Age-determined referral criteria of myopia for large-scale vision screening.

Background: This study aimed to explore the best screening measure of myopia and its associated optimal referral criteria for children aged between 6 and 16.

Methods: After informed consent of cycloplegia was obtained, a total of 6,321 children aged between 6 and 16 from 53 primary or junior middle schools in Jiading District of Shanghai were included in our population-based study. Receiver operating characteristic (ROC) curve was performed to determine the best cutoff points, sensitivities and specificities of different screening tests, including uncorrected visual acuity (UCVA), noncycloplegic autorefraction (NCAR) and the combination of these two tests.

Results: There was significant difference in prevalence of myopia between boys and girls (χ2 = 6.358, P = 0.012). Compared with children of low age, the prevalence of older children was significantly higher (χ2 = 1,386.404, P < 0.001). For the combination of UCVA and NCAR, the best cutoff point was UCVA less than or equal to 0.2 logarithm of minimum angle of resolution (MAR) (20/30) and NCAR spherical equivalent refraction (SER) less than or equal to -0.75 diopters (D), with associated sensitivity and specificity of 75.0% and 85.0%, respectively, which were higher than those of UCVA and NCAR alone. After stratified by age, the best cutoff points were varied among children. The accuracy for children aged between 9 and 12 was higher than that for other ages.

Conclusions: The best screening measure of myopia was the combination of UCVA and NCAR. The optimal referral criteria of myopia for children should be age-determined.