Open globe injuries: Epidemiology, visual and surgical predictive variables, prognostic models, and economic cost analysis.

BACKGROUND: Open globe injuries (OGI) represent a visually and economically devastating cause of vision loss. We examined the epidemiology, predictive variables, prognostic models, and economic cost of surgically managed OGI. METHODS: A retrospective tertiary centre study from 2008 to 2018 of 155 consecutive OGI in individuals aged 16 and older was performed. Medical records review, application of Ocular Trauma Score (OTS) and Classification and Regression Tree Analysis (CART) and cost analysis were undertaken. Key outcomes measured were visual acuity, number of operating theatre visits, prognostication using OTS and CART and estimated costs. RESULTS: Younger males at work with inadequate protective eyewear (89.1%) and falls in the elderly were overrepresented. Inferior visual outcomes were associated with a more severe OTS score, a larger injury zone, increasing age, the presence of retinal detachment, extraocular muscle involvement, intraocular foreign body, and globe rupture (R2  = 0.723, p < 0.001). Multiple operating theatre visits were required in the presence of retinal detachment, lens or orbit involvement, work-related injury, globe rupture, and a history of previous intraocular surgery (R2  = 0.0423, p < 0.001). Both OTS and CART prognosticated outcomes (p < 0.001). The OTS predicted for no vision (no light perception/enucleation/evisceration) and profound visual loss (worse than 6/120; specificity: both 100%, sensitivity: 88.2% and 88%) whereas the CART predicted for visual survival (light perception or better) and minimal-to-severe visual loss (6/120 or better; specificity: 88.5% and 81.7% , sensitivity: 97.7% and 100%). Estimated annual OGI cost for Australia was AUD48.1-60.5 million (USD37.3-47.0 million). CONCLUSIONS: The total cost of OGI is immense with young males and the elderly being disproportionately affected. Implementation of targeted government legislation and public health preventative measures may be cost-effective in ameliorating the significant burden.

Microbial Keratitis and Ocular Surface Disease: A 5-Year Study of the Microbiology, Risk Factors and Clinical Outcomes in Sydney, Australia.

Purpose: To report the microbiological and clinical profiles, and outcomes of patients with microbial keratitis who had ocular surface disease (OSD) at the Sydney Eye Hospital, Australia over a 5-year period.Methods: A retrospective case-series study was conducted. Patients diagnosed with microbial keratitis who had a history of OSD (dry eye, blepharitis, Steven Johnson syndrome (SJS) and ocular cicatricial pemphigoid (OCP)) from 1st January 2012 to 31st December 2016 were identified from hospital coding and pathology data. Data were extracted from the medical records.Results: 189 eyes from 171 patients with a mean age of 60 ± 19 years (range 20-96 years) were included. OSD included blepharitis (79%), dry eye (25%), SJS (4%) and OCP (2%). Coagulase-negative Staphylococcus (CoNS) (48%) were the most common isolated microorganism, made up of mostly Staphylococcus epidermidis (n = 37, 48%), Staphylococcus capitis (n = 16, 21%), and Staphylococcus warneri (n = 10, 13%). Median visual acuity at initial presentation was 0.52 logMAR and 0.30 logMAR at final visit. Median healing time was 12 days (IQR 6-27). The most common initial antimicrobial treatment prescribed was a combination of topical fortified cephalothin and gentamicin (n = 65, 34%); or topical ofloxacin (n = 56, 30%). Complications occurred in 69 eyes (37%), mainly non or slow-healing epithelial defects (n = 53, 43%) or corneal perforations (n = 24, 20%); and were more common in the elderly (n = 48/69, 70%).Conclusion: Microbial keratitis can affect those with OSD. In our setting, CoNS were the main organisms identified. Furthermore, patients prescribed a combination therapy of fortified antibiotics had poorer outcomes compared to monotherapy fluoroquinolones.

Clinical translation of recommendations from randomized trials for management of herpes simplex virus keratitis.

IMPORTANCE: To standardize initial anti-viral therapy for herpes simplex keratitis (HSK). BACKGROUND: To determine prescribing trends for the management of HSK and compare the trends to available clinical trial evidence. DESIGN: Retrospective review of patients at the Sydney Eye Hospital, Australia. PARTICIPANTS: Three hundred and one eyes of 296 patients prescribed anti-virals for HSK aged 18 years and above, from 1 January 2012 to 31 December 2013. METHODS: Patients were identified from viral swab results, pharmacy records and International Classification of Diseases 10 (ICD-10) coding data. MAIN OUTCOME MEASURE: Initial anti-viral therapy. RESULTS: Anti-viral therapy was given for therapeutic and prophylactic indications at presentation in 256 (85%) and 45 (15%) eyes, respectively. Overall, anti-virals prescribed included valaciclovir 500-1000 mg 1-3 times daily, aciclovir 200-400 mg 1-5 times daily, topical aciclovir 2-5 times daily and topical trifluorothymidine two hourly or as needed daily or combined oral and topical anti-virals. Indication and dose of prescribed anti-virals aligned with clinical evidence in 125 of 141 eyes (89%) with epithelial HSK, 2 of 22 eyes (9%) with stromal without ulceration HSK, 6 of 18 (28%) eyes with endothelial HSK and 31 of 45 (69%) eyes with HSK prophylaxis. Overall, 164 eyes (54%) received 'evidence-based' anti-viral therapy. CONCLUSIONS AND RELEVANCE: Prescribing patterns for anti-viral therapy to treat and prevent recurrence of HSK were diverse. Local guidelines are needed to standardize the indications and dose of initial anti-viral therapy for HSK. Implementation of these guidelines will likely improve patient care and rationalize the use of health resources.

Corneal biopsy for diagnosis of recalcitrant microbial keratitis.

PURPOSE: To document the findings of corneal biopsies for progressive microbial keratitis in a large tertiary referral institution. METHODS: A retrospective medical records review of all patients who underwent at least one corneal biopsy for the diagnosis of microbial keratitis at Sydney Eye Hospital, Australia between January 1, 2010 and December 31, 2016 was performed. RESULTS: Thirty-eight patients (18 men and 20 women) underwent a corneal biopsy for progressive microbial keratitis unresponsive to broad-spectrum topical antimicrobials. Risk factors for microbial keratitis included contact lens wear in 8 (21%), recent intraocular surgery in 5 cases (13%), recent agricultural trauma in 3 cases (8%), exposure keratopathy due to Graves' orbitopathy in 1 case (3%), and profound systemic immunosuppression due to chemotherapy for leukaemia in 1 case (3%). The remaining 20 patients had no identifiable risk factors. Fifteen patients (39%) had a positive biopsy result, which identified bacteria in 6 cases and Mycobacteria in 1 case, both by culture of the biopsy specimen. Three cases of fungus were identified on culture of biopsy specimen, two of which were also confirmed on histopathology and an additional case was identified from histopathology alone. A single case of Acanthamoeba was diagnosed by culture and histopathology, and an additional 3 cases were diagnosed on histopathology alone. A corneal biopsy yielded new organisms in 73% (11/15) cases where the culture results of biopsy specimens were positive. CONCLUSION: Corneal biopsy is an important tool in the diagnosis of progressive keratitis, often identifying causal organisms not found on corneal scraping alone.

Acanthamoeba keratitis in 194 patients: risk factors for bad outcomes and severe inflammatory complications.

BACKGROUND/AIMS: To determine demographic and clinical features of patients with Acanthamoeba keratitis (AK) that are independent risk factors both for bad outcomes and for severe inflammatory complications (SIC). METHODS: A retrospective audit of medical records of AK cases at Moorfields Eye Hospital from July 2000 to April 2012, including 12 earlier surgical cases. Cases with a bad outcome were defined as those having one or more of the following: corneal perforation, keratoplasty, other surgery (except biopsy), duration of antiamoebic therapy (AAT) ≥10.5 months (the 75th percentile of the whole cohort) and final visual acuity ≤20/80. SICs were defined as having scleritis and/or a stromal ring infiltrate. Multivariable analysis was used to identify independent risk factors for both bad outcomes and SICs. RESULTS: Records of 194 eyes (194 patients) were included, having bad outcomes in 93 (48%). Bad outcomes were associated with the presence of SIC, aged >34 years, corticosteroids used before giving AAT and symptom duration >37 days before AAT. The development of SIC was independently associated with aged >34 years, corticosteroids used before giving AAT and herpes simplex virus (HSV) keratitis treatment before AAT. CONCLUSIONS: The prompt diagnosis of AK, avoidance of a misdiagnosis of HSV keratitis and corticosteroid use before the exclusion of AK as a potential cause of keratitis are essential to the provision of a good outcome for patients and for the avoidance of SIC. Older age is an unmodifiable risk factor that may reflect differences in the immune response to AK in this patient subset.

The Impact of Topical Corticosteroids Used in Conjunction with Antiamoebic Therapy on the Outcome of Acanthamoeba Keratitis.

PURPOSE: To examine the impact of topical corticosteroid use after the start of antiamoebic therapy (AAT) on the outcomes of Acanthamoeba keratitis (AK) therapy. DESIGN: Cohort study. PARTICIPANTS: A total of 196 patients diagnosed with AK at Moorfields Eye Hospital, London, between January 1991 and April 2012. In 13 patients with bilateral AK, 1 eye was randomly excluded from analysis. METHODS: Patient demographics and clinical examination findings were collected both at the start of AAT and subsequently at the time that topical corticosteroid therapy was initiated. Preliminary a priori investigations were used to identify effect modifiers/confounders and extreme associations requiring consideration in multivariate regression modeling. A multivariable logistic model, optimized for assessment of corticosteroid use after the start of AAT, was used to estimate the odds ratios (ORs) of a suboptimal outcome. MAIN OUTCOME MEASURES: Suboptimal outcome was defined as final visual acuity ≤20/80, corneal perforation, or the need for keratoplasty. RESULTS: In multivariable analysis, restricted to 129 eyes (1 eye per patient) free of scleritis and hypopyon at the start of AAT, topical corticosteroids were not associated with worse outcomes (OR, 1.08; 95% confidence interval [CI], 0.39-3.03), even when corticosteroids had been used before the start of AAT. Risk factors significantly associated with worse outcomes were topical corticosteroid use before the start of AAT (OR, 3.85; 95% CI, 1.35-11.03), a corneal ring infiltrate (together with at least 1 other feature of AK) present at the start of AAT (OR, 5.89; 95% CI, 1.17-29.67), and age ≥33 years at the start of AAT (OR, 4.02; 95% CI, 1.46-11.06). CONCLUSIONS: Many corneal specialists currently are uncertain about the risk benefit associated with the use of topical corticosteroids for the management of inflammatory complications of AK. The evidence from this study gives clinicians and patients reassurance that the potential benefits of topical corticosteroid therapy, for treating pain and discomfort, are not associated with worse outcomes when initiated after starting modern AAT. Other potential benefits, in terms of resolution of inflammatory complications, will not be demonstrated without a carefully designed randomized clinical trial.

Established and emerging ancillary techniques in management of microbial keratitis: a review.

Microbial keratitis is a sight-threatening condition and an ocular emergency, because of the potential for rapid progression. Intensive topical antimicrobials are the mainstay and the gold standard of treatment for microbial keratitis. However, despite appropriate diagnosis and therapy, treatment failure is still common, and can result in significant morbidity due to corneal perforation and/or scarring. For this reason, clinicians continue to seek novel treatment techniques in order to expand the armamentarium of tools available to manage microbial keratitis, and in doing so improve clinical outcomes. In this review, we examine the evidence for some established, as well as a few emerging ancillary techniques used to manage microbial keratitis. These include topical corticosteroids, corneal collagen cross-linking, intrastromal antimicrobials, amniotic membrane transplantation and miscellaneous other techniques. Of these, collagen cross-linking shows some promise for selected cases of infectious keratitis, although more research in the area is required before it is accepted as mainstream treatment for this potentially blinding condition.

Therapeutic and optical keratoplasty in the management of Acanthamoeba keratitis: risk factors, outcomes, and summary of the literature.

OBJECTIVE: To report the risk factors for and outcomes of therapeutic and optical keratoplasty in the management of Acanthamoeba keratitis (AK). DESIGN: Retrospective case series. PARTICIPANTS: A total of 50 eyes of 196 patients with retrievable medical records, diagnosed with AK at Moorfields Eye Hospital, London, underwent keratoplasty between January 1991 and April 2012. METHODS: Patient demographics, initial clinical examination findings, and management details were collected. The ophthalmic characteristics of patients who underwent keratoplasty for AK were compared with those who did not. Patients undergoing therapeutic keratoplasty were compared with those undergoing optical keratoplasty for baseline characteristics, management details, and visual outcomes. A multivariate logistic model was used to derive the odds ratios of a poor visual outcome in all keratoplasty patients. MAIN OUTCOME MEASURES: Poor visual outcome was defined as final visual acuity of 20/200 or worse. Secondary outcomes of interest included number of clinic visits and the need for additional intraocular surgery. RESULTS: Of the 196 AK patients, a total of 50 patients (25.5%) underwent penetrating or anterior lamellar keratoplasty, 10 of whom (20%) underwent repeat procedures. Of these 50 patients, 26 (52%) had therapeutic keratoplasty, predominantly for corneal perforation. The remaining 24 patients (48%) underwent optical keratoplasty for visual rehabilitation. Thirty-seven (80.4%) patients in the keratoplasty group initially were misdiagnosed as having herpes simplex keratitis versus 59 (41.8%) patients who did not require a keratoplasty (P < 0.001). Final visual outcomes were significantly better in the optical group compared with the therapeutic group, with 13 (54.2%) achieving visual acuity of 20/30 or better versus 7 (26.9%), respectively. On multivariate analysis, beginning therapy at a hospital other than Moorfields and undergoing a therapeutic, rather than an optical, keratoplasty were associated significantly with a poor visual outcome from keratoplasty. CONCLUSIONS: The prognosis of keratoplasty differs markedly when performed for therapeutic purposes compared with visual rehabilitation. Where possible, keratoplasty should be delayed until such time as the eye is uninflamed and medically cured of Acanthamoeba.

Central toxic keratopathy after laser in situ keratomileusis.

PURPOSE: To review cases of central toxic keratopathy (CTK) occurring over a period of 46 days. SETTING: Moorfields Eye Hospital, London, United Kingdom. DESIGN: Retrospective consecutive case series. METHODS: This was a review of patients with CTK after uneventful laser in situ keratomileusis (LASIK) performed by 1 of 5 surgeons at a single institute. The following parameters were analyzed: corrected distance visual acuity (CDVA), manifest refraction, and central corneal thickness from Scheimpflug pachymetry readings (Pentacam). RESULTS: The cohort consisted of 15 eyes of 9 patients. Thirteen eyes were diagnosed within 7 days after LASIK, while the remaining 2 eyes developed CTK 12 days postoperatively. In 10 eyes, the time to resolution was 1 to 8 months. Five eyes still had residual signs at the last outpatient visit. At the final follow-up, 3 eyes (20%) had a CDVA worse than 0.0 logMAR. CONCLUSIONS: Although a rare entity, CTK can occur in clusters. Although a cause was not fully isolated, ultimately each eye achieved excellent CDVA (all better than 0.2 logMAR) at the last follow-up.

The impact of topical corticosteroid use before diagnosis on the outcome of Acanthamoeba keratitis.

OBJECTIVE: To examine the impact of topical corticosteroid use before the diagnosis of Acanthamoeba keratitis (AK) on final visual outcomes and to determine the prognostic factors predicting poorer outcomes. DESIGN: Cohort study. PARTICIPANTS: A total of 209 eyes of 196 patients with retrievable medical records, diagnosed with AK at Moorfields Eye Hospital, London, between January 1991 and April 2012. One eye was randomly excluded from analysis in the 13 cases of bilateral AK. METHODS: Patient demographic, initial clinical examination findings, and management details were collected. The outcomes of patients treated with topical corticosteroids before diagnosis of AK were compared with those not treated with topical corticosteroids before diagnosis. A multivariable logistic model, optimized for prior corticosteroid use, was used to derive the odds ratios (ORs) of a suboptimal visual outcome. MAIN OUTCOME MEASURES: Suboptimal visual outcome was defined as final visual acuity (VA) ≤ 20/80, corneal perforation, or need for keratoplasty. RESULTS: Acanthamoeba keratitis was diagnosed on microbiological culture in 94 eyes (48.0%), on histopathologic examination in 27 eyes (13.8%), on confocal microscopy in 38 eyes (19.4%), and on the basis of a typical clinical course and response to treatment in 37 eyes (18.9%). Final VA and prior corticosteroid use data were available for 174 eyes (88.8%). In multivariable analysis, corticosteroid use before diagnosis was associated with suboptimal visual outcome (OR, 3.90; 95% confidence interval [CI], 1.78-8.55), as were disease stage 3 at presentation (OR, 5.62; 95% CI, 1.59-19.80) and older age (60+ years) at diagnosis (OR, 8.97; 95% CI, 2.13-37.79). CONCLUSIONS: Corticosteroid use before diagnosis of AK is highly predictive of a poorer visual outcome. This is largely due to the initial misdiagnosis of AK as herpetic keratitis. It is important to include AK in the differential diagnosis of keratitis in all contact lens users with keratitis, particularly before making a diagnosis of herpes keratitis and before the use of topical corticosteroids in the therapy of any indolent keratitis.

A case of subacute cutaneous lupus erythematosus as a result of ranibizumab (Lucentis) treatment.

Cutaneous lupus erythematosus is a previously undiagnosed side-effect of ranibizumab. Here, we present a case of an 82-year-old female Caucasian patient with wet age-related macular degeneration. Following a single intraocular injection of Lucentis (ranibizumab), she developed a subacute cutaneous lupus erythematosus which, with treatment, took nearly 12 months to resolve. This shows that cutaneous lupus erythematosus is a potential side-effect of many medications, including ranibizumab, as in our case and, in an aging population where polypharmacy is a growing reality, clinicians should be aware of how to diagnose and best manage such cases.

Socio-economic, familial and perinatal factors associated with obesity in Sydney schoolchildren.

AIM: To examine associations between socio-economic, familial and perinatal factors with overweight/obesity in 6- and 12-year-old schoolchildren. METHODS: Eligible year-1 (1765/2238, mean age 6.7 years) and year-7 students (2353/3144, mean age, 12.7 years) from a random cluster sample of 55 Sydney schools were examined during 2003-2005. Height, weight and body mass index were measured. Overweight or obesity was classified using International Obesity Task Force cut points. Information about each child's socio-demographic status, familial and perinatal information was sought in parental questionnaires. RESULTS: After multivariate adjustment, lower parental education was significantly associated with prevalent overweight and obesity in 6-year-old children, odds ratio (OR) 1.52 (95% confidence interval (CI) 1.15-2.01) and OR 2.16 (CI 1.34-4.13), respectively. Smoking during pregnancy was associated with a higher likelihood of being obese among both 6- and 12-year-old children, OR 1.90 (CI 1.05-3.46) and OR 1.78 (CI 1.22-2.61). Population attributable risk estimates indicate that 14.9% and 10.1% of prevalent cases of obesity in 12-year-old children may be attributable to being: an only child or a heavy newborn, respectively. CONCLUSIONS: We show interdependent relationships between socio-economic, familial and perinatal factors and childhood weight status. Improved understanding of these pathways may help in developing childhood obesity prevention strategies.

Evidence of arteriolar narrowing in low-birth-weight children.

BACKGROUND: Cardiovascular disease may have its origins in utero, but the influence of in utero growth on microvascular structure in children is unknown. We hypothesized that poor in utero growth is associated with narrower arteriolar caliber, which may help explain the established association of low birth weight with hypertension and cardiovascular disease in adulthood. METHODS AND RESULTS: We examined the relation of birth weight and other markers of in utero growth to microvascular caliber in the retina in a population-based study of 1369 6-year-old children in Sydney, Australia (Sydney Childhood Eye Study). Birth weight, birth length, and head circumference were obtained from parental records. Retinal arteriolar and venular calibers were measured from digitized retinal photographs by a validated computer-assisted method. Lower birth weight, shorter birth length, and smaller head circumference were associated with narrower retinal arteriolar caliber. Each kilogram decrease in birth weight was associated with a 2.3-mum (95% CI 0.6 to 3.9, P=0.01) narrower retinal arteriolar caliber after controlling for age, gender, ethnicity, height, body mass index, axial length, mean arterial blood pressure, and prematurity. Similar associations were observed between shorter birth length and smaller head circumference with narrower retinal arteriolar caliber. CONCLUSIONS: Children who had lower birth weight, shorter birth length, and smaller head circumference had narrower retinal arteriolar calibers. These data support the concept that poor in utero growth may have an adverse influence on microvascular structure.

Prevalence of hyperopia and associations with eye findings in 6- and 12-year-olds.

PURPOSE: To describe the prevalence of hyperopia and associated factors in a representative sample of Australian schoolchildren 6 and 12 years old. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Schoolchildren ages 6 (n = 1765) and 12 (n = 2353) from 55 randomly selected schools across Sydney. METHODS: Detailed eye examinations included cycloplegic autorefraction, ocular biometry, cover testing, and dilated fundus examination. Information on birth and medical history were obtained from a parent questionnaire. MAIN OUTCOME MEASURES: Moderate hyperopia defined as spherical equivalent (SE) refraction of > or =+2.00 diopters (D), and eye conditions including amblyopia, strabismus, astigmatism, and anisometropia. RESULTS: Prevalences of moderate hyperopia among children ages 6 and 12 were 13.2% and 5.0%, respectively; it was more frequent in children of Caucasian ethnicity (15.7% and 6.8%, respectively) than in children of other ethnic groups. Compared with children without significant ametropia (-0.49 < or = SE refraction < or = +1.99 D), the prevalence of eye conditions including amblyopia, strabismus, abnormal convergence, and reduced stereoacuity was significantly greater in children with moderate hyperopia (all Ps < 0.01). Maternal smoking was significantly associated with moderate hyperopia among 6-year-olds (P = 0.03), but this association was borderline among 12-year-olds (P = 0.055). Early gestational age (<37 weeks) and low birth weight (<2500 g) were not statistically significant predictors of moderate hyperopia in childhood. CONCLUSIONS: Moderate hyperopia was strongly associated with many common eye conditions, particularly amblyopia and strabismus, in older children. Birth parameters did not predict moderate hyperopia.

Ethnic differences in the impact of parental myopia: findings from a population-based study of 12-year-old Australian children.

PURPOSE: To examine the influences of ethnicity, parental myopia, and near work on spherical equivalent refraction (SER) and axial length (AL) in a population-based sample of 12-year-old Australian children. METHODS: Year-7 children in the Sydney Myopia Study (n = 2353, 75.3% response) underwent an ophthalmic examination including cycloplegic autorefraction (1% cyclopentolate) and ocular biometry (IOLMaster; Carl Zeiss Meditec GmbH, Jena, Germany). Data for parental myopia, ethnicity, near work, and outdoor activities were derived from questionnaires and were available for 1781 children. Optical prescriptions of parents were sought if the spectacles were used. RESULTS: The prevalence of myopia in the children increased with the number of myopic parents (7.6%, 14.9%, and 43.6% for no, one, or two myopic parents). In parallel, the mean SER (+/-SE of the mean) was more negative (0.70 +/- 0.08, 0.34 +/- 0.09, and -0.55 +/- 0.34 D), and the mean AL was longer (23.32 +/- 0.05, 23.44 +/- 0.06, and 23.62 +/- 0.16 mm) after adjustment for demographic and environmental factors. In multivariate analyses, odds of childhood myopia did not change with higher levels of near work (odds ratio [OR] = 1.01; 95% confidence interval [CI] = 0.99-1.03). Interactions between parental myopia and ethnicity were significant for SER and AL (both P < 0.0001), reflecting greater decreases in SER and greater increases in AL with the number of myopic parents in the children of East Asian ethnicity than in the children of European Caucasian ethnicity. In the nonmyopic children, there was no association between parental myopia and AL. CONCLUSIONS: In this sample, parental myopia was associated with more myopic SER and longer AL, with significant ethnic interactions.

Can information on the purpose of spectacle use and age at first use predict refractive error type?

PURPOSE: To assess the sensitivity and specificity of predicting refractive error type using information from a four-item questionnaire on the purpose of spectacle use and age at first use. METHODS: The Sydney Myopia Study examined 1,740 year 1 (78.9% response) and 2,353 year 7 students (75.3% response) from a random cluster sample of 34 primary and 21 secondary schools across Sydney. Parents of participants completed a four-item questionnaire that sought data on parental spectacle use, age at first use, and purpose of use (for clear distant vision, close work, or both). Prescriptions were obtained for 720 of 3,209 (22%) parents (73% of those approached) for validation. A receiver operating characteristic (ROC) curve was used to determine the optimal cutoff age for spectacle use in myopia classification. RESULTS: Using the ROC curve, a cutoff age of 30 years at first spectacle use produced the highest accuracy in determining myopia. We combined information on the purpose for using spectacles (for distant and near vision) and age of first use at 30 years or younger to determine myopia, otherwise hyperopia. Validated against prescriptions, the sensitivity and specificity of these predictions were 0.89 and 0.83, respectively, for myopia. The specificity was 0.92 for hyperopia and 0.80 for astigmatism, though corresponding sensitivities were lower at 0.23 and 0.46, respectively. CONCLUSIONS: In a sample of the parents of Sydney Myopia Study participants, information on the purpose of spectacle use with an age-at-first-use criterion can identify myopic refractive error with reasonable sensitivity and specificity. This four-item questionnaire may assist future epidemiological studies of screening for myopia.