Development and validation of a novel nomogram for predicting the occurrence of myopia in schoolchildren: A prospective cohort study

PURPOSE: Myopia is a major public health issue and oc-curs at young ages. Apart from its high prevalence, my-opia results in high costs and irreversible blinding dis-eases. Accurate prediction of the risk of myopia onset is crucial for its precise prevention. We aimed to develop and validate an effective nomogram for predicting myopia onset in schoolchildren.center dot DESIGN: School-based prospective cohort study.center dot METHODS: A total of 1073 schoolchildren were en-rolled from November 2014 to May 2019 in China, and were divided into the training and validation cohorts. Myopia was defined as a spherical equivalent refraction (SER) <=-0.5 diopters. Predictors of myopia were deter-mined through the least absolute shrinkage and selection operator regression and multivariable Cox proportional hazard model based on the training cohort. The predictive performance of the nomogram was validated internally through time-dependent receiver operating characteristic (ROC) curves, calibration plot, decision curve analysis, and Kaplan-Meier curves.center dot RESULTS: Independent predictors at baseline includ-ing gender, SER, axial length, corneal refractive power, and positive relative accommodation were included in the nomogram prediction model. This nomogram demon-strated excellent calibration, clinical net benefit, and dis-crimination, with all the area under the ROC curves (AUCs) between 0.74 and 0.86 in the training and val-idation cohorts. The Kaplan-Meier curves showed that 3 distinct risk groups stratified through X-tile analysis were well discriminated and robust among subgroups. The Harrell's C-index and net reclassification improve-ment demonstrated that the nomogram substantially im-proved compared with previous models. An online my-opia risk calculator was generated for better individual prediction.center dot CONCLUTIONS: The nomogram provides accurate and individual prediction of myopia onset in schoolchildren. External validation is needed to verify the generalizability of this nomogram. (Am J Ophthalmol 2022;242: 96-106. (c) 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC -ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ))