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Lyu P, Hu J, Wang Y, Wang J, He X, Shi H. Impact of ophthalmic clinical service use in mitigating myopia onset and progression in preschool children: a retrospective cohort study. BMC Ophthalmol 2024; 24:221. [PMID: 38802768 PMCID: PMC11129446 DOI: 10.1186/s12886-024-03488-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Although school screenings identify children with vision problems and issue referrals for medical treatment at an ophthalmic hospital, the effectiveness of this approach remains unverified. OBJECTIVE To investigate the impact of ophthalmic clinical services on the onset and progression of myopia in preschool children identified with vision impairment. METHODS Using data from the Shanghai Child and Adolescent Large-scale Eye Study (SCALE), this retrospective cohort study evaluated the visual development of children from three districts-Jing'an, Minhang, and Pudong-which are representative of geographic diversity and economic disparity in Shanghai's 17 districts. Initially, in 2015, the study encompassed 14,572 children aged 4-6 years, of whom 5,917 needed a referral. Our cohort consisted of 5,511 children who had two or more vision screenings and complete personal information over the follow-up period from January 2015 to December 2020. We divided these children into two groups based on their initial spherical equivalent (SE): a High-risk group (SE > -0.5 D) and a Myopia group (SE ≤ -0.5 D). Within each of these groups, we further categorized children into Never, Tardily, and Timely groups based on their referral compliance to compare the differences in the occurrence and progression of myopia. Cox proportional models were applied to estimate hazard ratios (HRs) for myopia incidence per person-years of follow-up in High-risk group. Generalized additive models(GAM) was used to calculating the progression for annual spherical equivalent changes in all children. RESULTS Of the 5,511 preschool children (mean age, 5.25 years; 52.24% male) who received a referral recommendation, 1,327 (24.08%) sought clinical services at an ophthalmic hospital. After six years of follow-up, 65.53% of children developed myopia. The six-year cumulative incidence of myopia in the Never, Tardily, and Timely groups was 64.76%, 69.31%, and 57.14%, respectively. These percentages corresponded to hazard ratios (HRs) of 1.31 (95% CI, 1.10-1.55) for the Tardily group and 0.55 (95% CI, 0.33-0.93) for the Timely group, compared with the Never group. The HRs were adjusted for age, sex, and SE at study entry. Interestingly, the Timely group showed significantly less SE progression than the other groups (P < 0.001), and SE progression was higher in the High-risk group (-0.33 ± 0.37D/year) than in children with myopia (-0.08 ± 0.55D/year). CONCLUSION Timely utilization of ophthalmic clinical services among children aged 4 to 6 years who fail school vision screenings can significantly reduce the incidence of myopia and slow SE progression.
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Affiliation(s)
- Pingping Lyu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, 200032, China
| | - Jingwen Hu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, 200032, China
| | - Yujie Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, 200032, China
| | - Jingjing Wang
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Xiangui He
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Huijing Shi
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, 138 Yixueyuan Road, Xuhui District, Shanghai, 200032, China.
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Bourke CM, Loughman J, Flitcroft DI, Loskutova E, O'Brien C. We can't afford to turn a blind eye to myopia. QJM 2023; 116:635-639. [PMID: 30911761 DOI: 10.1093/qjmed/hcz076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Myopia is becoming increasingly prevalent throughout the world. It is an overlooked but leading cause of blindness, particularly among the working aged population. Myopia is often considered benign because it is easily corrected with glasses, contact lenses or refractive surgery. Traditionally myopia has been classified into physiological and pathological subtypes based on the degree of myopia present. Higher levels of myopia are associated with increased risk of pathological complications but it is important to note that there is no safe level of myopia. Even low levels of myopia increase the risk of retinal detachment and other ocular comorbidities which will be discussed in detail later. The most serious complication, myopic maculopathy, is the only leading cause of blindness without an established treatment and therefore leads to inevitable loss of vision in some myopes, even at a young age. AIM To highlight the current myopia epidemic and the sight threatening complications associated with it. DESIGN This is a commissioned review article. Data were gathered by performing a literature review, searching the PubMed database for recent articles regarding myopia. CONCLUSIONS Myopia is a potentially blinding disease. By identifying at risk individuals and intervening before they become myopic, eye care practitioners can prevent or delay spectacle use, reduce the risk of the myriad of myopic complications, thereby improve the patient's quality of life and positively impact its socio-economic effects.
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Affiliation(s)
- C M Bourke
- From the Ophthalmology Department, The Mater Misericordiae University Hospital, Eccles Street, Inns Quay, Dublin D07R2WY, Ireland
- Ophthalmology Department, Childrens University Hospital Temple Street, Temple Street, Dublin 1 D01YC67, Ireland
| | - J Loughman
- Centre for Eye Research Ireland, Dublin Institute of Technology, City Campus, Dublin D07HK68, Ireland
| | - D I Flitcroft
- Ophthalmology Department, Childrens University Hospital Temple Street, Temple Street, Dublin 1 D01YC67, Ireland
| | - E Loskutova
- Centre for Eye Research Ireland, Dublin Institute of Technology, City Campus, Dublin D07HK68, Ireland
| | - C O'Brien
- From the Ophthalmology Department, The Mater Misericordiae University Hospital, Eccles Street, Inns Quay, Dublin D07R2WY, Ireland
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Dan YS, Cheong KX, Lim SY, Wong QY, Chong RS, Wong CW, Hoang QV. Quantitative assessment of the choroidal vasculature in myopic macular degeneration with optical coherence tomographic angiography. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1202445. [PMID: 38983085 PMCID: PMC11182253 DOI: 10.3389/fopht.2023.1202445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/25/2023] [Indexed: 07/11/2024]
Abstract
Background To assess and compare choroidal morphometric vascular parameters, using optical coherence tomographic angiography (OCTA), in highly myopic adults with and without myopic macular degeneration (MMD). Methods This is a clinic-based observational study of 148 eyes with axial length (AL) ≥25mm, enrolled from the high myopia clinic of the Singapore National Eye Centre. MMD was graded from fundus photographs. Swept source OCT (SS-OCT) and OCTA were performed and assessed for choroidal layer thickness (CT) and choroidal vasculature (choroidal vessel density (CVD), choroidal branch area (CBA) and mean choroidal vessel width (MCVW)) in the different choroidal layers (overall choroidal layer (CL), medium-vessel choroidal layer (MVCL), large-vessel choroidal layer (LVCL)). Results CTCL (r=-0.58, p<0.001), CTMVCL (r=-0.22, p=0.04), MCVWCL (r=-0.58, p<0.001), and CVDCL (r=-0.19, p=0.02) were negatively correlated with AL, while CBACL (r=0.61, p<0.001) was positively correlated. Compared to eyes with no MMD, eyes with MMD2 had lower CTCL (120.37±47.18µm vs 218.33±92.70µm, p<0.001), CTMVCL (70.57±15.28µm vs 85.32±23.71µm, p=0.04), CTLVCL (101.65±25.36µm vs 154.55±68.41µm, p=0.001) and greater CVDCL (71.10±3.97% vs 66.97±3.63%, p<0.001), CVDMVCL (66.96±2.35% vs 65.06±2.69%, p=0.002), CVDLVCL (68.36±2.56% vs 66.58±2.88%, p=0.012), MCVWMVCL (6.14±0.34µm vs 5.90±0.35µm, p=0.007), and CBACL (12.69±1.38% vs 11.34±1.18%, p<0.001). After adjusting for age, thicker CTCL (odds ratio (OR) 0.98, 95% confidence interval (CI) 0.97-0.99, p<0.001), CTMVCL (OR 0.97 (0.94-0.99), p=0.002) and CTLVCL (OR 0.97 (0.96-0.98, p<0.001) were significantly associated with lower odds of MMD2, while increased CVDCL (OR 1.37 (1.20-1.55), p<0.001), CVDMVCL (OR 1.39 (1.12-1.73), p=0.003), CVDLVCL (OR 1.31 (1.07-1.60), p=0.009), CBACL (OR 2.19 (1.55-3.08), p<0.001) and MCVWMVCL (OR 6.97 (1.59-30.51), p=0.01) was significantly associated with higher odds of MMD2. Conclusion Decrease in choroidal vessel width, density and thickness, and an increase in vascular branching were observed in eyes with long AL. A thinner and denser choroid with greater branching area and vessel width, which may all be signs of hypoxia, were associated with greater odds of MMD2.
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Affiliation(s)
- Yee Shan Dan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Kai Xiong Cheong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Shen Yi Lim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Qiu Ying Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Rachel S. Chong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
| | - Chee Wai Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Quan V. Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City, NY, United States
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Larouche R, Kleinfeld M, Charles Rodriguez U, Hatten C, Hecker V, Scott DR, Brown LM, Onyeso OK, Sadia F, Shimamura H. Determinants of Outdoor Time in Children and Youth: A Systematic Review of Longitudinal and Intervention Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1328. [PMID: 36674085 PMCID: PMC9859594 DOI: 10.3390/ijerph20021328] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
Spending more time outdoors can improve children's social and cognitive development, physical activity, and vision. Our systematic review summarized the determinants of outdoor time (OT) based on the social-ecological model. We searched nine databases: MEDLINE, APA PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, SPORTDiscus, ERIC, SocINDEX, and ProQuest Dissertations and Theses. To be included, studies needed to be quantitative and longitudinal, include ≥1 potential determinant of OT among 0- to 17-year-olds, and be published in English, French, Japanese, or Spanish. We extracted the authors, publication year, country, design, sample size, OT measures, follow-up period, potential determinants, main results, and potential moderators or mediators. Fifty-five studies examining 119 potential determinants met the inclusion criteria. OT was consistently higher in warmer seasons and among participants reporting more OT at baseline. All three interventions that included both parent sessions and additional resources to promote OT (e.g., specific advice and community guides) were effective. COVID-19 restrictions and sun safety interventions discouraging midday outdoor activities led to less OT. The quality of evidence was rated as weak for 46 studies. Most potential determinants were examined in ≤3 studies; thus, more longitudinal studies are needed to enable stronger conclusions about the consistency of evidence and meta-analyses.
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Affiliation(s)
- Richard Larouche
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Madeline Kleinfeld
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | | | - Cheryl Hatten
- School of Human Services, Lethbridge College, Lethbridge, AB T1K 1L6, Canada
| | - Victoria Hecker
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - David R. Scott
- Library, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Leanna Marie Brown
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Ogochukwu K. Onyeso
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Farzana Sadia
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Hanako Shimamura
- Faculty of Applied Community Studies, Douglas College, Coquitlam, BC V3B 7X3, Canada
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Zhang X, Cheung SSL, Chan HN, Zhang Y, Wang YM, Yip BH, Kam KW, Yu M, Cheng CY, Young AL, Kwan MYW, Ip P, Chong KKL, Tham CC, Chen LJ, Pang CP, Yam JCS. Myopia incidence and lifestyle changes among school children during the COVID-19 pandemic: a population-based prospective study. Br J Ophthalmol 2022; 106:1772-1778. [PMID: 34340973 PMCID: PMC8359867 DOI: 10.1136/bjophthalmol-2021-319307] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/25/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The impacts of social restrictions for COVID-19 on children's vision and lifestyle remain unknown. AIMS To investigate myopia incidence, spherical equivalent refraction (SER) and lifestyle changes among schoolchildren during the COVID-19 pandemic. METHODS Two separate longitudinal cohorts of children aged 6-8 years in Hong Kong were included. The COVID-19 cohort was recruited at the beginning of the COVID-19 outbreak, whereas the pre-COVID-19 cohort was recruited before the COVID-19 pandemic. All children received ocular examinations, and answered a standardised questionnaire relating to their lifestyle, including time spent on outdoor activities and near work, both at baseline and at follow-up visits. RESULTS A total of 1793 subjects were recruited, of whom 709 children comprised the COVID-19 cohort with 7.89±2.30 months of follow-up, and 1084 children comprised the pre-COVID-19 cohort with 37.54±3.12 months of follow-up. The overall incidence was 19.44% in the COVID-19 cohort, and 36.57% in pre-COVID-19 cohort. During the COVID-19 pandemic, the change in SER and axial length was -0.50±0.51 D and 0.29±0.35 mm, respectively; the time spent on outdoor activities decreased from 1.27±1.12 to 0.41±0.90 hours/day (p<0.001), while screen time increased from 2.45±2.32 to 6.89±4.42 hours/day (p<0.001). CONCLUSIONS We showed a potential increase in myopia incidence, significant decrease in outdoor time and increase in screen time among schoolchildren in Hong Kong during the COVID-19 pandemic. Our results serve to warn eye care professionals, and also policy makers, educators and parents, that collective efforts are needed to prevent childhood myopia-a potential public health crisis as a result of COVID-19.
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Affiliation(s)
- Xiujuan Zhang
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Stephanie S L Cheung
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Hong Kong Eye Hospital, Hong Kong, Hong Kong
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Hei-Nga Chan
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yuzhou Zhang
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yu Meng Wang
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Benjamin H Yip
- The Jockey Club School of Public Health and Primary Care Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ka Wai Kam
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Marco Yu
- Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore
| | - Ching-Yu Cheng
- Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore
| | - Alvin L Young
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Mike Y W Kwan
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Kelvin Kam-Lung Chong
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Clement C Tham
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Hong Kong Eye Hospital, Hong Kong, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Li Jia Chen
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chi-Pui Pang
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jason C S Yam
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Hong Kong Eye Hospital, Hong Kong, Hong Kong
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Fernández Irigaray L, Balsa A, Armesto A, Magnetto I, Szeps A, Iribarren LR, Iribarren R, Grzybowski A. Outdoor exposure in children from Buenos Aires Province, Argentina. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:396-401. [PMID: 35779896 DOI: 10.1016/j.oftale.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/09/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To evaluate myopia risk factors, mainly outdoor exposure and reading habits, in a country with low prevalence of myopia (Buenos Aires Province, Argentina). METHODS Consecutive children interviewed in a clinical private practice setting were autorefracted under cycloplegia with cyclopentolate 1%. Their parents consented to fill a questionnaire about schooling, tutorial classes, outdoor exposure, reading habits, and cellphone use, both on weekdays and weekends. The Spanish questionnaire was based on past English questionnaires of myopia clinical trials. The spherical equivalent of the right eye was used for the refractive distribution. The average daily hours spent for each activity were calculated. RESULTS This study involved 115 children aged 10.48 ± 3.65 years (range 5-18 years), with 56.5% being girls. Children had 8 h of schooling per day in 62.6% of cases, and only 14.8 % had tutorial classes after school. There were 38.3% myopes (<-0.50 D), 24.3% hyperopes (>+2.00 D) and the rest were emmetropes. The mean time that these children spent outdoors per day was 3.94 ± 1.45 h (27.60 ± 10.16 h per week). The total mean time spent reading and writing per day was 1.50 ± 0.98 h, and that spent using cellphones and tablets was 2.43 ± 1.66 h. CONCLUSION In an environment with low myopia prevalence, children spend almoast 4 h per day outdoors, much more than the usual recommendation of 2 h a day for myopia prevention.
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Affiliation(s)
| | - A Balsa
- Oftalmólogos Augen, Ciudad de Buenos Aires, Argentina
| | - A Armesto
- Consulta Ocular Iribarren & Asoc., Ciudad de Buenos Aires, Argentina
| | - I Magnetto
- Centro de Visión Dr. Magnetto, Marcos Juárez, Provincia de Córdoba, Argentina
| | - A Szeps
- Departamento de Oftalmología, Prof. Alejandro Posadas, Hospital Nacional, Provincia de Buenos Aires, Argentina
| | - L R Iribarren
- Grupo de Enseñanza Científica, Instituto de Física de Líquidos y Sistemas Biológicos (IFLySIB), CONICET, Buenos Aires, Argentina
| | - R Iribarren
- Consulta Ocular Iribarren & Asoc., Ciudad de Buenos Aires, Argentina.
| | - A Grzybowski
- Departamento de Oftalmología, Universidad de Warmia y Mazury, Olsztyn, Poland; Instituto de Investigación de Oftalmología, Fundación de Desarrollo de Oftalmología, Poznan, Poland
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Mukazhanova A, Aldasheva N, Iskakbayeva J, Bakhytbek R, Ualiyeva A, Baigonova K, Ongarbaeva D, Vinnikov D. Prevalence of refractive errors and risk factors for myopia among schoolchildren of Almaty, Kazakhstan: A cross-sectional study. PLoS One 2022; 17:e0269474. [PMID: 35657822 PMCID: PMC9165805 DOI: 10.1371/journal.pone.0269474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/20/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Very little is known about the prevalence of refractive errors among children in Kazakhstan. The aim of this study was to investigate the prevalence of refractive errors and risk factors of myopia among schoolchildren in Almaty, Kazakhstan. Methods In the cross-sectional study of 2293 secondary school students (age 6–16), we examined cycloplegic autorefraction and offered a questionnaire in three age groups: 1st grade (N = 769), 5th grade (N = 768) and 9th grade (N = 756). The questionnaire covered main risk factors such as parental myopia, screen time, time outdoors, sports activities, near work, gender, grade, and school shift. Adjusted logistic regression analysis was applied to test the association of risk factors with myopia. Results The mean spherical equivalent (SER) was -0.54 ± 1.51 diopters (D). The overall prevalence of refractive errors was 31.6% (95% confidence interval (CI) 29.7; 33.5); myopia 28.3% (95% CI 26.5; 30.1); hyperopia 3.4% (95% CI 2.7–4.1) and astigmatism 2.8% (95% CI 2.1; 3.5). In the multivariate adjusted regression analysis, higher class level (5th grade (odds ratio (OR) 1.78; 95% CI 1.26; 2.52) and 9th grade (OR 3.34; 95% CI 2.31; 4.82)) were associated with myopia, whereas outdoors activity more than 2 hours a day (OR 0.64; 95% CI 0.46; 0.89) and sports (OR 0.70; 95% CI 0.52; 0.93) were associated with a lower incidence of myopia. Conclusions Myopia is a leading refractive error in schoolchildren in Almaty, Kazakhstan. Myopia prevention measures, including more time outdoors, should guide public health interventions in this population.
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Affiliation(s)
- Ainagul Mukazhanova
- Kazakh Eye Research Institute, Almaty, Kazakhstan
- Faculty of Medicine and Health Care, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | | | | | | | - Aliya Ualiyeva
- Faculty of Medicine and Health Care, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Kaini Baigonova
- Faculty of Medicine and Health Care, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Damet Ongarbaeva
- Faculty of Medicine and Health Care, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Denis Vinnikov
- Faculty of Medicine and Health Care, Al-Farabi Kazakh National University, Almaty, Kazakhstan
- Peoples’ Friendship University of Russia (RUDN University), Moscow, Russian Federation
- * E-mail:
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Liu M, Qin H, Wang Y, Gao Y. Refractive Errors and Risk Factors for Myopia in Primary School Students in Urumqi. Appl Bionics Biomech 2022; 2022:2657455. [PMID: 35572061 PMCID: PMC9106460 DOI: 10.1155/2022/2657455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/13/2022] [Accepted: 04/22/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the prevalence of refractive errors and risk factors for myopia in primary school students in Saybag District of Urumqi. Methods A total of 972 primary school students in two elementary schools in Saybag District were included in this study which was conducted from June 2019 to November 2019. Uncorrected visual acuity test and noncycloplegic autorefraction were performed, and their visual acuity was analyzed. Multivariate regression analysis was performed to predict risk factors for myopia. Results Myopia was the most frequent refractive error among primary school students aged 7-11 in Sayibake District, Urumqi City, with a prevalence rate of 60.39%, and mainly mild myopia. The proportion of myopia increased with age, and the proportion of females suffering from myopia was higher than that of males, and the proportion of students from the Han ethnic group suffering from myopia was also higher than that of the other ethnic groups. The students mainly suffered from mild myopia, and the degree of myopia was related to age and gender, regardless of ethnicity. In addition, multivariate regression analysis showed that age and gender were the influencing factors of myopia occurrence and progression. Conclusion Our study results showed a significant prevalence of myopia in pupils aged 7-11 years in Saybag District of Urumqi is affected by gender and age and not by ethnicity.
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Affiliation(s)
- Meng Liu
- Department of Ophthalmology, Xinjiang Uygur Autonomous Region Institute of Traditional Chinese Medicine, Urumqi, Xinjiang, 830000, China
| | - Han Qin
- Department of Ophthalmology, Xinjiang Uygur Autonomous Region Institute of Traditional Chinese Medicine, Urumqi, Xinjiang, 830000, China
| | - Yan Wang
- Department of Ophthalmology, Xinjiang Uygur Autonomous Region Institute of Traditional Chinese Medicine, Urumqi, Xinjiang, 830000, China
| | - Yunxian Gao
- Department of Ophthalmology, Xinjiang Uygur Autonomous Region Institute of Traditional Chinese Medicine, Urumqi, Xinjiang, 830000, China
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9
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Myopia Genetics and Heredity. CHILDREN 2022; 9:children9030382. [PMID: 35327754 PMCID: PMC8947159 DOI: 10.3390/children9030382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/19/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022]
Abstract
Myopia is the most common eye condition leading to visual impairment and is greatly influenced by genetics. Over the last two decades, more than 400 associated gene loci have been mapped for myopia and refractive errors via family linkage analyses, candidate gene studies, genome-wide association studies (GWAS), and next-generation sequencing (NGS). Lifestyle factors, such as excessive near work and short outdoor time, are the primary external factors affecting myopia onset and progression. Notably, besides becoming a global health issue, myopia is more prevalent and severe among East Asians than among Caucasians, especially individuals of Chinese, Japanese, and Korean ancestry. Myopia, especially high myopia, can be serious in consequences. The etiology of high myopia is complex. Prediction for progression of myopia to high myopia can help with prevention and early interventions. Prediction models are thus warranted for risk stratification. There have been vigorous investigations on molecular genetics and lifestyle factors to establish polygenic risk estimations for myopia. However, genes causing myopia have to be identified in order to shed light on pathogenesis and pathway mechanisms. This report aims to examine current evidence regarding (1) the genetic architecture of myopia; (2) currently associated myopia loci identified from the OMIM database, genetic association studies, and NGS studies; (3) gene-environment interactions; and (4) the prediction of myopia via polygenic risk scores (PRSs). The report also discusses various perspectives on myopia genetics and heredity.
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Karthikeyan SK, Ashwini DL, Priyanka M, Nayak A, Biswas S. Physical activity, time spent outdoors, and near work in relation to myopia prevalence, incidence, and progression: An overview of systematic reviews and meta-analyses. Indian J Ophthalmol 2022; 70:728-739. [PMID: 35225506 PMCID: PMC9114537 DOI: 10.4103/ijo.ijo_1564_21] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/21/2021] [Accepted: 09/21/2021] [Indexed: 12/13/2022] Open
Abstract
Myopia has reached epidemic levels in recent years. Stopping the development and progression of myopia is critical, as high myopia is a major cause of blindness worldwide. This overview aims at finding the association of time spent outdoors (TSO), near work (NW), and physical activity (PA) with the incidence, prevalence, and progression of myopia in children. Literature search was conducted in PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, ProQuest, and Web of Science databases. Systematic reviews (SR) and meta-analyses (MA) on the TSO, NW, and PA in relation to myopia were reviewed. Methodological nature of qualified studies were evaluated utilizing the Risk of Bias in Systematic Review tool. We identified four SRs out of which three had MA, which included 62 unique studies, involving >1,00,000 children. This overview found a protective trend toward TSO with a pooled odds ratio (OR) of 0.982 (95% confidence interval (CI) 0.979-0.985, I2 = 93.5%, P < 0.001) per extra hour of TSO every week. A pooled OR 1.14 (95% CI 1.08-1.20) suggested NW to be related to risk of myopia. However, studies associating myopia with NW activities are not necessarily a causality as the effect of myopia might force children to indoor confinement with more NW and less TSO. PA presented no effect on myopia. Though the strength of evidence is less because of high heterogeneity and lack of clinical trials with clear definition, increased TSO and reduced NW are protective against myopia development among nonmyopes.
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Affiliation(s)
- Siddharth K Karthikeyan
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Optometry, Netra Jyothi Institute of Allied Health Sciences, Udupi, Karnataka, India
| | - D L Ashwini
- Department of Optometry, Sankara College of Optometry, Sankara Eye Hospital, Bengaluru, Karnataka, India
| | - M Priyanka
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anush Nayak
- Department of Optometry, Netra Jyothi Institute of Allied Health Sciences, Udupi, Karnataka, India
- Faculty of Life and Allied Health Sciences, Ramaiah University of Applied Sciences, Bangalore, Karnataka, India
| | - Sayantan Biswas
- Visual Neurosciences Group, Singapore Eye Research Institute, Singapore
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Pärssinen O, Kauppinen M. Associations of near work time, watching TV, outdoors time, and parents' myopia with myopia among school children based on 38-year-old historical data. Acta Ophthalmol 2022; 100:e430-e438. [PMID: 34291573 DOI: 10.1111/aos.14980] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/01/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To study the prevalence and risk factors of myopia with data from a questionnaire study conducted in 1983 among Finnish school children. METHODS School children (n = 4 961) from the 1st, 5th and 8th grades of school (7-, 11- and 15-year-olds) in Central Finland were screened for vision followed by a questionnaire, which was returned by 4 352 (87.7%) participants. Myopia was categorized based on the questionnaire. Items concerned daily time spent on near work and outdoor activities, excluding time spent at school, watching TV and parental myopia and the associations of myopia with these factors were studied. RESULTS The prevalence of myopia was 3%, 15% and 27% among the 7-, 11- and 15-year-olds, and if daily near work at home was ≤1 hr, myopia prevalence was 0.5%, 3.3% and 17.6%, respectively. The adjusted risk of myopia for each daily near work hour was OR 1.476 (95% confidence interval 1.099-1.984, p = 0.010), OR 1.346 (1.170-1.584, p < 0.001) and OR 1.206 (1.076-1.352, p = 0.001), in the 3 age groups, respectively. The adjusted risk of myopia for each daily hour spent outdoors was OR 0.764 (0.648-0.900, p = 0.001) in the 11-year-olds and OR (0.840, 0.743-0.950, p = 0.005) in the 15-year-olds. Outdoors time prevented myopia at different levels of near work, although less at the highest levels, and near work increased risk of myopia with the level of outdoors time. If the ratio between near work and outdoors time was ≤0. 5 or >1.5, the prevalence of myopia was 1.4% versus 5.6%, 6.3% versus 24.7% and 15.9% versus 36.9%, among the 7-, 11- and 15-year-olds, respectively. The higher prevalence of myopia among the 11- and 15-year-old girls than boys was explained by more near work and less outdoor time among the girls. Having two myopic parents roughly doubled the risk of myopia compared to if one myopic parent in the 11- and 15-year-olds. CONCLUSIONS Myopic parents, greater near work time, less outdoors time, a higher near work/outdoors ratio, and being a girl increased the risk of myopia. Myopia was rare in the 7- and 11-year-olds if daily near work at home did not exceed one hour or if the near work/outdoors ratio was not higher than 0.5. Outdoors time was associated with the prevalence of myopia at all levels of near work, although the association was weaker at the highest level.
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Affiliation(s)
- Olavi Pärssinen
- Department of Ophthalmology Central Hospital of Central Finland Jyväskylä Finland
- Gerontology Research Center and Faculty of Sport and Health Sciences University of Jyvaskylä Jyväskylä Finland
| | - Markku Kauppinen
- Gerontology Research Center and Faculty of Sport and Health Sciences University of Jyvaskylä Jyväskylä Finland
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Nguyen HTT, Hoang TT, Pham CM, Nguyen TM, Dang TM, Fricke TR. Prevalence and related factors of myopic retinopathy - a hospital-based cross-section study in Vietnam. Clin Exp Optom 2022; 106:427-430. [PMID: 35188078 DOI: 10.1080/08164622.2022.2039555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CLINICAL RELEVANCE Myopia prevention and anti-myopia treatment is of great importance in South East Asia. BACKGROUND To evaluate the prevalence and related factors of myopic retinopathy in Vietnam. METHODS A cross-sectional study was conducted on 168 eyes of 88 patients with high myopia presenting to the Refraction Department of Vietnam National Eye Hospital. Inclusion criteria were high myopia (≤-6.00D with cycloplegic retinoscopy). Consecutive presenting patients recruited between January 2020 and August 2020 consented to participate. RESULTS Participant age range was 12-47 years. Peripapillary atrophy was present in 70.2% of participants, most commonly atrophy of one-quarter of the disc (38.7%). Central retinal changes were present in 66.1% of participants, subclassified as tessellated fundus in 60.7%, diffuse chorioretinal atrophy in 4.2% and patchy chorioretinal atrophy in 1.2%. Peripheral retinal lesions were present in 43.5% of participants, consisting of white-without-pressure in 32.1%, lattice degeneration in 16.1%, snail track degeneration in 4.2% and microcystoid degeneration in 1.2%. Myopia ≤-8.00D and axial length ≥26.5 mm were associated with additional risk of posterior ocular complications. Furthermore, age ≥19 years increased risk of central myopic retinopathy and ≥10 years since initial myopia diagnosis increased the risk of peripapillary atrophy and central retinal changes. Other factors such as the age of onset of myopia and family myopia history did not appear to alter the risk of peripheral retina damage. CONCLUSIONS Retinal disorders were common in Vietnamese people with high myopia. Within the current cohort with high myopia, myopia ≤-8.00D and axial length ≥26.5 mm were associated with a significant further elevation of risk.
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Affiliation(s)
| | - Tung Thanh Hoang
- Hanoi Medical University, Hanoi, Vietnam.,Save Sight Institute, University of Sydney, New South Wales, Australia
| | | | | | - Trung M Dang
- Eye Clinic Albury-Wodonga, Albury, New South Wales, Australia
| | - Timothy R Fricke
- Brien Holden Vision Institute, Sydney, New South Wales, Australia.,Department of Optometry and Vision Sciences, University of Melbourne, Victoria, Australia.,School of Optometry and Vision Science, University of New South Wales, New South Wales, Australia
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KOCAMIŞ Sİ, ÖZDEMİR İ. The difference between the cycloplegic and noncycloplegic refractive error may be an indicator for the myopia progression in myopic children. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1017563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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14
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Morgan IG, Rose KA. Myopia: is the nature‐nurture debate finally over? Clin Exp Optom 2021; 102:3-17. [DOI: 10.1111/cxo.12845] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/10/2018] [Accepted: 09/12/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Ian G Morgan
- Research School of Biology, Australian National University, Canberra, Australian Capital Territory, Australia,
- State Key Laboratory of Ophthalmology and Division of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat‐Sen University, Guangzhou, China,
| | - Kathryn A Rose
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia,
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Hoang QV, Chang S, Yu DJG, Yannuzzi LA, Freund KB, Grinband J. 3-D assessment of gaze-induced eye shape deformations and downgaze-induced vitreous chamber volume increase in highly myopic eyes with staphyloma. Br J Ophthalmol 2020; 105:1149-1154. [PMID: 32830122 DOI: 10.1136/bjophthalmol-2020-316084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine if the stress of normal eye movements results in gaze-induced globe deformations, vitreous chamber axial length and vitreous chamber axial volume (VCAV) change in highly myopic eyes. METHODS A prospective imaging study was performed on 82 eyes of 43 patients with high myopia (>27 mm of axial length) with a clinical diagnosis of staphyloma. Three-dimensional MRI scans were acquired while subjects gazed in five directions (primary, nasal, temporal, superior and inferior). Surface renderings were generated, and a processing pipeline was created to automate alignment of the eye and to measure VCAV within 5.5 mm of the visual axis for each eye in every gaze. The degree of gaze-induced globe deformation was determined by calculating the Dice coefficient to assess the degree of overlap of the sclera at each eccentric gaze with that found in primary gaze. Each eccentric gaze VCAV was compared to VCAV in primary gaze using a fixed-effects regression allowing for subject-specific and eye-specific effects. RESULTS The Dice coefficient showed significant gaze-induced eye shape changes in all gazes (all p<0.0001). There were no statistically significant gaze-induced VCAV changes when comparing primary gaze to nasal, temporal or upgaze. However, when changing from primary to downgaze, VCAV was increased by +4.79 mm3 (p=0.002, 95% CI 1.71 to 7.86). CONCLUSION Significant gaze-induced globe deformation was noted in all gazes, but a reversible, instantaneous VCAV increase occurred only in downgaze, which is consistent with studies supporting the association of environmental factors such as near work with myopia development and progression.
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Affiliation(s)
- Quan V Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke National University of Singapore, Singapore .,Ophthalmology, Columbia University College of Physicians and Surgeons, New York City, New York, USA
| | - Stanley Chang
- Ophthalmology, Columbia University College of Physicians and Surgeons, New York City, New York, USA
| | - Daryle Jason Go Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke National University of Singapore, Singapore
| | | | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, USA
| | - Jack Grinband
- Radiology, Columbia University College of Physicians and Surgeons, New York City, New York, USA
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Accommodation is unrelated to myopia progression in Chinese myopic children. Sci Rep 2020; 10:12056. [PMID: 32694658 PMCID: PMC7374687 DOI: 10.1038/s41598-020-68859-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/30/2020] [Indexed: 12/18/2022] Open
Abstract
This study shows accommodative accuracy and distance accommodation facility in myopic children do not play a role in myopia progression. In 144 subjects, the monocular distance accommodative facility (DAF) and continuous accommodative stimulus-response curves (ASRCs) were measured at the enrolment. Retrospective and prospective refraction with regard to the enrolment visit were obtained from the outpatient database system based on noncycloplegic subjective spherical equivalent refraction (SER). The rate of myopic progression at enrolment was the first derivative of the Gompertz function, which was fitted with each subject's longitudinal refractive error data, including at least four records of SER with an interval of more than 6 months between each visit. A mixed linear model for multilevel repeated-measures data was used to explore the associations between the rate of myopia progression and accommodative parameters. The mean rate of myopia progression at enrolment was -0.61 ± 0.31 D/y with a mean age of 12.27 ± 1.61 years. By adjusting for age and SER, it was shown that the myopic progression rate was not associated with the accommodative lag (F = 0.269, P = 0.604), accommodative lag area (F = 0.086, P = 0.354), slope of ASRC (F = 0.711, P = 0.399), and DAF (F = 0.619, P = 0.432).
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Grzybowski A, Kanclerz P, Tsubota K, Lanca C, Saw SM. A review on the epidemiology of myopia in school children worldwide. BMC Ophthalmol 2020; 20:27. [PMID: 31937276 PMCID: PMC6961361 DOI: 10.1186/s12886-019-1220-0] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/14/2019] [Indexed: 01/29/2023] Open
Abstract
Background Due to high prevalence myopia has gained importance in epidemiological studies. Children with early onset are at particular risk of complications associated with myopia, as progression over time might result in high myopia and myopic macular degeneration. Both genetic and environmental factors play a role in the increasing prevalence of myopia. The aim of this study is to review the current literature on epidemiology and risk factors for myopia in school children (aged 6–19 years) around the world. Main body PubMed and Medline were searched for the following keywords: prevalence, incidence, myopia, refractive error, risk factors, children and visual impairment. English language articles published between Jan 2013 and Mar 2019 were included in the study. Studies were critically reviewed for study methodology and robustness of data. Eighty studies were included in this literature review. Myopia prevalence remains higher in Asia (60%) compared with Europe (40%) using cycloplegic refraction examinations. Studies reporting on non-cycloplegic measurements show exceptionally high myopia prevalence rates in school children in East Asia (73%), and high rates in North America (42%). Low prevalence under 10% was described in African and South American children. In recent studies, risk factors for myopia in schoolchildren included low outdoor time and near work, dim light exposure, the use of LED lamps for homework, low sleeping hours, reading distance less than 25 cm and living in an urban environment. Conclusion Low levels of outdoor activity and near work are well-established risk factors for myopia; this review provides evidence on additional environmental risk factors. New epidemiological studies should be carried out on implementation of public health strategies to tackle and avoid myopia. As the myopia prevalence rates in non-cycloplegic studies are overestimated, we recommend considering only cycloplegic measurements.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland. .,Foundation for Ophthalmology Development, Institute for Research in Ophthalmology, Gorczyczewskiego 2/3, 60-554, Poznan, Poland.
| | | | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.,Tsubota Laboratory, Inc., Tokyo, Japan
| | - Carla Lanca
- Singapore Eye Research Institute, Singapore, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Shapira Y, Mimouni M, Machluf Y, Chaiter Y, Saab H, Mezer E. The Increasing Burden of Myopia in Israel among Young Adults over a Generation: Analysis of Predisposing Factors. Ophthalmology 2019; 126:1617-1626. [PMID: 31474440 DOI: 10.1016/j.ophtha.2019.06.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/03/2019] [Accepted: 06/20/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To determine the trends in prevalence of myopia in Israeli young adults over approximately a generation, as well as associated factors and variation in the impact of these factors on myopia prevalence in this region over time. DESIGN Retrospective, cross-sectional study. PARTICIPANTS One hundred four thousand six hundred eighty-nine consecutive persons 16 to 19 years of age born between 1971 and 1994 who had not yet enlisted in the Israeli Army but had completed the medical profiling process. METHODS Using data collected at a north Israel recruitment center, the prevalence of myopia over time was estimated, and a polynomial regression analysis was performed to assess significance of nonlinear trends. Associations of demographic and socioeconomic factors with myopia were assessed, and trends over time were analyzed using a factorial logistic regression. MAIN OUTCOME MEASURES The primary outcome measure was factors associated with the prevalence of myopia over time. The secondary outcome measure was a description of the change in prevalence of myopia over time. RESULTS The prevalence of myopia increased 1.284-fold over 24 years from 20.4% among participants born between 1971 and 1982 to 26.2% among participants born between 1983 and 1994. A quite similar increase was observed among males (from 17.9% to 22.7%, respectively) and females (from 23.9% to 30.8%, respectively). The factors found to be associated with myopia were as follows: more recent date of birth, female gender, more years of education, being the eldest child, non-Israeli ethnic origin, and urban residence. However, there were significant trends over time in the effects of some of these factors, most notably an attenuation of the difference between participants of different religions in the recent birth-years period. Most of these associations and trends were observed in both males and females separately, with some gender-specific variations. Immigrants from Ethiopia who were raised in Israel were highly more likely to demonstrate myopia than those who arrived at an older age. CONCLUSIONS This study demonstrated an increase in the prevalence of myopia and the possible associations of urbanization- and higher education-related factors among several subpopulations and the risk for myopia developing.
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Affiliation(s)
- Yinon Shapira
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel; Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology.
| | - Yossy Machluf
- Israel Defense Forces, Medical Corps, Israel; Shamir Research Institute, University of Haifa, Kazerin, Israel
| | | | - Haitam Saab
- Israel Defense Forces, Medical Corps, Israel
| | - Eedy Mezer
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel; Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology
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Harrington SC, O'Dwyer V. Ocular biometry, refraction and time spent outdoors during daylight in Irish schoolchildren. Clin Exp Optom 2019; 103:167-176. [PMID: 31187504 DOI: 10.1111/cxo.12929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Previous studies have investigated the relationship between ocular biometry and spherical equivalent refraction in children. This is the first such study in Ireland. The effect of time spent outdoors was also investigated. METHODS Examination included cycloplegic autorefraction and non-contact ocular biometric measures of axial length, corneal radius and anterior chamber depth from 1,626 children in two age groups: six to seven years and 12 to 13 years, from 37 schools. Parents/guardians completed a participant questionnaire detailing time spent outdoors during daylight in summer and winter. RESULTS Ocular biometric data were correlated with spherical equivalent refraction (axial length: r = -0.64, corneal radius: r = 0.07, anterior chamber depth: r = -0.33, axial length/corneal radius ratio: r = -0.79, all p < 0.0001). Participants aged 12-13 years had a longer axial length (6-7 years 22.53 mm, 12-13 years 23.50 mm), deeper anterior chamber (6-7 years 3.40 mm, 12-13 years 3.61 mm), longer corneal radius (6-7 years 7.81 mm, 12-13 years 7.87 mm) and a higher axial length/corneal radius ratio (6-7 years 2.89, 12-13 years 2.99), all p < 0.0001. Controlling for age: axial length was longer in boys (boys 23.32 mm, girls 22.77 mm), and non-White participants (non-White 23.21 mm, White 23.04 mm); corneal radius was longer in boys (boys 7.92 mm, girls 7.75 mm); anterior chamber was deeper in boys (boys 3.62 mm, girls 3.55 mm, p < 0.0001), and axial length/corneal radius ratios were higher in non-White participants (non-White 2.98, White 2.94, p < 0.0001). Controlling for age and ethnicity, more time outdoors in summer was associated with a less myopic refraction, shorter axial length, and lower axial length/corneal radius ratio. Non-White participants reported spending significantly less time outdoors than White participants (p < 0.0001). CONCLUSION Refractive error variance in schoolchildren in Ireland was best explained by variation in the axial length/corneal radius ratio with higher values associated with a more myopic refraction. Time spent outdoors during daylight in summer was associated with shorter axial lengths and a less myopic spherical equivalent refraction in White participants. Strategies to promote daylight exposure in wintertime is a study recommendation.
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Affiliation(s)
- Síofra C Harrington
- School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Veronica O'Dwyer
- School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
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Impact of various types of near work and time spent outdoors at different times of day on visual acuity and refractive error among Chinese school-going children. PLoS One 2019; 14:e0215827. [PMID: 31026279 PMCID: PMC6485919 DOI: 10.1371/journal.pone.0215827] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/09/2019] [Indexed: 11/19/2022] Open
Abstract
Background Various types of near work have been suggested to promote the incidence and progression of myopia, while outdoor activity appears to prevent or retard myopia. However, there is a lack of consensus on how to interpret these results and translate them into effective intervention strategies. This study examined the association between visual acuity and time allocated to various activities among school-going children. Methods Population-based survey of 19,934 students in grade 4 and 5 from 252 randomly selected rural primary schools in Northwest China in September 2012. This survey measured visual acuity and collected self-reported data on time spent outdoors and time spent doing various types of near activities. Results Prolonged (>60 minutes/day) computer usage (-0.025 LogMAR units, P = .011) and smartphone usage (-0.041 LogMAR units, P = .001) were significantly associated with greater refractive error, while television viewing and after-school study were not. For time spent outdoors, only time around midday was significantly associated with better uncorrected visual acuity. Compared to children who reported no midday time outdoors, those who spent time outdoors at midday for 31–60 minutes or more than 60 minutes had better uncorrected visual acuity by 0.016 LogMAR units (P = .014) and 0.016 units (P = .042), respectively. Conclusions Use of smart phones and computers were associated with declines in children’s vision, while television viewing was not. Statistically significant associations between outdoor time at midday and reduced myopia may support the hypothesis that light intensity plays a role in the protective effects of outdoor time.
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Ulaganathan S, Read SA, Collins MJ, Vincent SJ. Influence of seasons upon personal light exposure and longitudinal axial length changes in young adults. Acta Ophthalmol 2019; 97:e256-e265. [PMID: 30288926 DOI: 10.1111/aos.13904] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 07/29/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the association between objectively measured ambient light exposure and longitudinal axial length changes (and their seasonal variations) over a period of 12 months in young adults. METHODS This prospective longitudinal observational study included 43 healthy young adult university students (21 emmetropes and 22 myopes) aged between 18 and 30 years. Three axial length measurements were collected at 6-month intervals (i.e. at baseline, 6 and 12 months), in summer and winter to determine the axial eye growth. Personal ambient light exposure data were measured in winter and summer months with wearable sensors, from which the mean daily time exposed to bright (outdoor) light levels (>1000 lux) was derived. RESULTS Greater daily bright light exposure was associated with less axial eye growth (β = -0.002, p = 0.006) over 12 months. In summer, myopes exhibited significantly greater changes in axial length (mean change 0.04 ± 0.05 mm) compared to emmetropes (-0.01 ± 0.05 mm) (p = 0.001), but there was no significant difference between refractive groups in winter. Emmetropes also spent significantly greater time in outdoor light levels in summer compared to winter (p < 0.0001), while myopes spent similar time outdoors during both seasons (p = 0.12). Differences in light exposure between summer and winter were also associated with seasonal differences in axial eye growth (p = 0.026). CONCLUSION In young adults, greater time spent in bright light was associated with slower longitudinal axial eye growth. Seasonal light exposure and axial length changes were dependent on refractive error in this population and also exhibited an inverse relationship.
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Affiliation(s)
- Sekar Ulaganathan
- Contact Lens and Visual Optics Laboratory School of Optometry and Vision Science Queensland University of Technology Brisbane Queensland Australia
| | - Scott A. Read
- Contact Lens and Visual Optics Laboratory School of Optometry and Vision Science Queensland University of Technology Brisbane Queensland Australia
| | - Michael J. Collins
- Contact Lens and Visual Optics Laboratory School of Optometry and Vision Science Queensland University of Technology Brisbane Queensland Australia
| | - Stephen J. Vincent
- Contact Lens and Visual Optics Laboratory School of Optometry and Vision Science Queensland University of Technology Brisbane Queensland Australia
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Read SA, Vincent SJ, Tan CS, Ngo C, Collins MJ, Saw SM. Patterns of Daily Outdoor Light Exposure in Australian and Singaporean Children. Transl Vis Sci Technol 2018; 7:8. [PMID: 29862140 PMCID: PMC5976264 DOI: 10.1167/tvst.7.3.8] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/12/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Myopia is rising in prevalence in many locations, and there is evidence that outdoor light exposure is a major environmental factor playing a role in myopia development. This study examined the patterns of daily light exposure in similarly aged children from two geographic locations (Australia and Singapore) known to exhibit differences in myopia prevalence. METHODS Wearable light sensors were used to assess daily light exposure in 69 Singaporean children aged 8 to 12 years (mean, 9.2 ± 1.1) and 43 Australian children aged 10 to 12 years (mean, 11.3 ± 0.6). The mean daily time exposed to bright outdoor light (>1000 lux) and the number and duration of daily episodes of outdoor exposure were examined. RESULTS Patterns of daily outdoor light exposure differed substantially between Australia and Singapore. Australian children (105 ± 42 min/d) experienced significantly longer daily outdoor light exposure than Singaporean children (61 ± 40 min/d; P = 0.005), with the largest differences found on weekdays during school hours. Australian children (6.9 ± 1.5 episodes per day) had more frequent daily episodes of outdoor light exposure compared with Singaporean children (4.6 ± 1.5; P = 0.02); however, there was no significant difference in the mean duration of these episodes between countries (P = 0.54). CONCLUSIONS Children living in Singapore were exposed to significantly less daily outdoor light than Australian children, and these differences may be one of several factors contributing to the differences in myopia prevalence typically found between these populations. TRANSLATIONAL RELEVANCE Knowledge of these light exposure patterns may assist in the design of outdoor interventions, including school programs, to increase outdoor time in urban Asian populations.
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Affiliation(s)
- Scott A. Read
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Stephen J. Vincent
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Chuen-Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Cheryl Ngo
- Department of Ophthalmology, National University Hospital, Singapore
| | - Michael J. Collins
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Seang-Mei Saw
- Department of Ophthalmology, National University Hospital, Singapore
- Singapore Eye Research Institute, Singapore
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Morgan IG, French AN, Ashby RS, Guo X, Ding X, He M, Rose KA. The epidemics of myopia: Aetiology and prevention. Prog Retin Eye Res 2017; 62:134-149. [PMID: 28951126 DOI: 10.1016/j.preteyeres.2017.09.004] [Citation(s) in RCA: 583] [Impact Index Per Article: 83.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 09/11/2017] [Accepted: 09/20/2017] [Indexed: 02/06/2023]
Abstract
There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80-90%, and an accompanying high prevalence of high myopia in young adults (10-20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epidemics are linked, since the increasingly early onset of myopia, combined with high progression rates, naturally generates an epidemic of high myopia, with high prevalences of "acquired" high myopia appearing around the age of 11-13. The major risk factors identified are intensive education, and limited time outdoors. The localization of the epidemic appears to be due to the high educational pressures and limited time outdoors in the region, rather than to genetically elevated sensitivity to these factors. Causality has been demonstrated in the case of time outdoors through randomized clinical trials in which increased time outdoors in schools has prevented the onset of myopia. In the case of educational pressures, evidence of causality comes from the high prevalence of myopia and high myopia in Jewish boys attending Orthodox schools in Israel compared to their sisters attending religious schools, and boys and girls attending secular schools. Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge. Reforms to the organization of school systems to reduce intense early competition for accelerated learning pathways may also be important.
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Affiliation(s)
- Ian G Morgan
- Division of Biochemistry and Molecular Biology, Research School of Biology, Australian National University, Canberra, ACT, Australia; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, China.
| | - Amanda N French
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Regan S Ashby
- Centre for Research in Therapeutic Solutions, Biomedical Sciences, Faulty of Education, Science, Technology and Mathematics, University of Canberra, Canberra, Australia
| | - Xinxing Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, China; Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Xiaohu Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, China; Centre for Eye Research Australia, University of Melbourne, Parkville, VIC, Australia
| | - Kathryn A Rose
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Xiong S, Sankaridurg P, Naduvilath T, Zang J, Zou H, Zhu J, Lv M, He X, Xu X. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol 2017; 95:551-566. [PMID: 28251836 PMCID: PMC5599950 DOI: 10.1111/aos.13403] [Citation(s) in RCA: 291] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 12/21/2016] [Indexed: 12/25/2022]
Abstract
Outdoor time is considered to reduce the risk of developing myopia. The purpose is to evaluate the evidence for association between time outdoors and (1) risk of onset of myopia (incident/prevalent myopia); (2) risk of a myopic shift in refractive error and c) risk of progression in myopes only. A systematic review followed by a meta-analysis and a dose-response analysis of relevant evidence from literature was conducted. PubMed, EMBASE and the Cochrane Library were searched for relevant papers. Of the 51 articles with relevant data, 25 were included in the meta-analysis and dose-response analysis. Twenty-three of the 25 articles involved children. Risk ratio (RR) for binary variables and weighted mean difference (WMD) for continuous variables were conducted. Mantel-Haenszel random-effects model was used to pool the data for meta-analysis. Statistical heterogeneity was assessed using the I2 test with I2 ≥ 50% considered to indicate high heterogeneity. Additionally, subgroup analyses (based on participant's age, prevalence of myopia and study type) and sensitivity analyses were conducted. A significant protective effect of outdoor time was found for incident myopia (clinical trials: risk ratio (RR) = 0.536, 95% confidence interval (CI) = 0.338 to 0.850; longitudinal cohort studies: RR = 0.574, 95% CI = 0.395 to 0.834) and prevalent myopia (cross-sectional studies: OR = 0.964, 95% CI = 0.945 to 0.982). With dose-response analysis, an inverse nonlinear relationship was found with increased time outdoors reducing the risk of incident myopia. Also, pooled results from clinical trials indicated that when outdoor time was used as an intervention, there was a reduced myopic shift of -0.30 D (in both myopes and nonmyopes) compared with the control group (WMD = -0.30, 95% CI = -0.18 to -0.41) after 3 years of follow-up. However, when only myopes were considered, dose-response analysis did not find a relationship between time outdoors and myopic progression (R2 = 0.00064). Increased time outdoors is effective in preventing the onset of myopia as well as in slowing the myopic shift in refractive error. But paradoxically, outdoor time was not effective in slowing progression in eyes that were already myopic. Further studies evaluating effect of outdoor in various doses and objective measurements of time outdoors may help improve our understanding of the role played by outdoors in onset and management of myopia.
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Affiliation(s)
- Shuyu Xiong
- Department of Preventative Ophthalmology; Shanghai Eye Disease Prevention and Treatment Center; Shanghai Eye Hospital; Shanghai China
- Department of Ophthalmology; Shanghai General Hospital; Shanghai Jiao Tong University; Shanghai China
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute; Sydney New South Wales Australia
- School of Optometry and Vision Science; University of New South Wales; Sydney New South Wales Australia
| | | | - Jiajie Zang
- Department of Nutrition; Shanghai Municipal Center for Disease Control and Prevention; Shanghai China
| | - Haidong Zou
- Department of Preventative Ophthalmology; Shanghai Eye Disease Prevention and Treatment Center; Shanghai Eye Hospital; Shanghai China
- Department of Ophthalmology; Shanghai General Hospital; Shanghai Jiao Tong University; Shanghai China
| | - Jianfeng Zhu
- Department of Preventative Ophthalmology; Shanghai Eye Disease Prevention and Treatment Center; Shanghai Eye Hospital; Shanghai China
| | - Minzhi Lv
- Department of Preventative Ophthalmology; Shanghai Eye Disease Prevention and Treatment Center; Shanghai Eye Hospital; Shanghai China
| | - Xiangui He
- Department of Preventative Ophthalmology; Shanghai Eye Disease Prevention and Treatment Center; Shanghai Eye Hospital; Shanghai China
- Department of Maternal and Child Health; School of Public Health; Key Laboratory of Public Health Safety; Ministry of Education; Fudan University; Shanghai China
| | - Xun Xu
- Department of Preventative Ophthalmology; Shanghai Eye Disease Prevention and Treatment Center; Shanghai Eye Hospital; Shanghai China
- Department of Ophthalmology; Shanghai General Hospital; Shanghai Jiao Tong University; Shanghai China
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Lin Z, Vasudevan B, Ciuffreda KJ, Zhou HJ, Mao GY, Wang NL, Liang YB. Myopigenic Activity Change and Its Risk Factors in Urban Students in Beijing: Three-Year Report of Beijing Myopia Progression Study. Ophthalmic Epidemiol 2017; 24:388-393. [PMID: 28426334 DOI: 10.1080/09286586.2017.1307994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the myopigenic activity change and its risk factors in urban students in Beijing. METHODS A total of 241 primary or secondary students aged 6-17 years from the Beijing Myopia Progression Study (BMPS) were re-examined 3 years after their baseline enrollment. A detailed questionnaire was administered to assess myopigenic activities at both baseline and at the 3-year follow-up. Altogether, 217 students (90.0%) with completed data were included in the analysis. RESULTS Compared to baseline, primary students (n = 123) had significant increases in outdoor sports time (mean ± standard deviation: 3.5 ± 4.3 vs. 2.4 ± 3.0 hours/week, p = 0.02), near work time (32.1 ± 13.4 vs. 24.8 ± 9.2 hours/week, p < 0.001), diopter hours (128.8 ± 53.3 vs. 97.5 ± 35.9 diopter hours/week, p < 0.001), and indoor time (53.8 ± 22.8 vs. 41.4 ± 16.9 hours/week, p < 0.001) at the 3-year follow-up. At both baseline and follow-up, females spent less time than males on outdoor sports (baseline: 2.4 ± 2.8 vs. 4.0 ± 5.2 hours/week, p = 0.006; follow-up: 2.3 ± 3.1 vs. 5.1 ± 5.0 hours/week, p < 0.001), and total outdoors (baseline: 11.9 ± 7.9 vs. 14.4 ± 9.5 hours/week, p = 0.03; follow-up: 10.5 ± 8.2 vs. 13.9 ± 9.6 hours/week, p = 0.005). In the multivariate regression analysis after adjustment by student's gender, younger students had more increase in both near work time (slope = -0.99 hours/week for age, p = 0.009) and indoor time (slope = -2.04 hours/week for age, p = 0.001). CONCLUSIONS During the 3-year follow-up, primary students had more myopigenic activities. Female students had more myopigenic activities than males at both baseline and follow-up. Children's age was a significant risk factor for this myopigenic activity change.
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Affiliation(s)
- Zhong Lin
- a The Affiliated Eye Hospital, School of Ophthalmology and Optometry , Wenzhou Medical University , Wenzhou , Zhejiang , China
| | | | - Kenneth J Ciuffreda
- c Department of Biological and Vision Sciences , SUNY College of Optometry , New York , NY , USA
| | - Hong Jia Zhou
- a The Affiliated Eye Hospital, School of Ophthalmology and Optometry , Wenzhou Medical University , Wenzhou , Zhejiang , China
| | - Guang Yun Mao
- a The Affiliated Eye Hospital, School of Ophthalmology and Optometry , Wenzhou Medical University , Wenzhou , Zhejiang , China.,d School of Environmental Science & Public Health , Wenzhou Medical University , Wenzhou , Zhejiang , China
| | - Ning Li Wang
- e Beijing Tongren Eye Center, Beijing Tongren Hospital , Capital Medical University; Beijing Ophthalmology & Visual Science Key Lab , Beijing , China
| | - Yuan Bo Liang
- a The Affiliated Eye Hospital, School of Ophthalmology and Optometry , Wenzhou Medical University , Wenzhou , Zhejiang , China.,f Centre for Public Health, Queen's University , Belfast , UK
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Chen Y, Zhang J, Morgan IG, He M. Identifying Children at Risk of High Myopia Using Population Centile Curves of Refraction. PLoS One 2016; 11:e0167642. [PMID: 28030593 PMCID: PMC5193395 DOI: 10.1371/journal.pone.0167642] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/17/2016] [Indexed: 01/28/2023] Open
Abstract
Purpose To construct reference centile curves of refraction based on population-based data as an age-specific severity scale to evaluate their efficacy as a tool for identifying children at risk of developing high myopia in a longitudinal study. Methods Data of 4218 children aged 5–15 years from the Guangzhou Refractive Error Study in Children (RESC) study, and 354 first-born twins from the Guangzhou Twin Eye Study (GTES) with annual visit were included in the analysis. Reference centile curves for refraction were constructed using a quantile regression model based on the cycloplegic refraction data from the RESC. The risk of developing high myopia (spherical equivalent ≤ -6 diopters [D]) was evaluated as a diagnostic test using the twin follow-up data. Results The centile curves suggested that the 3rd, 5th, and 10th percentile decreased from -0.25 D, 0.00 D and 0.25 D in 5 year-olds to -6.00 D, -5.65D and -4.63 D in 15 year-olds in the population-based data from RESC. In the GTES cohort, the 5th centile showed the most effective diagnostic value with a sensitivity of 92.9%, a specificity of 97.9% and a positive predictive value (PPV) of 65.0% in predicting high myopia onset (≤-6.00D) before the age of 15 years. The PPV was highest (87.5%) in 3rd centile but with only 50.0% sensitivity. The Mathew’s correlation coefficient of 5th centile in predicting myopia of -6.0D/-5.0D/-4.0D by age of 15 was 0.77/0.51/0.30 respectively. Conclusions Reference centile curves provide an age-specific estimation on a severity scale of refractive error in school-aged children. Children located under lower percentiles at young age were more likely to have high myopia at 15 years or probably in adulthood.
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Affiliation(s)
- Yanxian Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ian G. Morgan
- Research School of Biology, Australian National University, Canberra, Australia
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria
- * E-mail:
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Wielkiewicz RM. Myopia is an Adaptive Characteristic of Vision: Not a Disease or Defect. REVIEW OF GENERAL PSYCHOLOGY 2016. [DOI: 10.1037/gpr0000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This article proposes that myopia (nearsightedness) is an adaptive characteristic of human vision. Most theories of the evolution of vision assume myopia is a disease or defect that would have resulted in decreased reproductive fitness in the absence of modern corrective lenses. In contrast, the present article argues that myopic individuals may have played important roles in hunter–gatherer groups such as making tools and weapons, and identifying medicinal plants, contributing to individual and group survival. This idea is called the “adaptive myopia hypothesis.” Evidence favoring this hypothesis is reviewed in the context of the metatheory of evolutionary psychology.
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Hua WJ, Jin JX, Wu XY, Yang JW, Jiang X, Gao GP, Tao FB. Elevated light levels in schools have a protective effect on myopia. Ophthalmic Physiol Opt 2016; 35:252-62. [PMID: 25913873 DOI: 10.1111/opo.12207] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 03/02/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE To determine whether elevated light levels in classrooms in rural areas can protect school-age children from myopia onset or myopia progression. METHODS A total of 317 subjects from 1713 eligible students aged six to 14 in four schools located in northeast China participated in the study. Students received a comprehensive eye examination including cycloplegic refraction and ocular biometry, which included axial length (AL), anterior chamber depth (ACD), and corneal curvature (CC) measurement, and completed a questionnaire. The intervention arm included 178 students in two schools with rebuilt elevated lighting systems and the control arm included 139 students in which lighting systems were unchanged. Results for the two arms were compared with a Wilcoxon rank sum test, a chi-squared test or a t-test, as appropriate. Factors that might help explain any differences were explored with multivariate linear regression analysis. RESULTS The median average illuminance of blackboards and desks and uniformity of desk lighting were significantly improved, however, the uniformity of blackboard lighting declined after intervention. At baseline, the mean refraction, AL, CC, ACD and myopia prevalence between the two arms were not significantly different. After 1 year, compared with the control arm the intervention arm had a lower incidence of new myopia onset (4% vs 10%; p = 0.029), a smaller decrease in refractive error among no myopic subjects (-0.25 dioptre [D] vs -0.47 D; p = 0.001), and shorter axial growth for both non-myopic (0.13 vs 0.18 mm; p = 0.023) and myopic subjects (0.20 vs 0.27 mm; p = 0.0001). Multivariate linear regression analysis showed the intervention program, lower hyperopic baseline refraction, lower father's education level, longer time sleeping and less time in screen-viewing activities were associated with less refractive shift in the direction of myopia in non-myopic children. For myopic subjects, myopia progression was significantly associated with family income only. The intervention program and older age had a protective effect on axial growth for both myopic and non-myopic subjects. The father's education level and sleep duration were significantly associated with axial growth in non-myopic children. CONCLUSIONS Elevated light levels in classrooms have a significant effect on myopia onset, decreases in refraction, and axial growth; if the findings of lighting intervention are reproduced in future studies, the ambient light levels in schools should be improved.
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Affiliation(s)
- Wen-Juan Hua
- School of Public Health, Anhui Medical University, Hefei, China
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McCullough SJ, O’Donoghue L, Saunders KJ. Six Year Refractive Change among White Children and Young Adults: Evidence for Significant Increase in Myopia among White UK Children. PLoS One 2016; 11:e0146332. [PMID: 26783753 PMCID: PMC4718680 DOI: 10.1371/journal.pone.0146332] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/14/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To determine six-year spherical refractive error change among white children and young adults in the UK and evaluate differences in refractive profiles between contemporary Australian children and historical UK data. Design Population-based prospective study. Participants The Northern Ireland Childhood Errors of Refraction (NICER) study Phase 1 examined 1068 children in two cohorts aged 6–7 years and 12–13 years. Prospective data for six-year follow-up (Phase 3) are available for 212 12–13 year olds and 226 18–20 year olds in each cohort respectively. Methods Cycloplegic refractive error was determined using binocular open-field autorefraction (Shin-Nippon NVision-K 5001, cyclopentolate 1%). Participants were defined by spherical equivalent refraction (SER) as myopic SER ≤-0.50D, emmetropic -0.50D<SER<+2.00 or hyperopic SER≥+2.00D. Main Outcome Measures Proportion and incidence of myopia. Results The proportion of myopes significantly increased between 6–7 years (1.9%) and 12–13 years (14.6%) (p<0.001) but not between 12–13 and 18–20 years (16.4% to 18.6%, p = 0.51). The estimated annual incidence of myopia was 2.2% and 0.7% for the younger and older cohorts respectively. There were significantly more myopic children in the UK at age 12–13 years in the NICER study (16.4%) than reported in Australia (4.4%) (p<0.001). However by 17 years the proportion of myopia neared equivalence in the two populations (NICER 18.6%, Australia 17.7%, p = 0.75). The proportion of myopic children aged 12–13 years in the present study (2006–2008) was 16.4%, significantly greater than that reported for children aged 10–16 years in the 1960’s (7.2%, p = 0.01). The proportion of hyperopes in the younger NICER cohort decreased significantly over the six year period (from 21.7% to 14.2%, p = 0.04). Hyperopes with SER ≥+3.50D in both NICER age cohorts demonstrated persistent hyperopia. Conclusions The incidence and proportion of myopia are relatively low in this contemporary white UK population in comparison to other worldwide studies. The proportion of myopes in the UK has more than doubled over the last 50 years in children aged between 10–16 years and children are becoming myopic at a younger age. Differences between the proportion of myopes in the UK and in Australia apparent at 12–13 years were eliminated by 17 years of age.
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Affiliation(s)
- Sara J. McCullough
- Biomedical Sciences Research Institute, School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine, N. Ireland, United Kingdom
- * E-mail:
| | - Lisa O’Donoghue
- Biomedical Sciences Research Institute, School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine, N. Ireland, United Kingdom
| | - Kathryn J. Saunders
- Biomedical Sciences Research Institute, School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine, N. Ireland, United Kingdom
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Affiliation(s)
- W Neil Charman
- Faculty of Life Sciences, University of Manchester, Manchester, UK
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Central Macular Thickness in Children with Myopia, Emmetropia, and Hyperopia: An Optical Coherence Tomography Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:847694. [PMID: 26167504 PMCID: PMC4475703 DOI: 10.1155/2015/847694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/17/2014] [Indexed: 12/13/2022]
Abstract
Purpose. To investigate the central macular thickness (CMT) in myopic, emmetropic, and hyperopic Chinese children using Optical Coherence Tomography. Methods. 168 right eyes of Chinese subjects aged 4–18 were divided into 3 groups based on their postcycloplegic spherical equivalent: myopes (<−1.0 D); emmetropes (≥−1.0 to ≤+1.0 D); and hyperopes (>+1.0 D) and the CMT was compared before/after age adjustment. The CMT was correlated with age, axial length, and peripapillary retinal nerve fibre layer (RNFL). Results. The mean CMT was 274.9 ± 50.3 μm and the mean population age was 7.6 ± 3.3 years. The CMT was thickest in the myopes (283.3 ± 57.3 μm, n = 56), followed by the hyperopes (266.2 ± 55.31 μm, n = 60) and then emmetropes (259.8 ± 28.7 μm, n = 52) (all P < 0.0001). When adjusted for age, myopes had a thicker CMT than the other 2 groups (all P < 0.0001) but there was no CMT difference between the emmetropes and hyperopes (P > 0.05). There was no significant correlation between CMT with age, axial length, or peripapillary RNFL (all P ≥ 0.2). Conclusion. Chinese children with myopia had a thicker CMT than those with emmetropia or hyperopia. There was no correlation of the CMT with age, axial length, or peripapillary RNFL thickness.
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Lee JWY, Yau GSK, Woo TTY, Lai JSM. The association between macular thickness and peripapillary retinal nerve fiber layer thickness in Chinese children. Medicine (Baltimore) 2015; 94:e567. [PMID: 25715254 PMCID: PMC4554147 DOI: 10.1097/md.0000000000000567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To investigate the association between macular thickness and peripapillary retinal nerve fiber layer (RNFL) thickness in Chinese children. This cross-sectional study recruited consecutive cases of healthy pediatric subjects aged 4 to 18 from Caritas Medical Centre in Hong Kong Special Administrative Region, China, from 2013 to 2014. Subjects with only eye, ocular tumors, congenital glaucoma, congenital cataract, congenital nystagmus, microphthalmos, optic nerve or retinal disease, active ocular infections, corneal scars, and severe visual impairment of any cause were excluded. Peripapillary RNFL thickness and macular thickness at 1-mm-diameter fovea center (C1), 3-mm-diameter temporal quadrant (T3), and 3-mm-diameter nasal quadrant (N3) were measured with optical coherence tomography. Best-corrected visual acuity, axial length, and cycloplegic refraction were also recorded. Spearman correlation was used to analyze the association between T3, C1, and N3 with each of the following: average and quadrant RNFL thickness, axial length, and spherical equivalent. In 179 subjects, the mean age was 7.9 ± 3.6 years. There were 90 male and 89 female subjects, all of Chinese ethnicity. The mean spherical equivalent was -0.1 ± 3.1 D and mean axial length was 22.9 ± 1.4 mm. There were significant and positive correlations of the average (T3: r = 0.20, P = 0.04; N3: r = 0.2, P = 0.005), superior (T3: r = 0.20, P = 0.03; N3: r = 0.2, P = 0.03), and inferior (T3: r = 0.20, P = 0.02; N3: r = 0.2, P = 0.01) peripapillary RNFL thicknesses with the T3 and N3 macular thicknesses but not C1. The nasal peripapillary RNFL thickness was also positively correlated with T3 (r = 0.20, P = 0.01). There were no significant associations between the macular thickness (T3, C1, N3) with neither the spherical equivalent (P > 0.2) nor the axial length (P > 0.3). The macular thickness was positive correlated with the peripapillary RNFL thickness in a population of healthy Chinese children.
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Affiliation(s)
- Jacky W Y Lee
- From the Department of Ophthalmology (JWYL, GSKY, TTYW), Caritas Medical Centre; and Department of Ophthalmology (JWYL, JMSL), University of Hong Kong, Hong Kong Special Administrative Region, China
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McMonnies CW. Clinical prediction of the need for interventions for the control of myopia. Clin Exp Optom 2014; 98:518-26. [PMID: 25346495 DOI: 10.1111/cxo.12212] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 06/23/2014] [Accepted: 07/27/2014] [Indexed: 11/27/2022] Open
Abstract
The prevalence of myopia is increasing in Western populations but in East Asian countries, it is increasing to epidemic levels, where there are also markedly increased rates of progression to pathological myopia. Measures to more effectively control the development and progression of myopia are urgently needed. Notwithstanding a large volume of research, especially regarding the different mechanisms for the development of myopia and the efficacy of particular methods of intervention, there is still a great need and scope for improvements in clinical efforts to prevent and/or control myopic progression. Too often clinical efforts may involve only one method of intervention; however, the heterogenous nature of myopia suggests that clinical intervention may be more successful when interventions are employed in combination. The decision to prescribe interventions for the control of myopia in children, especially prior to onset, may be better framed by a comprehensive estimation of the degree of risk for the development and/or progression of myopia. For example, rather than ascribing equal weight to any degree of parental myopia, more accurate estimates may be obtained, if risk is judged to increase with the degree of parental myopia and the extent of any associated degenerative pathology. Risk estimates may be limited to broad mild, moderate and severe classifications due to lack of accurate weighting of risk factors. Nevertheless, comprehensive assessment of risk factors appears likely to better inform a prognosis and discussions with parents. Consideration of numerous environmental influences, for example, such as continuity and intensity of near work and time spent outdoors, may contribute to better risk estimation. Family-based practice appears to be ideally suited for risk estimation and the clinical application of approaches to control myopia. A proactive approach to estimating risk of developing myopia prior to its onset may be beneficial. Earlier implementation of interventions to control myopia could significantly reduce the chance of progression to pathological myopia.
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Affiliation(s)
- Charles W McMonnies
- School of Optometry and Vision Science, University of New South Wales, Kensington, Australia.
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Abstract
This review is intended to summarize the current knowledge from basic science and clinical medical literature cited within PubMed that pertain to gender-related factors and affect those individuals with hereditary ocular disorders. We consider gender-related biological factors that (a) affect disease onset and progression, (b) gender differences for major X-linked ocular disorders, (c) gender-specific conditions, (d) medications that may influence genetic eye disorders, and finally, (e) gender-related issues that influence the management and quality of life of these patients. Several studies have demonstrated the manner in which sex-related hormones in animal models are capable of influencing cell pathway and survival that are likely to affect hereditary eye disorders. There are very few clinical studies that provide compelling evidence for gender differences in human ocular conditions, other than for a number of X-linked disorders. Disease expression for X-linked disorders may be impacted by genetic mechanisms such as lyonization or uniparental disomy. Clinical evidence regarding the impact of gender-related medical conditions and therapies on eye conditions is extremely limited and primarily based on anecdotal evidence. Gender-specific factors may play a major role in the underlying biological pathways that influence the onset, rate of progression, and clinical findings associated with ocular genetic conditions. Clinicians need to be aware of the variable phenotypes observed in female carriers of X-linked disorders of gender specific issues, many of which are inadequately addressed in the current literature. Clinicians need to be sensitive to gender differences in social, cultural, and religious systems and they should also be aware of how their own gender biases may influence how they counsel patients. Finally, it is clear that the lack of effective clinical studies in this area creates an opportunity for future research that will have real benefits for these patients.
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Abstract
PURPOSE To investigate the changes occurring in the axial length, choroidal thickness, and anterior biometrics of the eye during a 10-minute near task performed in downward gaze. METHODS Twenty young adult subjects (10 emmetropes and 10 myopes) participated in this study. To measure ocular biometrics in downward gaze, an optical biometer was inclined on a custom-built height- and tilt-adjustable table. Baseline measures were collected after each subject performed a distance primary gaze control task for 10 minutes to provide washout period for previous visual tasks before each of three different accommodation/gaze conditions. These other three conditions included a near task (2.5 diopters [D]) in primary gaze and a near (2.5 D) and a far (0 D) accommodative task in downward gaze (25 degrees), all for 10 minutes' duration. Immediately after and then 5 and 10 minutes from the commencement of each trial, measurements of ocular biometrics (e.g., anterior biometrics, axial length, choroidal thickness, and retinal thickness) were obtained. RESULTS Axial length increased with accommodation and was significantly greater for downward gaze with accommodation (mean ± SD change, 23 ± 13 μm at 10 minutes) compared with primary gaze with accommodation (8 ± 15 μm at 10 minutes) (p < 0.05). A small amount of choroidal thinning was also found during accommodation that was statistically significant in downward gaze (13 ± 14 μm at 10 minutes; p < 0.05). Accommodation in downward gaze also caused greater changes in anterior chamber depth and lens thickness compared with accommodation in primary gaze. CONCLUSIONS Axial length, choroidal thickness, and anterior eye biometrics change significantly during accommodation in downward gaze as a function of time. These changes seem to be caused by the combined influence of biomechanical factors (i.e., extraocular muscle forces, ciliary muscle contraction) associated with near tasks in downward gaze.
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Muhamedagic L, Muhamedagic B, Halilovic EA, Halimic JA, Stankovic A, Muracevic B. Relation between near work and myopia progression in student population. Mater Sociomed 2014; 26:100-3. [PMID: 24944532 PMCID: PMC4035135 DOI: 10.5455/msm.2014.26.100-103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 04/02/2014] [Indexed: 11/03/2022] Open
Abstract
AIM To determine relation between near work and myopia progression in student population. Causes of myopia occurrence are not sufficiently explained. METHODS This retrospective-prospective, descriptive research included 100 students with verified myopia up to -3 Dsph. Ophthalmological examination and measurement diopter-hours variable (Dh) were done twice, in the period from January 2011 until January 2012. RESULTS A multivariate regression analysis of impact on the difference of distance visual acuity without correction to the right and left eye and difference of automatic computer refractometry in cycloplegia of both eyes indicates that, diopter-hours variable (Dh) had statistically significant impact on increase of distance visual acuity difference (right eye OR: I measurement-Dh 1.489, II measurement-Dh 1.544, p<0.05; left eye OR: I measurement-Dh 1.602, II measurement-Dh 1.538, p<0.05) and automatic computer refractometry in cycloplegia (right eye OR: I measurement 1.361, II measurement 1.493, p<0.05; left eye OR: I measurement 0.931, II measurement 1.019, p<0.05) during both measurements. CONCLUSION Near work cause the increase of myopia. This research opened a perspective for other researches on the impact of near work on myopia.
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Affiliation(s)
- Lejla Muhamedagic
- Institute for Occupational and Sports Medicine of the Zenica-Doboj Canton, Zenica, Bosnia and Herzegovina
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Scheiman M, Zhang Q, Gwiazda J, Hyman L, Harb E, Weissberg E, Weise KK, Dias L. Visual activity and its association with myopia stabilisation. Ophthalmic Physiol Opt 2013; 34:353-61. [PMID: 24345071 DOI: 10.1111/opo.12111] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 11/21/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the association between outdoor and nearwork activities at baseline and myopia stabilisation by age 15 in the Correction of Myopia Evaluation Trial (COMET). METHODS Correction of Myopia Evaluation Trial enrolled 469 children (ages: 6-11 years) with spherical equivalent myopia between -1.25 and -4.50 D, who were randomised to progressive addition or single vision lenses and followed for 5 years in their original lenses. At baseline, families recorded the child's outdoor and nearwork activities for 3 days within a week. Weekly hours spent in nearwork and outdoor activities were calculated for each participant. Refractions collected over 11 years were fit using the Gompertz function to determine each participant's myopia stabilisation age. Myopia for each child was then categorized as stable/not stable by age 15. RESULTS Half (233/469) of participants had usable baseline activity diaries and refraction data that could be fit with the Gompertz function, 59.7% (139/233) had stable myopia by age 15 and 40.3% had myopia that was not yet stable. The frequency of stable myopia was similar for the two categories (median split) of outdoor activities: 60% (71/118) for ≤9.0 hours/week(-1) and 59% (68/115) for >9.0 hours/week(-1) . 56% (64/114) of children reporting >21.0 h of baseline weekly nearwork activity had stable myopia by age 15 compared to 63% (75/119) with ≤21.0 h of near work (adjusted OR = 0.74; 95% CI: 0.43-1.29). Using baseline nearwork as a continuous variable, the multivariable odds ratio for the association between baseline nearwork hours and stabilisation by age 15 is 0.98: 95% CI: 0.96-1.00, a result trending towards significance. CONCLUSION While time spent in outdoor activities in childhood does not appear to be related to myopia stabilisation by age 15, less near work activity might potentially be associated with myopia stabilisation by that age.
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Affiliation(s)
- Mitchell Scheiman
- Pennsylvania College of Optometry, Salus University, Philadelphia, USA
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Norton TT, Siegwart JT. Light levels, refractive development, and myopia--a speculative review. Exp Eye Res 2013; 114:48-57. [PMID: 23680160 PMCID: PMC3742693 DOI: 10.1016/j.exer.2013.05.004] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 04/30/2013] [Accepted: 05/02/2013] [Indexed: 11/18/2022]
Abstract
Recent epidemiological evidence in children indicates that time spent outdoors is protective against myopia. Studies in animal models (chick, macaque, tree shrew) have found that light levels (similar to being in the shade outdoors) that are mildly elevated compared to indoor levels, slow form-deprivation myopia and (in chick and tree shrew) lens-induced myopia. Normal chicks raised in low light levels (50 lux) with a circadian light on/off cycle often develop spontaneous myopia. We propose a model in which the ambient illuminance levels produce a continuum of effects on normal refractive development and the response to myopiagenic stimuli such that low light levels favor myopia development and elevated levels are protective. Among possible mechanisms, elevation of retinal dopamine activity seems the most likely. Inputs from intrinsically-photosensitive retinal ganglion cells (ipRGCs) at elevated light levels may be involved, providing additional activation of retinal dopaminergic pathways.
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Affiliation(s)
- Thomas T Norton
- Department of Vision Sciences, School of Optometry, University of Alabama at Birmingham, USA.
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French AN, Ashby RS, Morgan IG, Rose KA. Time outdoors and the prevention of myopia. Exp Eye Res 2013; 114:58-68. [PMID: 23644222 DOI: 10.1016/j.exer.2013.04.018] [Citation(s) in RCA: 210] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/20/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
Abstract
Recent epidemiological evidence suggests that children who spend more time outdoors are less likely to be, or to become myopic, irrespective of how much near work they do, or whether their parents are myopic. It is currently uncertain if time outdoors also blocks progression of myopia. It has been suggested that the mechanism of the protective effect of time outdoors involves light-stimulated release of dopamine from the retina, since increased dopamine release appears to inhibit increased axial elongation, which is the structural basis of myopia. This hypothesis has been supported by animal experiments which have replicated the protective effects of bright light against the development of myopia under laboratory conditions, and have shown that the effect is, at least in part, mediated by dopamine, since the D2-dopamine antagonist spiperone reduces the protective effect. There are some inconsistencies in the evidence, most notably the limited inhibition by bright light under laboratory conditions of lens-induced myopia in monkeys, but other proposed mechanisms possibly associated with time outdoors such as relaxed accommodation, more uniform dioptric space, increased pupil constriction, exposure to UV light, changes in the spectral composition of visible light, or increased physical activity have little epidemiological or experimental support. Irrespective of the mechanisms involved, clinical trials are now underway to reduce the development of myopia in children by increasing the amount of time they spend outdoors. These trials would benefit from more precise definition of thresholds for protection in terms of intensity and duration of light exposures. These can be investigated in animal experiments in appropriate models, and can also be determined in epidemiological studies, although more precise measurement of exposures than those currently provided by questionnaires is desirable.
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Affiliation(s)
- Amanda N French
- Discipline of Orthoptics, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW 2011, Australia
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