Analysis Of Factors Related To Myopia Progression In Children With Convergence Insufficiency Exophoria

Objective: To analyze the factors influencing the progression of myopia in children with convergence insufficiency exophoria,and to provide reference for the prevention and control of myopia.Methods: Cohort study.A total of 128 children aged 6 to 16 years who visited Qilu Hospital(Qingdao),Cheeloo College of Medicine,Shandong University from January 2020 to August 2021 were selected to participate in the baseline survey.There were 66 males(51.56%)and 62 females(48.44%).There were 68(53.13%)children with convergence insufficiency exophoria and 60(46.87%)children with orthotropia.At baseline,all children underwent ophthalmic examination,including slit lamp,fundus,eye movement and eye position examination,von Graefe method for far and Near eye position measurement.Both Near point of convergence(NPC)and positive fusional vergence(PFV)were measured in children with convergence insufficiency exophoria.All the tested children were given 1% atropine to obtain the refractive diopter,and one year later,all the tested children were given 1% atropine to obtain the refractive diopter again,and a questionnaire survey was conducted.The gender,age,the number of parents with myopia,the time of outdoor activities every day,and the time of near work outside class every day were recorded in the questionnaire.In this study,the diopter was calculated using Spherical Equivalent(SE),where SE = spherical diopter +1/2 cylindrical diopter.The progression of myopia was represented by SE change,which was equal to the absolute value of SE difference between two cycloplegic retinoscopy.Data of right eye were collected from all children.The gender,eye position and the number of parents with myopia were recorded,and the percentage was calculated.The age,refractive and eye position of the subjects,the time of outdoor activities every day and the time of near work outside class every day were recorded,and the mean value or median was calculated.Myopia progression(SE)as dependent variable,with eye position(this study only includes convergence insufficiency exophoria and orthotropia)、gender、 the number of parents with myopia、age、the time of outdoor activities every day and the time of near work outside class every day as the independent variable,respectively through the single factor(rank and test,rank correlation analysis) and multiple factors,multivariate linear regression analysis,The relationship between these factors and the progression of myopia was analyzed,and the difference between the progression of myopia in children with convergence insufficiency exophoria and orthotropia was compared.Results: The median age(QR)at baseline was 10.00(4.00)years,the median change of SE(QR)was 1.00(0.63)D,the median time of outdoor activities every day(QR)was 1.50(1.00)h,and the median time of near work outside class every day(QR)was 1.50(1.00)h.In the multiple linear regression model,after adjusting for gender,the number of parents with myopia,age,the time of outdoor activities every day and the time of near work outside class every day,eye position was significantly correlated with myopia progression(β=0.249,95%CI: 0.148-0.351,P < 0.01).The progression of myopia was faster in the group with convergence insufficiency exophoria than in the orthotropia group,and the SE 1-year change was 1.25(0.38)D in the group with convergence insufficiency exophoria,which was significantly higher than that in the group with orthotropia(0.75)D,with statistical significance(Z=-7.30,P < 0.01).Multiple linear regression analysis showed that the number of parents with myopia was significantly correlated with the progression of myopia(β=0.141,95%CI: 0.058-0.225,P < 0.01),and the time of near work outside class every day was significantly correlated with the progression of myopia(β=0.239,95%CI: 0.158-0.320,P < 0.01),gender was significantly correlated with myopia progression(β=0.139,95%CI: 0.041-0.238,P < 0.01),while the time of outdoor activities every day was not significantly correlated with myopia progression(β=0.011,95%CI:-0.061-0.082,P > 0.05),and there was no significant correlation between age and myopia progression(β=-0.010,95%CI:-0.031-0.011,P > 0.05).Conclusion:The progression of myopia in children aged 6-16 years with convergence insufficiency exophoria is faster than that of orthotropia.Myopia progression is correlated with eye position,gender,the number of parents with myopia,the time of near work outside class every day,and not correlated with age and the time of outdoor activities every day.