Assessing Behavioral Factors in Myopia: Development of a Visual Activity Survey



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Purpose: To conduct a systematic review on near work and myopia and to develop and provide scoring guidelines for the University of Houston Near Work, Environment, Activity, and Refractive Error (UH NEAR) Survey, a comprehensive visual activity survey to aid researchers and clinicians in identifying and quantifying risk factors for myopia.

Methods: PubMed and Medline were used to find peer-reviewed studies from 1980 to July 2020 investigating near work and myopia. The reference lists of relevant publications were considered as source for additional articles. The development of the UH NEAR Survey was carried out in 4 phases. In phase 1, three methods of parental reporting for the presence of myopia in their child (Direct, Lay, and Indirect methods) were investigated through a questionnaire (N = 109) to determine sensitivity and specificity. In phase 2, relevant questions regarding demographic factors and visual behavior were compiled, assessed, and refined. In phase 3, the UH NEAR Survey was administered to focus groups of parents (N = 5). In phase 4, a scoring system was developed.

Results: The literature suggests that a relationship between near work and myopia exists, although the mechanisms remain unclear. Longitudinal studies with objective, continuously measuring rangefinders are necessary to more precisely quantify near work metrics. For subjective methods of determining myopic status, the highest sensitivity was the indirect method (0.84), and the lowest was the direct method (0.41). The highest specificity was the direct method (0.86), once eliminating the “don’t know” responses, and the lowest was the indirect method (0.53). The direct method yielded a 53.2% “don’t know” response rate, 50.5% for the lay method, and 1.8% for the indirect method. Time to complete the survey was 10:09 ± 2:45 minutes, and the final survey was refined based on feedback.

Conclusion: A review of literature implicates a role of near work in myopia. Validation of methods to report myopia showed the indirect method provided the highest sensitivity and best understanding by parents. Focus groups confirmed good comprehensibility and comprehensiveness of the UH NEAR Survey. The scoring system allows clinicians and researchers to easily quantify behaviors across different categories.



Near work, Myopia


Portions of this document appear in: Gajjar S, Ostrin LA. A systematic review of near work and myopia: measurement, relationships, mechanisms and clinical corollaries. Acta Ophthalmol. 2022 Jun;100(4):376-387. doi: 10.1111/aos.15043. Epub 2021 Oct 7. PMID: 34622560.