Hyperopic reserve, early myopia risk and screening strategies in children: A multi-regional analysis from the CREAM-KIDS consortium

Reduced hyperopic reserve (HR) in early childhood is a strong predictor of future myopia. A harmonized dataset from the CREAM-Kids Consortium was utilized to assess regional differences in HR. Among 7-year olds, mean (SD) HR was 1.44 (1.17) D in Europe, 1.32 (0.80) D in Australia, 0.78 (0.89) D in Hong Kong, and 0.59 (0.66) D in Singapore (p < 0.001). The annualized decline in HR was -0.12 D/year among European-Australian followed from age 6.73 (0.64) to 11.64 (1.49), and -0.35 D/year among Asian followed from age 7.71 (0.77) to 10.71 (0.77). In European-Australian aged 6-7, the sensitivity and specificity of myopia screening was 67%-75% and 98%, and in Asian aged 4-9, 92%-99% and 70%-77%, respectively. Asian children demonstrated substantially lower HR and a faster consumption than their European and Australian peers, placing a larger proportion of Asian children at higher risk for early-onset myopia.