Family history and reading habits in adult-onset myopia

Early Age of the First Myopic Spectacle Prescription, as an Indicator of Early Onset of Myopia, Is a Risk Factor for High Myopia in Adulthood

Purpose

The present study investigated the risk factors for high myopia in adulthood, with a focus on the age at which children wore their first spectacles.

Methods

Adults aged between 20 and 45 years were invited to complete a questionnaire about age, sex, current refractive error, high myopia in parents, early onset of myopia presented by the age of the first myopic spectacle prescription, refractive power of the first spectacles, and life habits at different educational stages. The associations between these factors and high myopia in adulthood were then evaluated and analyzed.

Results

In total, 331 participants were enrolled. Their average refractive error was −4.03 diopters, and high myopia was noted in 27.5% of the study participants. Only 3.3% of participants had fathers with high myopia, while 6.0% had mothers with high myopia. The participants received their first myopic spectacle prescription at a mean age of 13.35 years, with a mean refractive error of −1.63 diopters. The significant risk factors for developing high myopia in adult life were earlier age of the first spectacles prescribed (p < 0.001), higher refractive power of the first spectacles (p < 0.001), mother with high myopia (p=0.015), and after-school class attendance in senior high school (p=0.018). Those who wore their first spectacles at <9 years of age were more predisposed to high myopia than those who did so at ≧13 years, with an odds ratio of 24.9.

Conclusion

The present study shows that earlier onset of myopia, which is presented by the age of the first myopic spectacle prescription, higher myopic refraction of the first spectacles, mothers with high myopia, and after-school class attendance in senior high school are risk factors for high myopia in adulthood. It suggests that delaying the onset of myopia in children is important for the prevention of high myopia in later life.

Adult onset unilateral high myopia in a female patient: A case report

Purpose

We report a rare case of unilateral progressive adult-onset myopia in a healthy 27 year old female patient.

Observations

The patient presented to our clinic in 2014 with gradual decrease in vision in the right eye since one and a half years. Her uncorrected visual acuity (UCVA) in the right eye was 0.05, improving to 1.0 with −2.25 Diopter Sphere (DS). The left eye uncorrected visual acuity was 1.0 partial improving to 1.0 with −0.50 Diopter Cylinder (DC) at 10°. The myopia in her right eye continued to increase steadily until her last detailed ophthalmic examination in November 2018, at the age of 31 years, showed a refractive error of −6.75 Diopter Sphere with −0.5 Diopter Cylinder at 170°. Ocular biometry readings showed an axial length (AL) of 25.79mm in the right eye compared to 25.05mm in 2015. The ocular examination of both eyes including clinical examination of anterior and posterior segment, corneal topography, lens densitometry, ultrasound B scan all were within normal limits. Over the last two years she has gradually developed moderate constant esotropia in the right eye, currently +30 Prism Diopters. A short visit to the clinic in December 2019, showed a refraction of −6.75DS with −0.5DC at 170° in the right eye and −0.50DC at 10° in the left eye.

Conclusions and importance

The abrupt onset of myopia in one eye in a healthy individual in this case, the degree of myopia, the nature and rate of progression, absence of risk factors, and otherwise normal ocular examination except for progressive increase in axial length is unusual. Our case brings us to conjecture the role of powerful local factors in the intrinsic regulation of eyeball growth going askew. We believe more and more reporting of myopia cases deviating from natural history and their study might provide clues in a new direction about myopia pathogenesis and our understanding and tackling of one of the oldest eye disease with an ever increasing prevalence.

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.

Age of lens use onset in a myopic sample of office-workers

PURPOSE

The present study was developed to assess prevalence of myopic refractive error and the relative percentages of youth- and adult- onset myopia in a Caucasian adult population.

METHODS

Subjects were office-workers sent consecutively from their workplace for a general health check-up, without refractive selection. Each subject received a questionnaire about academic achievement and family history of myopia. Subsequently, an ophthalmologist performed the vision examination. Although age of initial lens use is not necessarily the same as age of onset of myopia, it was considered to be so for this paper. A subject was considered an adult-onset myope if lens use began at age 18 or later.

RESULTS

Subjects (n=349) had a mean age of 37.6 +/- 9.3 years. One hundred seventeen subjects (33.5% prevalence) had myopic spherical equivalent refraction. Further analysis comprises only subjects with simple myopia (astigmatism <1 diopter, n=95). Nearly half of the simple myopic subjects were of adult-onset (47.8%). There was no difference in family history of myopia between youth- and adult-onset myopes (at least one myopic parent in 53.1% and 47.8% respectively, p=0.53), and no clear cut-off point separated the two myopic subgroups with respect to the age of lens use onset. However, adult-onset myopes had myopia of lower diopter amount than youth-onset myopes.

CONCLUSIONS

Adult-onset myopes comprised nearly half of the simple myopic subjects, and their family history of myopia was similar to that of youth-onset myopes. There is no clear cut-off point between both myopic subgroups when age of onset is the variable considered.

Family history of myopia is not related to the final amount of refractive error in low and moderate myopia

BACKGROUND

Previous research has found an association between family history and presence of myopia. It is possible that family history also could be related to the final amount of refractive error developed. If that were true, then family history of myopia could have predictive value for the amount of refractive error a child or young adult would develop after first lens prescription.

METHODS

Consecutive myopic adult outpatients were enrolled during the year 2003. They received a refractive examination and a questionnaire concerning age of onset of lens use, academic achievement, and parental history of myopia.

RESULTS

In the group of 271 mild and moderate myopes (myopia lower than -6 D) there were 157 subjects with at least one myopic parent and 114 subjects without family history. The presence or absence of a family history of myopia was not associated with either the final myopic refractive error (-3.2 +/- 1.5 D and -2.9 +/- 1.3 D, respectively, P = 0.08) or the age of onset of lens use (17.0 +/- 6.2 years vs 18.1 +/- 6.7 years, respectively, P = 0.15).

CONCLUSIONS

In the present retrospective study of a clinical sample of mild and moderate myopic subjects, family history of myopia did not show predictive value for either the age of first prescription, or the final refractive error developed in adulthood.