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The Dream Study: Is childhood progression correlated to final adulthood myopia?

Myopia progression poses an elevated risk of complications, and while there is extensive documentation of myopia development across different age groups, there remains much to uncover regarding its natural trajectory post-onset.

Myopia Management

In this journey of understanding myopia progression, a recent study titled "Myopia progression from wearing first glasses to adult age: the DREAM Study, conducted by Polling et al., sheds light on the crucial connection between the age at which a child receives their first myopia correction and their final adult myopia.

The study explores the natural progression of myopia from its onset to adulthood, relying on data gathered from opticians in the Netherlands spanning the years 1985 to 2015. Analysing the records of 2,555 individuals, the study employed the age at the first spectacle prescription as a proxy for the onset of myopia.

The Progression Timeline

In this retrospective analysis, a correlation emerged between the age at which a child received their initial myopia correction and the eventual severity of adult myopia. Notably, children prescribed glasses before the age of 10 exhibited the most significant progression, emphasising the importance of early intervention. Those who developed myopia of -3 D or worse by the age of 10 were at a high risk of adult high myopia (≤-6D).

Implications for Myopia Management

Understanding the natural course of myopia progression is crucial for effective myopia management strategies. The study provides valuable insights for clinicians, offering a guide for predicting myopia outcomes in European children. The research advocates for the careful monitoring of children who receive their first myopic prescription before the age of 10 and emphasises the need for tailored interventions to control myopia progression.

Challenges and Limitations

While the study contributes significantly to our understanding of myopia progression, it is essential to acknowledge its limitations.  The retrospective design, potential lifestyle changes, and exclusion of certain risk factors are recognised limitations. The design included children who were myopic between 1980 and 2000, overlooking lifestyle changes for later-born children. Important risk factors like outdoor time and near activities were not assessed. The classification of first myopia correction, limited representation in the north of the Netherlands, and lack of consideration for ethnicity are additional constraints, making the study's findings not universally applicable.

The study adds a crucial chapter to our understanding of myopia. By emphasizing the link between early correction and adult myopia, the study offers valuable insights for clinicians and researchers working towards effective myopia management strategies. As we navigate the challenges posed by the global surge in myopia, studies like DREAM pave the way for a clearer vision of a myopia-free future.


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

Authors: Polling, Jan R; Klaver, Caroline; Tideman, Jan W

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.

Conclusions: 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.

The original journal article can be accessed here.

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