Seasonal variations in the progression of myopia in children enrolled in the correction of myopia evaluation trial

Abstract

Purpose: To investigate monthly and seasonal variations in the progression of myopia in children enrolled in the Correction of Myopia Evaluation Trial (COMET).

Methods: An ethnically diverse cohort of 469 myopic 6- to <12 year-old children was randomized to single vision or progressive addition lenses and followed for 3 years with 98.5% retention. Progression of myopia was measured semiannually by noncycloplegic autorefraction (Nidek ARK 700A) and annually by cycloplegic autorefraction, with the former measurements used in these analyses. The semiannual progression rate was calculated as (change in spherical equivalent refraction between two consecutive semiannual visits/number of days between the two visits) times 182.5. Months were categorized as the midpoint between two visit dates. Seasons were classified as winter (October through March) or summer (April through September). The seasonal difference was tested using a linear mixed model adjusting for demographic variables (age, sex, ethnicity), baseline refraction, and treatment group.

Results: Data from 358 children (mean [± SD] age = 9.84 ± 1.27 years; mean myopia = -2.54 ± 0.84 diopters [D]) met the criteria for these analyses. Myopia progression varied systematically by month; it was slower in April through September than in the other months. Mean progression in winter was -0.35 ± 0.34 D and in summer was -0.14 ± 0.32 D, a statistically significant difference (0.21 D, P < 0.0001). The same seasonal pattern was found by age, sex, ethnicity (except in the small sample of Asians), lens type, and clinical center.

Conclusions: The slower progression of myopia found in summer is likely related to children's spending more time outdoors and fewer hours in school. The data have clinical implications regarding the time of year and the frequency with which myopic children have eye examinations and the need for precise timing of visits in clinical trials testing new myopia treatments. (ClinicalTrials.gov number, NCT00000113.).

Keywords: children's vision; myopia; refractive error.

Figures

Figure 1

Semiannual progression rate by midpoint month in the first year of COMET. Winter months are shown by dark bars and summer months by hatched bars.

Figure 2

Semiannual progression rate in winter and summer stratified by age in the first year of COMET. Winter months are shown by dark bars and summer months by hatched bars.

Figure 3

Semiannual progression rate in winter and summer stratified by ethnicity in the first year of COMET. Winter months are shown by dark bars and summer months by hatched bars.

Figure 4

Semiannual progression rate in winter and summer in white children stratified by clinical center in the first year of COMET. Winter months are shown by dark bars and summer months by hatched bars.

Figure 5

Semiannual progression rate in winter and summer over the first 3 years of COMET. Winter months are shown by dark bars and summer months by hatched bars.

Figure 6

Comparison of COMET seasonal progression of myopia (winter–summer) with other studies using either single vision lenses (hatched bars) and/or PALs/bifocals (dark bars).