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Progression pattern of non-amblyopic Anisomyopic eyes compared to Isomyopic eyes

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Abstract

This study aimed to determine the progression pattern of non-amblyopic anisomyopic children from ages 6 to 16 years. This retrospective study analyzed the electronic medical records of 8680 myopic children who visited Sankara Nethralaya, Chennai, India over eight years (2009 to 2017). A total of 711 records were retrieved based on inclusion criteria. In addition, 423 records out of 711 had consecutive follow-up for three years (baseline plus three follow-up visits) and were considered to determine the progression pattern. The cycloplegic sphero-cylindrical refraction was taken for analysis and converted to vector notation of M (SE), J0, and J45. Anisomyopia referred to the interocular difference of myopic SE of ≥ 1 D whereas isomyopia referred to the interocular difference of myopic SE of < 1 D. Based on the refraction of the less ametropic eye, anisomyopes were further categorized into bilateral anisometropic myopia (BAM) and unilateral anisometropic myopia (UAM). The isomyopic cohort showed a mean annual progression of -0.49 ± 0.54 D (median [IQR] -0.38 D [{-0.75}-0.00]). In BAM, the mean annual progression of the more myopic eye was -0.45 ± 0.55 D (median [IQR] -0.38 D [{-0.75}-0.00]), and the less myopic eye was -0.37 ± 0.55 D (median [IQR] -0.25 D [{-0.63}-0.00]). This difference was significant (t (212) = -2.14, p < 0.05). In UAM, the myopic eyes (-0.39 ± 0.51 D; median [IQR] -0.25 D [{-0.75}-0.00]) showed a statistically significant higher mean annual progression compared to emmetropic eyes (-0.22 ± 0.36 D; median [IQR] 0.00 D [{-0.44}-0.00]; t (96) = -3.30, p < 0.001). In terms of progression trend, in the BAM group, the rate of change of mean SE between the more myopic and the less myopic eyes were similar (-1.12 ± 1.20 D; median [IQR] -1.13 D [{-2.00}-{-0.38}] vs. -1.05 ± 1.25 D; median [IQR] -0.88 D [{-1.75}-{-0.13}]; t (138) = -0.64, p > 0.05). However, the more myopic eyes of UAM showed a higher myopic trend compared to the emmetropic eyes (-1.37 ± 1.06 D; median [IQR] -1.32 D [{-2.13}-{-0.50}] vs. -0.96 ± 1.11 D; median [IQR] -0.75 D [{-1.56}-{-0.25}]; t (61) = -2.74, p < 0.05).

   Conclusion: Children with BAM and UAM eyes exhibit different progression patterns from each other. While the rate of the refractive shift in myopic eyes of UAM is similar to isomyopic eyes, BAM eyes present a slower rate of progression than isomyopic eyes.

What is Known:

• The rate of change of refraction in anisomyopes is higher compared to isomyopic children.

• Less myopic eyes tend to shift towards more myopia while more myopic eyes show stable refraction.

What is New:

• The progression pattern of bilateral anisometropic myopia and unilateral anisometropic myopia differ from one another.

• While the rate of the refractive shift in myopic eyes of unilateral anisometropic myopia is similar to isomyopic eyes, bilateral anisometropic myopia eyes present a slower rate of progression than isomyopic eyes.

• The pattern of change in the interocular difference of anisometropia depends on the laterality (bilateral or unilateral ametropia), and degree of spherical equivalent in the more ametropic eye.

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Data availability

All data underlying the results are available as part of the article and no additional source data are required.

Abbreviations

AL:

Axial length

BAM:

Bilateral anisometropic myopia

D:

Diopter

UAM:

Unilateral anisometropic myopia

SE:

Spherical equivalent refraction

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Author information

Authors and Affiliations

  1. Myopia Clinic, Unit of Medical Research Foundation, Sankara Nethralaya, No.41, College Road, Nungambakkam, Chennai, India

    Azfira Hussain, Aparna Gopalakrishnan & Saurav Chowdhury

  2. Department of Pediatric Ophthalmology, Unit of Medical Research Foundation, Sankara Nethralaya, Chennai, India

    Sumita Agarkar

Authors
  1. Azfira Hussain
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  2. Aparna Gopalakrishnan
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  3. Saurav Chowdhury
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  4. Sumita Agarkar
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Azfira Hussain, Aparna Gopalakrishnan, and Saurav Chowdhury. The first draft of the manuscript was written by Azfira Hussain and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Azfira Hussain.

Ethics declarations

Ethics approval

This study was approved by the Institutional research committee (706-2018-P) of Sankara Nethralaya, Chennai, India and the procedures conform to the tenets of the Declaration of Helsinki.

Consent to participate and publish

As part of the hospital protocol, the written consent form was obtained from each subject prior to the comprehensive eye examination assenting to the use of their data for research purposes if any.

Competing interest

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Communicated by Gregorio Milani

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Hussain, A., Gopalakrishnan, A., Chowdhury, S. et al. Progression pattern of non-amblyopic Anisomyopic eyes compared to Isomyopic eyes. Eur J Pediatr 182, 4329–4339 (2023). https://doi.org/10.1007/s00431-023-05088-9

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