number of homogenous classes present.
Materials and Methods: Stratified random cluster sampling recruited white children aged 6-7 years (n=392) and 12-13 years (n=661) (NICER Study). Cycloplegic autorefraction and AL were assessed at baseline and prospectively at 3, 6 and 9 year intervals. Latent growth modelling of SER and AL were conducted using Mplus v7.4. The fit of six models (one to six-class) were used to determine the best fit model for each cohort. Predictive variables for emergent classes were explored for the younger cohort (Odds ratios OR, confidence intervals CI).
Results: For the younger cohort (6-16 years): a four-class solution was the best fit for SER labelled as ‘Persistent Emmetropes-PEMM’, ‘Persistent Moderate Hyperopes-PMHYP’, ‘Persistent High Hyperopes-PHHYP’ and ‘Emerging Myopes-EMYO’ and a two-class solution fitted AL best (Fig. 1A&B). For the older cohort (12-22 years): a five-class solution was the best fit for SER, labelled as “PHHYP”, “PMHYP”, “PEMM”, “Low Progressing Myopes-LPMYO” and “Moderate Progressing Myopes-MPMYO” and a four-class solution fitted AL best (Fig. 2A&B). Those in the EMYO class were significantly more likely to have a longer AL at baseline (OR 2.5, CI 1.05-5.97) and at least one myopic parent (OR 6.28, CI 1.01-38.93). Other variables were not predictive (Gender, socioeconomic status, physical activity, time spent outdoors, time spent doing near work, BMI, breastfed). 
Conclusion: Four classes of refractive development from childhood to teenage years were evident and five classes from teenage years into adulthood. The two-class solution for AL growth in children 6-16 years (compared to four-class for SER) suggests other ocular components, such as lens shape are important determinants of SER alongside AL. Parental history of myopia and longer AL at 6-7 years are risk factors for emergent myopia. These population-based data can be used to identify, at an early stage, white children who may benefit from myopia intervention.
Original languageEnglish
Publication statusPublished (in print/issue) - 15 Mar 2019
EventNorthern Ireland Clinical Research Network - Belfast, United Kingdom
Duration: 15 Mar 201915 Mar 2019


ConferenceNorthern Ireland Clinical Research Network
Abbreviated titleNICRN
Country/TerritoryUnited Kingdom


  • refractive error
  • myopia
  • progression
  • growth curves
  • latent class analysis


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