Aims To build a questionnaire-based myopia proxy and to validate the proxy by confirming its association with educational attainment and a Polygenic Risk Score (PRS) for myopia.
Methods Data were collected between 2014 and 2017 from 88 646 Dutch adults from the LifeLines Cohort. First, we performed principal component analysis (PCA) to responses of five refraction-status questions. Second, we measured the refractive state in a subset of LifeLines participants (n=326) and performed logistic regression using myopia (mean spherical equivalent <−0.5 D) as a dependent variable and the principal components (PCs) as independent variables. We identified specificity, sensitivity and the classification threshold. Third, the classification equation was applied to the remaining LifeLines participants. The value of the proxy was then explored by calculating its association with educational attainment and a PRS of myopia.
Results A total of 77 096 participants (58.1% women) were eligible for the PCA. The first two PCs had a specificity of 91.9% (95% CI 87.8% to 95.4%) and a sensitivity of 90.4% (95% CI 84.3% to 96.4%) for myopia. The area under the receiver operating characteristic curve was 95.0% (95% CI 92.2% to 97.8%). The age-standardised prevalence of proxy-inferred myopia was 33.8% (95% CI 33.4% to 34.3%). Compared with low education level, the ORs of proxy-inferred myopia were 1.66 (95% CI 1.58 to 1.74, p=5.94×10−90) and 2.54 (95% CI 2.41 to 2.68, p=4.04×10−271) for medium and high education levels, respectively. Similarly, individuals at the top 10% of PRS (vs lower 90%) had an OR of 2.18 (95% CI 1.98 to 2.41, p=6.57×10−56) for proxy-inferred myopia, whereas those at the highest decile had an OR of 4.51 (95% CI 3.9 to 5.21, p=1.74×10−89) when compared with the lowest decile.
Conclusion Self-administered refractive error-related questions could be used as an effective tool to capture proxy-inferred myopic cases in a population-based setting.
- optics and refraction
- public health
Data availability statement
Data may be obtained from a third party and are not publicly available. Data used in the current study were obtained from the LifeLines Cohort Study. LifeLines data are open for all researchers upon reasonable request.
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Contributors NGA, NMJ and HS conceived the idea and designed the study. NGA analysed the data and wrote the manuscript with intellectual inputs from NMJ and HS. IMN performed the Polygenic Risk Score analysis. JV prepared the questionnaire. AN collected refraction data. NMJ, HS, AN, JV and IMN interpreted the data. NGA, HS, and NMJ accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. All authors approved the final version of the manuscript for submission.
Funding This project has received funding from the European Union’s Horizon 2020 research and innovation programme (Marie Skłodowska-Curie grant agreement number 661 883). Additional funding was provided by the Rotterdamse Stichting Belangen (grant number B20150036).
Disclaimer The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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