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Clinical science
Development and validation of a questionnaire-based myopia proxy in adults: the LifeLines Cohort Study
  1. Nigus G Asefa1,
  2. Anna Neustaeter2,
  3. Jelle Vehof2,
  4. Ilja M Nolte1,
  5. Harold Snieder1,
  6. Nomdo M Jansonius2
  1. 1 Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
  2. 2 Department of Ophthalmology, University Medical Centre Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Nigus G Asefa, Department of Epidemiology, University Medical Centre Groningen, Groningen 9713 GZ, The Netherlands; n.g.asefa{at}umcg.nl

Abstract

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
  • epidemiology

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.

https://doi.org/10.1136/bjophthalmol-2021-319166

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    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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    Footnotes

    • 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.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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