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Original Investigation |

Accuracy and Utility of Self-report of Refractive Error

Phillippa M. Cumberland, MSc1,2; Antonietta Chianca, PhD1,2; Jugnoo S. Rahi, PhD, FRCOphth1,2,3,4,5 ; for the UK Biobank Eye and Vision Consortium
[+] Author Affiliations
1Life Course Epidemiology and Biostatistics Section, University College London (UCL) Institute of Child Health, London, England
2Ulverscroft Vision Research Group, UCL, London, England
3Great Ormond Street Hospital for Children National Health Service (NHS) Foundation Trust, National Institute for Health Research Biomedical Research Centre, London, England
4Moorfields Eye Hospital NHS Foundation Trust, London, England
5UCL Institute of Ophthalmology, London, England
JAMA Ophthalmol. 2016;134(7):794-801. doi:10.1001/jamaophthalmol.2016.1275.
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Importance  Large-scale generic studies offer detailed information on potential risk factors for refractive error across the life course, but ophthalmic examination in such cases to determine the refractive error phenotype is challenging and costly. Thus, refractive status is commonly assigned using questionnaires. In a population survey, often only a few condition-specific self-reported questions can be included, so the questions used must be effective in ruling in those who have the trait of interest and ruling out those who do not.

Objective  To determine the accuracy of identification of refractive status using self-reported age at and/or reason for first use of glasses or contact lenses (optical correction).

Design, Setting, and Participants  The UK Biobank study, a cross-sectional epidemiologic study, included 117 278 participants aged 40 to 69 years in 6 regional centers in England and Wales. Data for the present study were assessed from June 2009 to July 2010. Patients underwent autorefraction measurement. Spherical equivalent in the more extreme eye was used to categorize myopia (−1.00 diopter [D] or more extreme) and hypermetropia (+1.00 D or more extreme).

Main Outcomes and Measures  Sensitivity and specificity of the reason for optical correction were assessed using autorefraction as the gold standard. Receiver operating characteristic curves assessed the accuracy of self-reported age at first use of optical correction and incremental improvement with addition of the reason.

Results  Of the 95 240 participants who reported using optical correction (55.6% female; mean [SD] age, 57.7 [7.5] years), 92 121 (96.7%) provided their age at first use and 93 156 (97.8%) provided the reason. For myopia, sensitivity of the reason for optical correction was 89.1% (95% CI, 88.7%-89.4%), specificity was 83.7% (95% CI, 83.4%-84.0%), and positive and negative predictive values were 72.7% (95% CI, 72.2%-73.1%) and 94.0% (95% CI, 93.8%-94.2%), respectively. The area under the curve was 0.829 (95% CI, 0.826-0.831) and improved to 0.928 (95% CI, 0.926-0.930) with combined information. By contrast, self-report of the reason for optical correction of hypermetropia had low sensitivity (38.1%; 95% CI, 37.6%-38.6%), and the area under the curve with combined information was 0.713 (95% CI, 0.709-0.716).

Conclusions and Relevance  In combination, self-report of the 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 leading to development of novel prevention or treatment strategies.

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Figure 1.
Distribution of Age at First Use of Optical Correction by Refractive Error

For this study, myopia is defined as a spherical equivalent (SE) of −1.00 diopters (D) or more extreme; hypermetropia, SE of 1.00 D or more extreme.

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Figure 2.
Receiver Operating Characteristic (ROC) Curve for Sensitivity and Specificity of Myopia and Hypermetropia

The ROC curves assess the accuracy of self-reported age at first use of optical correction (age) and incremental improvement with the addition of the reason for optical correction (age and reason).

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