Cumberland, PM; Rahi, JS; Chianca, A; (2016) Accuracy and Utility of Self-report of Refractive Error. JAMA Ophthalmology , 134 (7) pp. 794-801. 10.1001/jamaophthalmol.2016.1275.

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Abstract

Importance Large-scale generic epidemiological studies offer detailed information on potential risk factors for refractive error across the life course, often lacking in ophthalmology-specific studies. However, ophthalmic examination to determine refractive error phenotype is challenging and costly thus, in that context, refractive status is commonly assigned using questionnaires. In a population survey there is often only scope to include a few condition-specific self-reported questions so it is critical that the questions used are effective in both ‘ruling in’ those who have the trait of interest and ‘ruling out’ those without it. Objective We determined the accuracy of identification of refractive status using self-reported age and/or reason for first wearing optical correction. Design UK Biobank study: cross-sectional epidemiological study. Setting Six regional centres in England and Wales. Participants 117,278 participants, aged 40–69 years in 2009/10. Main outcome and Measures Subjects had autorefraction measurement of refractive status. Spherical equivalent (SphEqu) on the more ‘extreme’ eye was used to categorise myopia (SphEqu ≤-1diopter) and hypermetropia (SphEqu ≥+1diopter). Sensitivity and specificity of reason for optical correction were assessed, using autorefraction as the gold-standard. ROC curves assessed the accuracy of self-reported age of first wearing optical correction and incremental improvement with additional information on the reason. Results Of those reporting using glasses/contact lenses, 92,121/95,240 (97%) gave age at first use and 93,156 (98%) the reason. For myopia, sensitivity of reason for optical correction was 89.1% [88.7, 89.4], specificity 83.7% [83.4, 84.0] and positive and negative predictive values were 72.7% [72.2, 73.1] and 94% [93.8, 94.2] respectively. The area under the curve (AUC) was 0.829 [0.826, 0.831], improving to 0.928 [0.926, 0.930] with combined information. By contrast self-report of reason for optical correction for hypermetropia had low sensitivity (38.1% [37.6, 38.6]) and the AUC with combined information was 0.71 [0.709, 0.716]. Conclusions and Relevance In combination, self-report of reason for and age at first use of optical correction are accurate in identifying myopia. These findings indicate an agreed set of questions could be implemented effectively in large-scale generic population-based studies, to increase opportunities for integrated research on refractive error to develop novel prevention or treatment strategies.

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