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Mei Z, Zhang Y, Jiang W, Lam C, Luo S, Cai C, Luo S. Efficacy of outdoor interventions for myopia in children and adolescents: a systematic review and meta-analysis of randomized controlled trials. Front Public Health 2024; 12:1452567. [PMID: 39193200 PMCID: PMC11347293 DOI: 10.3389/fpubh.2024.1452567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 07/29/2024] [Indexed: 08/29/2024] Open
Abstract
Objectives The objective of this systematic review and meta-analysis was to evaluate the overall efficacy of outdoor interventions for myopia in children and adolescents, and to provide evidence for the prevention and control of myopia. Methods Randomized controlled trials of outdoor interventions for myopia in children and adolescents were identified using electronic databases and manual searches. The Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess risk of bias in randomized controlled trials. A mean difference (MD) and a risk ratio (RR) with a 95% confidence interval (CI) were used to combine effect sizes. A sensitivity analysis was performed for each outcome using a stepwise elimination method to assess whether the pooled results were significantly affected by individual studies. Results The analysis included seven randomized controlled trials involving a total of 9,437 subjects. The meta-analysis showed marked and statistically significant improvements in spherical equivalent refraction (MD = 0.19; 95% CI 0.14 to 0.25; p < 0.01), axial length (MD = -0.09; 95% CI -0.13 to -0.05; p < 0.01), and myopia incidence (RR = 0.84; 95% CI 0.78 to 0.91; p < 0.01) following outdoor interventions. Conclusion Outdoor interventions effectively contributed to the prevention and control of myopia in children and adolescents, positively impacting spherical equivalent refraction, axial length, and myopia incidence. Outdoor interventions were characterized by low risk and high therapeutic benefits and could serve as alternative or adjuvant approaches to medication for the treatment of myopia. Considering the advantages in terms of safety and efficacy, outdoor interventions may be considered as a preferred intervention for the treatment of myopia in children and adolescents, while susceptibility to diseases associated with sunlight, particularly UV exposure, must be taken into account. Systematic review registration https://www.crd.york.ac.uk/prospero/, Identifier CRD42024538695.
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Affiliation(s)
- Zhengyang Mei
- School of Physical Education, Southwest University, Chongqing, China
| | - Yuanzhuo Zhang
- School of Physical Education, Southwest University, Chongqing, China
| | - Wenfeng Jiang
- School of Physical Education, Southwest University, Chongqing, China
| | - Chifong Lam
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China
| | - Shulai Luo
- School of Physical Education, Southwest University, Chongqing, China
| | - Chenyi Cai
- School of Physical Education, Southwest University, Chongqing, China
| | - Shi Luo
- School of Physical Education, Southwest University, Chongqing, China
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Wolf AT, Klawe J, Liu B, Ahmad S. Association Between Serum Vitamin D Levels and Myopia in the National Health and Nutrition Examination Survey (2001-2006). Ophthalmic Epidemiol 2024; 31:229-239. [PMID: 37415384 DOI: 10.1080/09286586.2023.2232460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 06/25/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To assess the relationship between serum vitamin D levels and myopia in people aged 12-50 years using the National Health and Nutrition Examination Survey (NHANES) database. METHODS Demographics, vision, and serum vitamin D levels from NHANES (2001-2006) were analyzed. Multivariate analyses were performed to examine the relationship between serum vitamin D levels and myopia while controlling for sex, age, ethnicity, education level, serum vitamin A, and poverty status. The main outcome was presence or absence of myopia, defined as a spherical equivalent of -1 diopters or more. RESULTS Of the 11669 participants, 5,310 (45.5%) had myopia. The average serum vitamin D concentration was 61.6 ± 0.9 nmol/L for the myopic group and 63.1 ± 0.8 nmol/L for the non-myopic group (p = .01). After adjusting for all covariates, having higher serum vitamin D was associated with lower odds of having myopia (odds ratio 0.82 [0.74-0.92], p = .0007). In linear regression modeling that excluded hyperopes (spherical equivalent > +1 diopters), there was a positive relationship between spherical equivalent and serum vitamin D levels. Specifically, as serum vitamin D doubled, spherical equivalent increased by 0.17 (p = .02) indicating a positive dose-response relationship between vitamin D and myopia. CONCLUSIONS Participants with myopia, on average, had lower serum concentrations of vitamin D compared to those without myopia. While further studies are needed to determine the mechanism, this study suggests that higher vitamin D levels are associated with lower incidence of myopia.
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Affiliation(s)
- Amber T Wolf
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Janek Klawe
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bian Liu
- Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sumayya Ahmad
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Eppenberger LS, Grzybowski A, Schmetterer L, Ang M. Myopia Control: Are We Ready for an Evidence Based Approach? Ophthalmol Ther 2024; 13:1453-1477. [PMID: 38710983 PMCID: PMC11109072 DOI: 10.1007/s40123-024-00951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/11/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Myopia and its vision-threatening complications present a significant public health problem. This review aims to provide an updated overview of the multitude of known and emerging interventions to control myopia, including their potential effect, safety, and costs. METHODS A systematic literature search of three databases was conducted. Interventions were grouped into four categories: environmental/behavioral (outdoor time, near work), pharmacological (e.g., atropine), optical interventions (spectacles and contact lenses), and novel approaches such as red-light (RLRL) therapies. Review articles and original articles on randomized controlled trials (RCT) were selected. RESULTS From the initial 3224 retrieved records, 18 reviews and 41 original articles reporting results from RCTs were included. While there is more evidence supporting the efficacy of low-dose atropine and certain myopia-controlling contact lenses in slowing myopia progression, the evidence about the efficacy of the newer interventions, such as spectacle lenses (e.g., defocus incorporated multiple segments and highly aspheric lenslets) is more limited. Behavioral interventions, i.e., increased outdoor time, seem effective for preventing the onset of myopia if implemented successfully in schools and homes. While environmental interventions and spectacles are regarded as generally safe, pharmacological interventions, contact lenses, and RLRL may be associated with adverse effects. All interventions, except for behavioral change, are tied to moderate to high expenditures. CONCLUSION Our review suggests that myopia control interventions are recommended and prescribed on the basis of accessibility and clinical practice patterns, which vary widely around the world. Clinical trials indicate short- to medium-term efficacy in reducing myopia progression for various interventions, but none have demonstrated long-term effectiveness in preventing high myopia and potential complications in adulthood. There is an unmet need for a unified consensus for strategies that balance risk and effectiveness for these methods for personalized myopia management.
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Affiliation(s)
- Leila Sara Eppenberger
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Andrzej Grzybowski
- University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Poznan, Poland
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemical and Biological Engineering, Nanyang Technological University, Singapore, Singapore
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
- Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore, Singapore.
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Yu CY, Dong L, Li YF, Wei WB. Vitamin D and myopia: a review. Int Ophthalmol 2024; 44:95. [PMID: 38368573 DOI: 10.1007/s10792-024-03009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 10/29/2023] [Indexed: 02/19/2024]
Abstract
Myopia is a worldwide public health problem of vision disorder caused by multiple factors, which has posed a huge socioeconomic burden, raising concerns about sight-threatening ocular complications. Vitamin D, as a kind of fat-soluble vitamin, related to time-spent-outdoors, has been considered by extensive studies to have potential relationship with myopia. We reviewed studies published in a decade which estimated the association of blood vitamin D status with myopia and summarized the universality and individuality of all research articles. Several research articles suggested the known environmental risk factors of myopia, including age, gender, ethnicity, education level, parental and school conditions, time-spent-outdoors, and sunlight exposure, and recent epidemiological studies demonstrate that increased vitamin D levels, by virtue of the extended outdoor time, may be an important modifiable factor and a protective effect that delay the progression of myopia in children and adolescents rather than in adults. The genetic studies have been conducted to get access to the evidence of gene polymorphism for explaining the association of serum vitamin D status and myopia, but the precise genetic interpretation of vitamin D and myopia remains unclear so far; on the other hand, the possible mechanisms are various like copolymerization mechanism, calcium homeostasis and imbalance of ciliary muscle function regulation, but nearly all of the investigators are inclined to remain skeptical. This article reviews the age-related epidemiological proofs, existent genetics correlations, possible underlying biological mechanisms and further values for the protective association between vitamin D and myopia, providing the possibility of prevention or postponement for myopia.
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Affiliation(s)
- Chu-Yao Yu
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, 100730, China
| | - Li Dong
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, 100730, China
| | - Yi-Fan Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, 100730, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, 100730, China.
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5
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Biswas S, El Kareh A, Qureshi M, Lee DMX, Sun CH, Lam JSH, Saw SM, Najjar RP. The influence of the environment and lifestyle on myopia. J Physiol Anthropol 2024; 43:7. [PMID: 38297353 PMCID: PMC10829372 DOI: 10.1186/s40101-024-00354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Myopia, commonly known as near-sightedness, has emerged as a global epidemic, impacting almost one in three individuals across the world. The increasing prevalence of myopia during early childhood has heightened the risk of developing high myopia and related sight-threatening eye conditions in adulthood. This surge in myopia rates, occurring within a relatively stable genetic framework, underscores the profound influence of environmental and lifestyle factors on this condition. In this comprehensive narrative review, we shed light on both established and potential environmental and lifestyle contributors that affect the development and progression of myopia. MAIN BODY Epidemiological and interventional research has consistently revealed a compelling connection between increased outdoor time and a decreased risk of myopia in children. This protective effect may primarily be attributed to exposure to the characteristics of natural light (i.e., sunlight) and the release of retinal dopamine. Conversely, irrespective of outdoor time, excessive engagement in near work can further worsen the onset of myopia. While the exact mechanisms behind this exacerbation are not fully comprehended, it appears to involve shifts in relative peripheral refraction, the overstimulation of accommodation, or a complex interplay of these factors, leading to issues like retinal image defocus, blur, and chromatic aberration. Other potential factors like the spatial frequency of the visual environment, circadian rhythm, sleep, nutrition, smoking, socio-economic status, and education have debatable independent influences on myopia development. CONCLUSION The environment exerts a significant influence on the development and progression of myopia. Improving the modifiable key environmental predictors like time spent outdoors and engagement in near work can prevent or slow the progression of myopia. The intricate connections between lifestyle and environmental factors often obscure research findings, making it challenging to disentangle their individual effects. This complexity underscores the necessity for prospective studies that employ objective assessments, such as quantifying light exposure and near work, among others. These studies are crucial for gaining a more comprehensive understanding of how various environmental factors can be modified to prevent or slow the progression of myopia.
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Affiliation(s)
- Sayantan Biswas
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Antonio El Kareh
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Mariyem Qureshi
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | | | - Chen-Hsin Sun
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Janice S H Lam
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Raymond P Najjar
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, Singapore.
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Wang B, Watt K, Chen Z, Kang P. Predicting the child who will become myopic - can we prevent onset? Clin Exp Optom 2023; 106:815-824. [PMID: 37194117 DOI: 10.1080/08164622.2023.2202306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/06/2023] [Indexed: 05/18/2023] Open
Abstract
Myopia has become a global epidemic with significant public health impacts. Identifying the child at risk of developing myopia, i.e. the pre-myopic child and implementing strategies to prevent the onset of myopia, could significantly reduce the burden of myopia on an individual and society. This paper is a review of publications that have identified ocular characteristics of children at risk of future myopia development including a lower than age normal amount of hyperopia and accelerated axial length elongation. Risk factors associated with increased risk of myopia development such as education exposure and reduced outdoor time, and strategies that could be implemented to prevent myopia onset in children are also explored. The strong causal role of education and outdoor time on myopia development suggests that lifestyle modifications could be implemented as preventative measures to at-risk children and may significantly impact the myopia epidemic by preventing or delaying myopia onset and its associated ocular health consequences.
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Affiliation(s)
- Bingjie Wang
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Kathleen Watt
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Zhi Chen
- Department of Ophthalmology, Fudan University Eye and ENT Hospital, Shanghai, China
| | - Pauline Kang
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Trier K, Cui D, Ribel-Madsen S, Guggenheim J. Oral administration of caffeine metabolite 7-methylxanthine is associated with slowed myopia progression in Danish children. Br J Ophthalmol 2023; 107:1538-1544. [PMID: 35995571 DOI: 10.1136/bjo-2021-320920] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Myopia is associated with an increased risk of permanent vision loss. The caffeine metabolite 7-methylxanthine (7-MX), licensed in Denmark since 2009 as a treatment to reduce the rate of childhood myopia progression, is the only orally administered therapy available. The purpose of the current study was to assess the rate of myopia progression in children taking 7-MX. METHODS Longitudinal cycloplegic refraction and axial length data for 711 myopic children from Denmark treated with varying doses of oral 7-MX (0-1200 mg per day) were analysed using linear mixed models. RESULTS The median age at baseline was 11.1 years (range 7.0 -15.0 years). Children were followed for an average of 3.6 years (range 0.9-9.1 years) and the average myopia progression was 1.34 dioptres (D) (range -6.50 to +0.75 D). Treatment with 7-MX was associated with a reduced rate of myopia progression (p<0.001) and axial elongation (p<0.002). Modelling suggested that, on average, an 11-year-old child taking 1000 mg 7-MX daily would develop -1.43 D of myopia over the next 6 years, compared with -2.27 D if untreated. Axial length in this child would increase by 0.84 mm over 6 years when taking a daily dose of 1000 mg of 7-MX, compared with 1.01 mm if untreated. No adverse effects of 7-MX therapy were reported. CONCLUSIONS Oral intake of 7-MX was associated with reduced myopia progression and reduced axial elongation in this sample of myopic children from Denmark. Randomised controlled trials are needed to determine whether the association is causal.
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Affiliation(s)
- Klaus Trier
- Trier Research Laboratories, Ojenlage Klaus Trier ApS, Hellerup, Denmark
| | - Dongmei Cui
- Shenzhen Eye Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Søren Ribel-Madsen
- Trier Research Laboratories, Ojenlage Klaus Trier ApS, Hellerup, Denmark
| | - Jeremy Guggenheim
- School of Optometry & Vision Sciences, Cardiff University, Cardiff, UK
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Zhang RH, Yang Q, Dong L, Li YF, Zhou WD, Wu HT, Li HY, Shao L, Zhang C, Wang YX, Wei WB. Association between vitamin D and myopia in adolescents and young adults: Evidence of national cross-sectional study. Eur J Ophthalmol 2023; 33:1883-1891. [PMID: 36866629 DOI: 10.1177/11206721231161498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE Studies have indicated that the observed association between vitamin D and myopia was confounded by time spent outdoors. This study aimed to elucidate this association using a national cross-sectional dataset. METHODS Participants with 12 to 25 years who participated in non-cycloplegic vision exam from National Health and Nutrition Examination Survey (NHANES) 2001 to 2008 were included in the present study. Myopia was defined as spherical equivalent of any eyes ≤ -0.5 diopters (D). RESULTS 7,657 participants were included. The weighted proportion of emmetropes, mild myopia, moderate myopia, and high myopia were 45.5%, 39.1%, 11.6%, and 3.8%, respectively. After adjusting for age, gender, ethnicity, TV/computer usage, and stratified by education attainment, every 10 nmol/L increment of serum 25(OH)D concentration was associated with a reduced risk of myopia (odds ratio [OR] = 0.96, 95% confidence interval [95%CI] 0.93-0.99 for any myopia; OR = 0.96, 95%CI 0.93-1.00 for mild myopia; OR = 0.99, 95%CI 0.97-1.01 for moderate myopia; OR = 0.89, 95%CI 0.84-0.95 for high myopia). Serum 25(OH)D level was closely correlated with time spent outdoors. After categorizing time spent outdoors into quarters (low, low-medium, medium-high, and high), every 1 quarter increment of time spent outdoors was associated with 2.49 nmol/L higher serum 25(OH)D concentration. After adjusting for time spent outdoors, serum 25(OH)D level did not show significant association with myopia (OR = 1.01, 95%CI 0.94-1.06 for 10 nmol/L increment). CONCLUSIONS The association between high serum vitamin D and reduced risk of myopia is confounded by longer time spent outdoors. Evidence from the present study does not support that there is a direct association between serum vitamin D level with myopia.
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Affiliation(s)
- Rui-Heng Zhang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiong Yang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Li Dong
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yi-Fan Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wen-Da Zhou
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hao-Tian Wu
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - He-Yan Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lei Shao
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chuan Zhang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ya-Xing Wang
- Beijing Institute of Ophthalmology and Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wen Bin Wei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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9
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Li Y, Hu P, Wu X, Zou Q, Liu X, Liu J, Fu Y. Association between serum vitamin D and refractive status in United States adolescents: A cross-sectional study. Front Nutr 2022; 9:1038963. [PMID: 36570139 PMCID: PMC9773557 DOI: 10.3389/fnut.2022.1038963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose We performed this study to determine the relationship between serum vitamin D levels and refractive status in adolescents aged 12-19 years. Methods Cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) database from 2001 to 2006. We used weighted multivariate linear regression models to assess the association between serum vitamin levels and adolescent refractive status and then built a smooth curve fitting to investigate their internal non-linear relationships. Finally, subgroup analysis was performed according to gender, and the threshold effect of serum vitamin D levels on spherical equivalent degree was analyzed using a two-piecewise linear regression model. Result A total of 5,901 adolescents aged 12 to 19 years were included in this study. After adjusting for all confounding factors, the multiple linear regression model showed no significant correlation between adolescent spherical equivalent degree and serum vitamin D [0.0019 (-0.0018, 0.0046)]. However, smooth curve fitting analysis showed an inverted U-shaped curve relationship between spherical equivalent degree and serum vitamin D levels in adolescents (turning point: 58.1 nmol/L). In analyses by gender subgroup, this inverted U-shaped relationship was found to be more pronounced in female adolescents (turning point: 61.6 nmol/L). Conclusion Our results suggest that the correlation between refractive status and serum vitamin D in adolescents differs by gender. When serum vitamin D concentrations were <61.6 nmol/L in female adolescents and <53.2 nmol/L in male adolescents, the spherical equivalent degree showed a positive correlation with serum vitamin D levels. However, there was no significant correlation when adolescent vitamin levels exceeded this threshold.
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Affiliation(s)
- Yanqing Li
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Pengcheng Hu
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xianhui Wu
- Department of Ophthalmology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Qian Zou
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaozhu Liu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jialing Liu
- Department of Phase I Clinical Trial Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Jialing Liu,
| | - Yuxian Fu
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China,Yuxian Fu,
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Vitamin D, the Vitamin D Receptor, Calcitriol Analogues and Their Link with Ocular Diseases. Nutrients 2022; 14:nu14112353. [PMID: 35684153 PMCID: PMC9183042 DOI: 10.3390/nu14112353] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/21/2022] Open
Abstract
The global prevalence of eye diseases continues to grow, bringing with it a reduction in the activity levels and quality of life of patients, and partial or complete blindness if left untreated. As such, there is considerable interest in identifying more effective therapeutic options and preventive agents. One such agent is vitamin D, known to have a range of anti-cancer, anti-angiogenic, anti-inflammatory and anti-oxidative properties, and whose deficiency is linked to the pathogenesis of a range of cardiovascular, cancer, and inflammatory diseases. This review presents the current stage of knowledge concerning the link between vitamin D and its receptor and the occurrence of eye disease, as well as the influence of analogues of calcitriol, an active metabolite of vitamin D. Generally, patients affected by various ocular disorders have vitamin D deficiency. In addition, previous findings suggest that vitamin D modulates the course of eye diseases and may serve as a marker, and that its supplementation could mitigate some disorders. However, as these studies have some limitations, we recommend further randomized trials to clarify the link between vitamin D and its activity with eye disease.
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Chan HN, Zhang XJ, Ling XT, Bui CHT, Wang YM, Ip P, Chu WK, Chen LJ, Tham CC, Yam JC, Pang CP. Vitamin D and Ocular Diseases: A Systematic Review. Int J Mol Sci 2022; 23:ijms23084226. [PMID: 35457041 PMCID: PMC9032397 DOI: 10.3390/ijms23084226] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
The contributory roles of vitamin D in ocular and visual health have long been discussed, with numerous studies pointing to the adverse effects of vitamin D deficiency. In this paper, we provide a systematic review of recent findings on the association between vitamin D and different ocular diseases, including myopia, age-related macular degeneration (AMD), glaucoma, diabetic retinopathy (DR), dry eye syndrome (DES), thyroid eye disease (TED), uveitis, retinoblastoma (RB), cataract, and others, from epidemiological, clinical and basic studies, and briefly discuss vitamin D metabolism in the eye. We searched two research databases for articles examining the association between vitamin D deficiency and different ocular diseases. One hundred and sixty-two studies were found. There is evidence on the association between vitamin D and myopia, AMD, DR, and DES. Overall, 17 out of 27 studies reported an association between vitamin D and AMD, while 48 out of 54 studies reported that vitamin D was associated with DR, and 25 out of 27 studies reported an association between vitamin D and DES. However, the available evidence for the association with other ocular diseases, such as glaucoma, TED, and RB, remains limited.
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Affiliation(s)
- Hei-Nga Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
| | - Xiu-Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
| | - Xiang-Tian Ling
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
| | - Christine Huyen-Trang Bui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
| | - Yu-Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong, China;
| | - Wai-Kit Chu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Li-Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Clement C. Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Jason C. Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
- Correspondence: (J.C.Y.); (C.-P.P.)
| | - Chi-Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
- Correspondence: (J.C.Y.); (C.-P.P.)
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12
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Li X, Lin H, Jiang L, Chen X, Chen J, Lu F. Low Serum Vitamin D Is Not Correlated With Myopia in Chinese Children and Adolescents. Front Med (Lausanne) 2022; 9:809787. [PMID: 35186996 PMCID: PMC8856508 DOI: 10.3389/fmed.2022.809787] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This cross-sectional study investigated the association between serum 25-hydroxyvitamin D [25(OH)D] concentration and myopia in two groups of Chinese children aged 6–14 years from different geographic and economic locations. Methods A total of 294 children from a lowland area and 89 from a highland area were enrolled as two groups of study subjects. The visual acuity, ocular biometry, and automated refraction were measured. The serum level of 25(OH)D was determined by chemiluminescence immunoassay. Near vision and outdoor exposure durations were assessed with a questionnaire interview. Data were analyzed for differences using Chi-square and Wilcoxon rank sum tests. The risk factors were evaluated using logistic regression analysis. Results We found that the serum level of 25(OH)D of the subjects from lowland area was 20.9 ng/mL which was higher than that of subjects from highland area (16.9 ng/mL). The median spherical equivalent refraction (SER) was −0.25 diopters(D) in lowland subjects and −0.63D in highland subjects. The prevalence of myopia was 45.2% in lowland subjects and 55.1% in highland subjects. The average axial length was similar, 23.6 mm and 23.1 mm in lowland and highland subjects, respectively. We found no statistical difference between the average SER and serum 25(OH)D concentration in subjects of either lowland or highland area. The ratio of myopia to non-myopia was also similar in subjects with three levels (sufficient, deficient, and insufficient) of serum 25(OH)D in these two areas. Conclusions There is no association between serum 25(OH)D concentration and myopia in the 6–14 years old Chinese children.
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Affiliation(s)
- Xiaoman Li
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Haishuang Lin
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- Wenzhou Medical University, Wenzhou, China
| | - Longfei Jiang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Xin Chen
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Jie Chen
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- *Correspondence: Jie Chen
| | - Fan Lu
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- Fan Lu
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13
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Lingham G, Mackey DA, Zhu K, Lucas RM, Black LJ, Oddy WH, Holt P, Walsh JP, Sanfilippo PG, Chan She Ping‐Delfos W, Yazar S. Time spent outdoors through childhood and adolescence - assessed by 25-hydroxyvitamin D concentration - and risk of myopia at 20 years. Acta Ophthalmol 2021; 99:679-687. [PMID: 33423400 DOI: 10.1111/aos.14709] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate the relationship between time spent outdoors, at particular ages in childhood and adolescence, and myopia status in young adulthood using serum 25-hydroxyvitamin D [25(OH)D] concentration as a biomarker of time spent outdoors. METHODS Participants of the Raine Study Generation 2 cohort had 25(OH)D concentrations measured at the 6-, 14-, 17- and 20-year follow-ups. Participants underwent cycloplegic autorefraction at age 20 years, and myopia was defined as a mean spherical equivalent -0.50 dioptres or more myopic. Logistic regression was used to analyse the association between risk of myopia at age 20 years and age-specific 25(OH)D concentrations. Linear mixed-effects models were used to analyse trajectory of 25(OH)D concentrations from 6 to 20 years. RESULTS After adjusting for sex, race, parental myopia, body mass index and studying status, myopia at 20 years was associated with lower 25(OH)D concentration at 20 years (per 10 nmol/L decrease, odds ratio (aOR)=1.10, 95% CI: 1.02, 1.18) and a low vitamin D status [25(OH)D < 50 nmol/L] at 17 years (aOR = 1.71, 95% CI: 1.06, 2.76) and 20 years (aOR = 1.71, 95% CI: 1.14, 2.56), compared to those without low vitamin D status. There were no associations between 25(OH)D at younger ages and myopia. Individuals who were myopic at 20 years had a 25(OH)D concentration trajectory that declined, relative to non-myopic peers, with increasing age. Differences in 25(OH)D trajectory between individuals with and without myopia were greater among non-Caucasians compared to Caucasians. CONCLUSIONS Myopia in young adulthood was most strongly associated with recent 25(OH)D concentrations, a marker of time spent outdoors.
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Affiliation(s)
- Gareth Lingham
- Lions Eye Institute Centre for Ophthalmology and Visual Science University of Western Australia Perth Australia
| | - David A. Mackey
- Lions Eye Institute Centre for Ophthalmology and Visual Science University of Western Australia Perth Australia
| | - Kun Zhu
- Medical School University of Western Australia Perth Australia
- Department of Endocrinology and Diabetes Sir Charles Gairdner Hospital Perth Australia
| | - Robyn M. Lucas
- Lions Eye Institute Centre for Ophthalmology and Visual Science University of Western Australia Perth Australia
- National Centre for Epidemiology and Population Health Research School of Population Health Australian National University Canberra Australia
| | | | - Wendy H. Oddy
- Menzies Institute for Medical Research University of Tasmania Hobart Australia
| | | | - John P. Walsh
- Medical School University of Western Australia Perth Australia
- Department of Endocrinology and Diabetes Sir Charles Gairdner Hospital Perth Australia
| | - Paul G. Sanfilippo
- Centre for Eye Research Australia Royal Victorian Eye and Ear Hospital University of Melbourne Melbourne Australia
| | | | - Seyhan Yazar
- Lions Eye Institute Centre for Ophthalmology and Visual Science University of Western Australia Perth Australia
- Garvan Institute of Medical Research Sydney Australia
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14
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Harb EN, Wildsoet CF. Nutritional Factors and Myopia: An Analysis of National Health and Nutrition Examination Survey Data. Optom Vis Sci 2021; 98:458-468. [PMID: 33973916 PMCID: PMC8137665 DOI: 10.1097/opx.0000000000001694] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE The rise in the prevalence of myopia, a significant worldwide public health concern, has been too rapid to be explained by genetic factors alone and thus suggests environmental influences. PURPOSE Relatively little attention has been paid to the possible role of nutrition in myopia. The availability of the large National Health and Nutrition Examination Survey data set, which includes results from vision examinations, offers the opportunity to investigate the relationship between several nutrition-related factors, including body metrics, and the presence and magnitude of myopia. METHODS Cross-sectional survey data sets with vision examination, demographic, body metrics, and nutritional data, collected as part of the National Health and Nutrition Examination Survey over the years of 2003 to 2008, were extracted for analysis. Based on already published basic and epidemiological studies, the following parameters were selected for study: body height and body mass index, demographics, serum vitamin D and glucose/insulin levels, and caffeine intake, using multivariable models and objectively measured refractive errors as the main outcome measure. RESULTS Data from a total of 6855 ethnically diverse Americans aged 12 to 25 years were analyzed. In final multivariate models, female sex and age were the most significant factors related to myopia status and refractive error. In general, body metrics (body mass index) or nutritional factors (serum vitamin D, glucose levels, and caffeine intake) were found to be associated with refractive error or myopia status; however, increased insulin levels were related to increased odds of having myopia. CONCLUSIONS These largely negative findings suggest that other environmental factors, such as those related to the visual environment, may contribute more to the development and/or progression of myopia and would argue for continued research in these areas in support of more evidence-based myopia clinical management.
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15
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Németh J, Tapasztó B, Aclimandos WA, Kestelyn P, Jonas JB, De Faber JTHN, Januleviciene I, Grzybowski A, Nagy ZZ, Pärssinen O, Guggenheim JA, Allen PM, Baraas RC, Saunders KJ, Flitcroft DI, Gray LS, Polling JR, Haarman AEG, Tideman JWL, Wolffsohn JS, Wahl S, Mulder JA, Smirnova IY, Formenti M, Radhakrishnan H, Resnikoff S. Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute. Eur J Ophthalmol 2021; 31:853-883. [PMID: 33673740 PMCID: PMC8369912 DOI: 10.1177/1120672121998960] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/04/2021] [Indexed: 12/13/2022]
Abstract
The prevalence of myopia is increasing extensively worldwide. The number of people with myopia in 2020 is predicted to be 2.6 billion globally, which is expected to rise up to 4.9 billion by 2050, unless preventive actions and interventions are taken. The number of individuals with high myopia is also increasing substantially and pathological myopia is predicted to become the most common cause of irreversible vision impairment and blindness worldwide and also in Europe. These prevalence estimates indicate the importance of reducing the burden of myopia by means of myopia control interventions to prevent myopia onset and to slow down myopia progression. Due to the urgency of the situation, the European Society of Ophthalmology decided to publish this update of the current information and guidance on management of myopia. The pathogenesis and genetics of myopia are also summarized and epidemiology, risk factors, preventive and treatment options are discussed in details.
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Affiliation(s)
- János Németh
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Beáta Tapasztó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | | | | | - Jost B Jonas
- Department of Ophthalmology, Heidelberg University, Mannheim, Germany
| | | | | | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Olavi Pärssinen
- Gerontology Research Centre and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | | | - Peter M Allen
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Rigmor C Baraas
- National Centre for Optics, Vision and Eye Care, University of South-Eastern Norway, Kongsberg, Norway
| | - Kathryn J Saunders
- Centre for Optometry and Vision Science research, Ulster University, Coleraine, UK
| | - Daniel Ian Flitcroft
- Temple Street Children’s Hospital, Dublin, Ireland
- Centre for Eye Research Ireland (CERI) Technological University Dublin, Ireland
| | | | - Jan Roelof Polling
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Optometry and Orthoptics, Hogeschool Utrecht, University of Applied Science, Utrecht, The Netherlands
| | - Annechien EG Haarman
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J Willem L Tideman
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - James Stuart Wolffsohn
- Optometry and Vision Science, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Siegfried Wahl
- Institute for Ophthalmic Research, University Tübingen, Tübingen, Germany
- Carl Zeiss Vision International GmbH, Tübingen, Germany
| | - Jeroen A Mulder
- Department of Optometry and Orthoptics, Hogeschool Utrecht, University of Applied Science, Utrecht, The Netherlands
| | | | - Marino Formenti
- Department of Physics, School of Science, University of Padova, Padova, Italy
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- Brien Holden Vision Institute, Sydney, Australia
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16
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Morgan IG, Wu PC, Ostrin LA, Tideman JWL, Yam JC, Lan W, Baraas RC, He X, Sankaridurg P, Saw SM, French AN, Rose KA, Guggenheim JA. IMI Risk Factors for Myopia. Invest Ophthalmol Vis Sci 2021; 62:3. [PMID: 33909035 PMCID: PMC8083079 DOI: 10.1167/iovs.62.5.3] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Risk factor analysis provides an important basis for developing interventions for any condition. In the case of myopia, evidence for a large number of risk factors has been presented, but they have not been systematically tested for confounding. To be useful for designing preventive interventions, risk factor analysis ideally needs to be carried through to demonstration of a causal connection, with a defined mechanism. Statistical analysis is often complicated by covariation of variables, and demonstration of a causal relationship between a factor and myopia using Mendelian randomization or in a randomized clinical trial should be aimed for. When strict analysis of this kind is applied, associations between various measures of educational pressure and myopia are consistently observed. However, associations between more nearwork and more myopia are generally weak and inconsistent, but have been supported by meta-analysis. Associations between time outdoors and less myopia are stronger and more consistently observed, including by meta-analysis. Measurement of nearwork and time outdoors has traditionally been performed with questionnaires, but is increasingly being pursued with wearable objective devices. A causal link between increased years of education and more myopia has been confirmed by Mendelian randomization, whereas the protective effect of increased time outdoors from the development of myopia has been confirmed in randomized clinical trials. Other proposed risk factors need to be tested to see if they modulate these variables. The evidence linking increased screen time to myopia is weak and inconsistent, although limitations on screen time are increasingly under consideration as interventions to control the epidemic of myopia.
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Affiliation(s)
- Ian G Morgan
- Research School of Biology, Australian National University, Canberra, ACT, Australia.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Lisa A Ostrin
- College of Optometry, University of Houston, Houston, Texas, United States
| | - J Willem L Tideman
- Department of Ophthalmology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Weizhong Lan
- Aier School of Ophthalmology, Central South University, Changsha, China.,Aier School of Optometry, Hubei University of Science and Technology, Xianning, China.,Aier Institute of Optometry and Vision Science, Aier Eye Hospital Group, Changsha, China.,Guangzhou Aier Eye Hospital, Jinan University, Guangzhou, China
| | - Rigmor C Baraas
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Xiangui He
- 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.,Shanghai Key Laboratory of Ocular Fundus Diseases, National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute Limited, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Amanda N French
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Kathryn A Rose
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Jeremy A Guggenheim
- School of Optometry & Vision Sciences, Cardiff University, Cardiff, United Kingdom
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17
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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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18
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Ramamurthy D, Lin chua SY, Saw S. A review of environmental risk factors for myopia during early life, childhood and adolescence. Clin Exp Optom 2021; 98:497-506. [DOI: 10.1111/cxo.12346] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 08/16/2015] [Accepted: 08/20/2015] [Indexed: 01/01/2023] Open
Affiliation(s)
- Dharani Ramamurthy
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,
| | | | - Seang‐mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,
- Myopia Unit, Singapore Eye Research Institute, Singapore,
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19
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Time spent outdoors in childhood is associated with reduced risk of myopia as an adult. Sci Rep 2021; 11:6337. [PMID: 33737652 PMCID: PMC7973740 DOI: 10.1038/s41598-021-85825-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
Myopia (near-sightedness) is an important public health issue. Spending more time outdoors can prevent myopia but the long-term association between this exposure and myopia has not been well characterised. We investigated the relationship between time spent outdoors in childhood, adolescence and young adulthood and risk of myopia in young adulthood. The Kidskin Young Adult Myopia Study (KYAMS) was a follow-up of the Kidskin Study, a sun exposure-intervention study of 1776 children aged 6–12 years. Myopia status was assessed in 303 (17.6%) KYAMS participants (aged 25–30 years) and several subjective and objective measures of time spent outdoors were collected in childhood (8–12 years) and adulthood. Index measures of total, childhood and recent time spent outdoors were developed using confirmatory factor analysis. Logistic regression was used to assess the association between a 0.1-unit change in the time outdoor indices and risk of myopia after adjusting for sex, education, outdoor occupation, parental myopia, parental education, ancestry and Kidskin Study intervention group. Spending more time outdoors during childhood was associated with reduced risk of myopia in young adulthood (multivariable odds ratio [OR] 0.82, 95% confidence interval [CI] 0.69, 0.98). Spending more time outdoors in later adolescence and young adulthood was associated with reduced risk of late-onset myopia (≥ 15 years of age, multivariable OR 0.79, 95% CI 0.64, 0.98). Spending more time outdoors in both childhood and adolescence was associated with less myopia in young adulthood.
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Abstract
Myopia, also known as short-sightedness or near-sightedness, is a very common condition that typically starts in childhood. Severe forms of myopia (pathologic myopia) are associated with a risk of other associated ophthalmic problems. This disorder affects all populations and is reaching epidemic proportions in East Asia, although there are differences in prevalence between countries. Myopia is caused by both environmental and genetic risk factors. A range of myopia management and control strategies are available that can treat this condition, but it is clear that understanding the factors involved in delaying myopia onset and slowing its progression will be key to reducing the rapid rise in its global prevalence. To achieve this goal, improved data collection using wearable technology, in combination with collection and assessment of data on demographic, genetic and environmental risk factors and with artificial intelligence are needed. Improved public health strategies focusing on early detection or prevention combined with additional effective therapeutic interventions to limit myopia progression are also needed.
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21
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The Association between Childhood Myopia Prevalence and Environmental Factors in China: A Metaregression Analysis. J Ophthalmol 2020. [DOI: 10.1155/2020/8736314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Myopia prevalence varies across the country among schoolchildren in China. Recently, environmental factors have been shown to be important in myopia development and progression. Given China’s geographical diversity with variable environmental factors, we investigated whether environmental factors could explain the regional variations in myopia in mainland China. Methods. We searched PubMed, Web of Science, and Chinese Science Periodical Databases for studies with reports of myopia prevalence in schoolchildren in mainland China from the years 1979 to 2019. Data on environmental factors (annual sunshine hours, temperature, and population density) were obtained from past records. A random-effect univariate metaregression analysis was used to investigate the association between the environmental factors and myopia prevalence and to determine the proportion of variation in regional myopia prevalence that can be attributed to each factor. Results. Forty-nine eligible studies were identified that included 666,864 schoolchildren aged 6 to 20 years. The pooled estimate of myopia prevalence was 32.88% (95% confidence interval: 26.69–39.08%). Univariate metaregression analysis indicated that annual sunshine hours (27.97% of variance), annual temperature (24.66%), and population density (7.06%) significantly contributed to regional myopia prevalence variation (each
), while seasonal variation in sunshine hours (1.54%,
) was not a significant predictor of myopia prevalence. However, only annual sunshine hours was significantly associated with myopia prevalence in the multivariate metaregression model. Conclusion. Myopia prevalence in children was higher in regions with low sunshine hours, and annual sunshine hours was significantly associated with regional variation in myopia prevalence in mainland China.
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Specht IO, Jacobsen N, Frederiksen P, Heitmann BL. Neonatal vitamin D status and myopia in young adult men. Acta Ophthalmol 2020; 98:500-505. [PMID: 31943811 DOI: 10.1111/aos.14349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/20/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE The prevalence of myopia is increasing worldwide, and modifiable risk factors are thus important to identify. Season of birth has been associated with later myopia risk. Neonatal vitamin D status is highly dependent on season of birth due to maternal sun exposure late in gestation. We hypothesize that prenatal exposure to low levels of vitamin D can interfere with visual development in term-born infants and that this might contribute to adult visual dysfunction. The aim of this study was thus to compare neonatal vitamin D levels from stored dried blood spots taken shortly after birth among young term-born men with myopia (cases) and random controls with emmetropia. METHODS In this case-control study, we analysed neonatal 25(OH)D3 levels of 457 myopic male cases and 1280 emmetropic male controls assessed for myopia at the mandatory Danish conscript examination. Data were analysed using logistic regression analysis and results presented as crude and adjusted for potential confounders namely maternal age, maternal ethnicity, maternal and paternal education and season of birth. RESULTS We did not observe a seasonal variation in myopia risk, neither did we observe increased odds of myopia in relation to low neonatal 25(OH)D3 levels. CONCLUSION The rapid increase in myopia does not seem related to neonatal vitamin D status.
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Affiliation(s)
- Ina Olmer Specht
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Nina Jacobsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Peder Frederiksen
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Berit L Heitmann
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, Australia.,The Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark
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23
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Chou HD, Yao TC, Huang YS, Huang CY, Yang ML, Sun MH, Chen HC, Liu CH, Chu SM, Hsu JF, Chen KJ, Hwang YS, Lai CC, Wu WC. Myopia in school-aged children with preterm birth: the roles of time spent outdoors and serum vitamin D. Br J Ophthalmol 2020; 105:468-472. [PMID: 32561534 DOI: 10.1136/bjophthalmol-2019-315663] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/13/2020] [Accepted: 05/09/2020] [Indexed: 12/18/2022]
Abstract
AIMS To analyse the factors associated with myopia in school-aged children with preterm birth and with or without retinopathy of prematurity (ROP). METHODS Children born prematurely between January 2010 and December 2011 were enrolled in this cross-sectional study when they reached school age between April 2017 and June 2018 in a referral centre. The main parameters were cycloplegic refraction, time spent outdoors and serum 25-hydroxyvitamin D (25(OH)D) concentration. RESULTS A total of 99 eyes from 99 children with a mean age of 6.8 years underwent analysis. The average time spent outdoors was significantly higher in the non-myopic group (0.9 ± 0.5 hours/day) than in the myopic group (0.7 ± 0.3 hours/day) (p = 0.032). After adjustment for age, sex, number of myopic parents, ROP severity, near-work time and serum 25(OH)D concentration, more time spent outdoors was correlated with a lower odds of myopia (OR, 0.13 per additional hour per day; 95% CI, 0.02-0.98; p = 0.048). Mean serum 25(OH)D concentrations were similar between the myopic and non-myopic groups (49.7 ± 13.6 and 48.8 ± 14.0 nmol/mL; p = 0.806) and were not correlated with spherical equivalence power (r = -0.09; p = 0.418). Vitamin D insufficiency was present in 57% of the participants. CONCLUSIONS Among preterm children with or without ROP, more time spent outdoors was associated with lower odds of myopia. The serum 25(OH)D concentration was not associated with myopia, but a high proportion of the participants had insufficient levels.
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Affiliation(s)
- Hung-Da Chou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Chieh Yao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yu-Shu Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chung-Ying Huang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Men-Ling Yang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Hui Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hsiu Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Chu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Jen-Fu Hsu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan .,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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24
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Jung BJ, Jee D. Association between serum 25-hydroxyvitamin D levels and myopia in general Korean adults. Indian J Ophthalmol 2019; 68:15-22. [PMID: 31856458 PMCID: PMC6951132 DOI: 10.4103/ijo.ijo_760_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose We performed this study to determine the association between serum 25-hydroxyvitamin D [25(OH) D] level and myopia in adults. Methods A total of 25,199 subjects aged ≥20 years were included from the National Health and Nutrition Examination Survey 2008-2012. Blood 25(OH)D levels were evaluated from blood samples. Refractive error was measured without cycloplegia. Myopia and high myopia were defined as ≥-0.50 diopters (D) and ≥-6.0 D, respectively. Other covariates such as education, physical activity, and economic status were obtained from interviews. Results Linear regression analysis showed that as 25(OH) D level increased by 1 ng/mL, myopic refractive error significantly decreased by 0.01 D (P < 0.001) after adjusting for potential confounders including sex, age, height, education level, economic status, physical activity, and sunlight exposure time. The odds ratios for myopia was 0.75 (95% Confidence interval [CI]; 0.67-0.84, P < 0.001) in the highest 25(OH) D quintile compared to the lowest quintile. The odds ratios for high myopia was 0.63 (95% CI; 0.47-0.85, P < 0.001) in the highest 25(OH)D quintile compared to the lowest quintile. Conclusion : Serum 25(OH)D level was inversely associated with myopia in Korean adults.
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Affiliation(s)
- Byung J Jung
- Department of Ophthalmology, Apgujung St. Mary's Eye Center, Seoul, Korea
| | - Donghyun Jee
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital College of Medicine, Catholic University of Korea, Suwon, Korea
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25
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Lingham G, Mackey DA, Lucas R, Yazar S. How does spending time outdoors protect against myopia? A review. Br J Ophthalmol 2019; 104:593-599. [PMID: 31722876 DOI: 10.1136/bjophthalmol-2019-314675] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/07/2019] [Accepted: 10/30/2019] [Indexed: 01/12/2023]
Abstract
Myopia is an increasingly common condition that is associated with significant costs to individuals and society. Moreover, myopia is associated with increased risk of glaucoma, retinal detachment and myopic maculopathy, which in turn can lead to blindness. It is now well established that spending more time outdoors during childhood lowers the risk of developing myopia and may delay progression of myopia. There has been great interest in further exploring this relationship and exploiting it as a public health intervention aimed at preventing myopia in children. However, spending more time outdoors can have detrimental effects, such as increased risk of melanoma, cataract and pterygium. Understanding how spending more time outdoors prevents myopia could advance development of more targeted interventions for myopia. We reviewed the evidence for and against eight facets of spending time outdoors that may protect against myopia: brighter light, reduced peripheral defocus, higher vitamin D levels, differing chromatic spectrum of light, higher physical activity, entrained circadian rhythms, less near work and greater high spatial frequency (SF) energies. There is solid evidence that exposure to brighter light can reduce risk of myopia. Peripheral defocus is able to regulate eye growth but whether spending time outdoors substantially changes peripheral defocus patterns and how this could affect myopia risk is unclear. Spectrum of light, circadian rhythms and SF characteristics are plausible factors, but there is a lack of solid evidence from human studies. Vitamin D, physical activity and near work appear unlikely to mediate the relationship between time spent outdoors and myopia.
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Affiliation(s)
- Gareth Lingham
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Robyn Lucas
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia.,National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Seyhan Yazar
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia .,Single Cell and Computational Genomics, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
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26
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Update on Myopia Risk Factors and Microenvironmental Changes. J Ophthalmol 2019; 2019:4960852. [PMID: 31781378 PMCID: PMC6875023 DOI: 10.1155/2019/4960852] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/06/2019] [Accepted: 09/05/2019] [Indexed: 12/13/2022] Open
Abstract
The focus of this update is to emphasize the recent advances in the pathogenesis and various molecular key approaches associated with myopia in order to reveal new potential therapeutic targets. We review the current evidence for its complex genetics and evaluate the known or candidate genes and loci. In addition, we discuss recent investigations regarding the role of environmental factors. This paper also covers current research aimed at elucidating the signaling pathways involved in the pathogenesis of myopia.
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27
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Ye B, Liu K, Cao S, Sankaridurg P, Li W, Luan M, Zhang B, Zhu J, Zou H, Xu X, He X. Discrimination of indoor versus outdoor environmental state with machine learning algorithms in myopia observational studies. J Transl Med 2019; 17:314. [PMID: 31533735 PMCID: PMC6751881 DOI: 10.1186/s12967-019-2057-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 09/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Wearable smart watches provide large amount of real-time data on the environmental state of the users and are useful to determine risk factors for onset and progression of myopia. We aim to evaluate the efficacy of machine learning algorithm in differentiating indoor and outdoor locations as collected by use of smart watches. METHODS Real time data on luminance, ultraviolet light levels and number of steps obtained with smart watches from dataset A: 12 adults from 8 scenes and manually recorded true locations. 70% of data was considered training set and support vector machine (SVM) algorithm generated using the variables to create a classification system. Data collected manually by the adults was the reference. The algorithm was used for predicting the location of the remaining 30% of dataset A. Accuracy was defined as the number of correct predictions divided by all. Similarly, data was corrected from dataset B: 172 children from 3 schools and 12 supervisors recorded true locations. Data collected by the supervisors was the reference. SVM model trained from dataset A was used to predict the location of dataset B for validation. Finally, we predicted the location of dataset B using the SVM model self-trained from dataset B. We repeated these three predictions with traditional univariate threshold segmentation method. RESULTS In both datasets, SVM outperformed the univariate threshold segmentation method. In dataset A, the accuracy and AUC of SVM were 99.55% and 0.99 as compared to 95.11% and 0.95 with the univariate threshold segmentation (p < 0.01). In validation, the accuracy and AUC of SVM were 82.67% and 0.90 compared to 80.88% and 0.85 with the univariate threshold segmentation method (p < 0.01). In dataset B, the accuracy and AUC of SVM and AUC were 92.43% and 0.96 compared to 80.88% and 0.85 with the univariate threshold segmentation (p < 0.01). CONCLUSIONS Machine learning algorithm allows for discrimination of outdoor versus indoor environments with high accuracy and provides an opportunity to study and determine the role of environmental risk factors in onset and progression of myopia. The accuracy of machine learning algorithm could be improved if the model is trained with the dataset itself.
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Affiliation(s)
- Bin Ye
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Kangping Liu
- Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Center for Quantitative Biology (CQB), Peking University, Beijing, China
| | - Siting Cao
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute, Sydney, NSW Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW Australia
| | - Wayne Li
- Brien Holden Vision Institute, Sydney, NSW Australia
| | - Mengli Luan
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Bo Zhang
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Jianfeng Zhu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Haidong Zou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Xiangui He
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- 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
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28
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Abstract
Refractive errors are the product of a mismatch between the axial length of the eye and its optical power, creating blurred vision. Uncorrected refractive errors are the second leading cause of worldwide blindness. One refractive error currently attracting significant scientific interest is myopia, mostly owing to the recent rise in its prevalence worldwide and associated ocular disease burden. This increase in myopia prevalence has also been rapid, suggesting environmental influences in addition to any genetic influences on eye growth. This review defines refractive errors, describes their prevalence, and presents evidence for the influence of genetic and environmental factors related to refractive error development.
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Affiliation(s)
- Elise N. Harb
- School of Optometry, University of California, Berkeley, California 94720, USA;,
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29
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Wildsoet CF, Chia A, Cho P, Guggenheim JA, Polling JR, Read S, Sankaridurg P, Saw SM, Trier K, Walline JJ, Wu PC, Wolffsohn JS. IMI - Interventions Myopia Institute: Interventions for Controlling Myopia Onset and Progression Report. Invest Ophthalmol Vis Sci 2019; 60:M106-M131. [PMID: 30817829 DOI: 10.1167/iovs.18-25958] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Myopia has been predicted to affect approximately 50% of the world's population based on trending myopia prevalence figures. Critical to minimizing the associated adverse visual consequences of complicating ocular pathologies are interventions to prevent or delay the onset of myopia, slow its progression, and to address the problem of mechanical instability of highly myopic eyes. Although treatment approaches are growing in number, evidence of treatment efficacy is variable. This article reviews research behind such interventions under four categories: optical, pharmacological, environmental (behavioral), and surgical. In summarizing the evidence of efficacy, results from randomized controlled trials have been given most weight, although such data are very limited for some treatments. The overall conclusion of this review is that there are multiple avenues for intervention worthy of exploration in all categories, although in the case of optical, pharmacological, and behavioral interventions for preventing or slowing progression of myopia, treatment efficacy at an individual level appears quite variable, with no one treatment being 100% effective in all patients. Further research is critical to understanding the factors underlying such variability and underlying mechanisms, to guide recommendations for combined treatments. There is also room for research into novel treatment options.
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Affiliation(s)
- Christine F Wildsoet
- Berkeley Myopia Research Group, School of Optometry and Vision Science Program, University of California Berkeley, Berkeley, California, United States
| | - Audrey Chia
- Singapore Eye Research Institute and Singapore National Eye Center, Singapore
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong
| | - Jeremy A Guggenheim
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Jan Roelof Polling
- Erasmus MC Department of Ophthalmology, Rotterdam, The Netherlands.,HU University of Applied Sciences, Optometry and Orthoptics, Utrecht, The Netherlands
| | - Scott Read
- School of Optometry and Vision Science and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Klaus Trier
- Trier Research Laboratories, Hellerup, Denmark
| | - Jeffrey J Walline
- The Ohio State University College of Optometry, Columbus, Ohio, United States
| | - Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - James S Wolffsohn
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
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30
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Pan M, Jiao S, Reinach PS, Yan J, Yang Y, Li Q, Srinivasalu N, Qu J, Zhou X. Opposing Effects of PPARα Agonism and Antagonism on Refractive Development and Form Deprivation Myopia in Guinea Pigs. Invest Ophthalmol Vis Sci 2019; 59:5803-5815. [PMID: 30521668 DOI: 10.1167/iovs.17-22297] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine if drug-induced peroxisome proliferator-activated receptor α (PPARα) signal pathway modulation affects refractive development and myopia in guinea pigs. Methods Pigmented guinea pigs were randomly divided into normal vision (unoccluded) and form deprivation myopia (FDM) groups. Each group received daily peribulbar injections of either a vehicle or (1) PPARα agonist, GW7647, clofibrate, or bezafibrate or (2) PPARα antagonist, GW6471, for 4 weeks. Baseline and posttreatment refraction and ocular biometric parameters were measured. Immunofluorescent staining of PPARα and two of its downstream readouts, cytosolic malic enzyme 1 (ME1) and apolipoproteinA II (apoA-II), was undertaken in selected scleral sections. Western blot analysis determined collagen type I expression levels. Results GW6471 induced a myopic shift in unoccluded eyes, but had no effect on form-deprived eyes. Conversely, GW7647 inhibited FDM progression without altering unoccluded eyes. Bezafibrate and clofibrate had effects on refraction similar to those of GW7647 in unoccluded and form-deprived eyes. GW6471 downregulated collagen type I expression in unoccluded eyes whereas bezafibrate inhibited collagen type I decreases in form-deprived eyes. GW6471 also reduced the density of ME1- and apoA-II-stained cells in unoccluded eyes whereas bezafibrate increased apoA-II-positive cell numbers in form-deprived eyes. Conclusions As GW7647 and GW6471 had opposing effects on myopia development, PPARα signaling modulation may be involved in this condition in guinea pigs. Fibrates are potential candidates for treating myopia since they reduced both FDM and the associated axial elongation. Bezafibrate also inhibited form deprivation-induced decreases in scleral collagen type I expression and the density of apoA-II expressing cells.
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Affiliation(s)
- Miaozhen Pan
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology, and Vision Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Shiming Jiao
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology, and Vision Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Peter S Reinach
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology, and Vision Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Jiaofeng Yan
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology, and Vision Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yanan Yang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology, and Vision Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Qihang Li
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology, and Vision Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Nethrajeith Srinivasalu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology, and Vision Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Jia Qu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology, and Vision Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xiangtian Zhou
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology, and Vision Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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31
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Lucas RM, Yazar S, Young AR, Norval M, de Gruijl FR, Takizawa Y, Rhodes LE, Sinclair CA, Neale RE. Human health in relation to exposure to solar ultraviolet radiation under changing stratospheric ozone and climate. Photochem Photobiol Sci 2019; 18:641-680. [PMID: 30810559 DOI: 10.1039/c8pp90060d] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Montreal Protocol has limited increases in the UV-B (280-315 nm) radiation reaching the Earth's surface as a result of depletion of stratospheric ozone. Nevertheless, the incidence of skin cancers continues to increase in most light-skinned populations, probably due mainly to risky sun exposure behaviour. In locations with strong sun protection programs of long duration, incidence is now reducing in younger age groups. Changes in the epidemiology of UV-induced eye diseases are less clear, due to a lack of data. Exposure to UV radiation plays a role in the development of cataracts, pterygium and possibly age-related macular degeneration; these are major causes of visual impairment world-wide. Photodermatoses and phototoxic reactions to drugs are not uncommon; management of the latter includes recognition of the risks by the prescribing physician. Exposure to UV radiation has benefits for health through the production of vitamin D in the skin and modulation of immune function. The latter has benefits for skin diseases such as psoriasis and possibly for systemic autoimmune diseases such as multiple sclerosis. The health risks of sun exposure can be mitigated through appropriate sun protection, such as clothing with both good UV-blocking characteristics and adequate skin coverage, sunglasses, shade, and sunscreen. New sunscreen preparations provide protection against a broader spectrum of solar radiation, but it is not clear that this has benefits for health. Gaps in knowledge make it difficult to derive evidence-based sun protection advice that balances the risks and benefits of sun exposure.
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Affiliation(s)
- R M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia. and Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - S Yazar
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia and MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | | | - M Norval
- Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - F R de Gruijl
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Y Takizawa
- Akita University School of Medicine, National Institute for Minamata Disease, Nakadai, Itabashiku, Tokyo, Japan
| | - L E Rhodes
- Centre for Dermatology Research, School of Biological Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - R E Neale
- QIMR Berghofer Institute of Medical Research, Herston, Brisbane, Australia and School of Public Health, University of Queensland, Australia
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32
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Han SB, Jang J, Yang HK, Hwang JM, Park SK. Prevalence and risk factors of myopia in adult Korean population: Korea national health and nutrition examination survey 2013-2014 (KNHANES VI). PLoS One 2019; 14:e0211204. [PMID: 30677087 PMCID: PMC6345425 DOI: 10.1371/journal.pone.0211204] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/09/2019] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To evaluate the prevalence and risk factors of myopia in adult Korean population. METHODS Population-based cross-sectional data of 3,398 subjects aged 19 to 49 years was obtained using the Korea National Health and Nutrition Examination Survey 2013-2014 (KNHANES VI). Data, including refractive errors and potential risk factors were analyzed. The prevalence and risk factors of myopia, low myopia, and high myopia-defined as a spherical equivalent (SEQ) ≤ -0.5 diopters (D), -6.0 D < SEQ <-0.5 D, and SEQ ≤ -6.0 D, respectively-were evaluated. RESULTS The prevalence of myopia and high myopia were 70.6 (standard error (SE), ±1.1)% and 8.0 (SE, ±0.6)%, respectively. In multivariable analysis, younger age, higher education (≥12 years), parental myopia, lower serum 25-hydroxyvitamin D (25(OH)D) concentration (<9 ng/mL), longer time spent on near work (≥3 hours/day), and higher white blood cell (WBC) count (5-8.9 x 103) were associated with increased prevalence of both myopia and high myopia. Serum 25(OH)D concentration of ≥ 9 ng/ml was significantly associated with decreased prevalence of high myopia in participants with near work of ≥3 hours/day, although the effect was not significant in myopia and low myopia. CONCLUSIONS The prevalence of myopia and high myopia in Korean adults was substantially high, which increased with decreasing age. In addition to parental myopia, the serum 25(OH)D concentration, near work and inflammation reflected by WBC counts may be associated with myopia.
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Affiliation(s)
- Sang Beom Han
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine, Chuncheon, Korea
| | - Jieun Jang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- * E-mail: (J-MH); (SKP)
| | - Sue K. Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- * E-mail: (J-MH); (SKP)
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Lingham G, Yazar S, Lucas RM, Walsh JP, Zhu K, Hunter M, Lim EM, Cooke BR, Mackey DA. Low 25-Hydroxyvitamin D Concentration Is Not Associated With Refractive Error in Middle-Aged and Older Western Australian Adults. Transl Vis Sci Technol 2019; 8:13. [PMID: 30697464 PMCID: PMC6348994 DOI: 10.1167/tvst.8.1.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/15/2018] [Indexed: 12/29/2022] Open
Abstract
Purpose To investigate the association between serum 25-hydroxyvitamin D (25[OH]D) concentration and refractive error in a community-based cohort of adults aged 46 to 69 years. Methods Residents of the City of Busselton in Western Australia born between 1946 and 1964 were invited to participate. Participants underwent cycloplegic autorefraction and completed questionnaires on education, occupational sun exposure, and physical activity. Blood samples were collected and serum frozen at −80°C. Serum 25[OH]D concentration was measured by immunoassay. Data on 25[OH]D were deseasonalized and multivariate models built to analyze the association between 25[OH]D concentration and spherical equivalent and myopia, defined as spherical equivalent <−0.50 D. Results After exclusions, data were available for 4112 participants. Serum 25[OH]D concentration was not associated with spherical equivalent or myopia after adjustment for confounding factors (β = −0.01, 95% confidence interval [CI]: −0.03 to −0.008, P = 0.25, and odds ratio = 1.02, 95% CI: 0.99 to 1.05, P = 0.12, respectively). When participants were classified into 25[OH]D groups of lower (<50 nmol/L), medium (≥50 to <75 nmol/L), and upper (≥75 nmol/L), the upper group had slightly greater myopic refractive error than the medium group (P = 0.02) but not the lower group, after adjustment for confounders. Conclusions There was no substantial association between 25[OH]D levels and spherical equivalent or odds of myopia in this study. The association previously noted between low serum 25[OH]D level and myopia in younger Western Australians is not evident in later adulthood. Translational Relevance This study provides further evidence suggesting that vitamin D levels are unrelated to myopia risk in adults and thus not a suitable target for myopia intervention.
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Affiliation(s)
- Gareth Lingham
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Seyhan Yazar
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Robyn M Lucas
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia.,National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - John P Walsh
- Medical School, University of Western Australia, Perth, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Kun Zhu
- Medical School, University of Western Australia, Perth, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Michael Hunter
- Busselton Population Medical Research Institute, Busselton, Australia.,School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Ee Mun Lim
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia
| | - Brian R Cooke
- PathWest Laboratory Medicine, Fiona Stanley Hospital, Perth, Australia
| | - David A Mackey
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
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Plotnikov D, Guggenheim JA. Mendelian randomisation and the goal of inferring causation from observational studies in the vision sciences. Ophthalmic Physiol Opt 2019; 39:11-25. [DOI: 10.1111/opo.12596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/10/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Denis Plotnikov
- School of Optometry & Vision Sciences Cardiff University Cardiff UK
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Prevalence of Myopia among Children Attending Pediatrics Ophthalmology Clinic at Ohud Hospital, Medina, Saudi Arabia. J Ophthalmol 2018; 2018:3708409. [PMID: 30524756 PMCID: PMC6247464 DOI: 10.1155/2018/3708409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/09/2018] [Accepted: 10/10/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Around half of the visually impaired population has uncorrected refractive errors (URE), and myopia constitutes a high proportion of them. URE should be screened and treated early to prevent long-term complications. The aim of this study was to determine the prevalence of myopia among all patients attending a pediatric outpatient clinic at Ohud Hospital in Medina, Saudi Arabia (KSA). Method This study was conducted using a convenience sample of all patients attending the clinic (1500 patients) aged between 3 and 14 years, and they were enrolled in the study during the period from May 2017 until September 2017. Result Of 1215 subjects, only 43 (3.54%) were diagnosed with myopia. Out of the study participants, 56.8% were female and the mean age was 9.7 ± 3.6. Myopia was more prevalent in male participants than female participants (n = 525, 4%, n = 690, 3.1%, p=0.5). Low myopia was the most common form among the screened individuals. The level of myopia was associated with the degree of the strabismus angle. Approximately 22% of patients with myopia had >25° strabismus angle. There was a statistically significant association with both near work indoor and outdoor activities on weekends and the level of myopia. Conclusion The prevalence of myopia among pediatrics patients in Medina is 3.54%. We hope that the results of this study will contribute to a better understanding of this public health issue in Saudi Arabia in order to implant a strict screening program for early detection and interventions to reduce the risk of further progression of visual impairment.
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Kearney S, O'Donoghue L, Pourshahidi LK, Richardson P, Laird E, Healy M, Saunders KJ. Conjunctival ultraviolet autofluorescence area, but not intensity, is associated with myopia. Clin Exp Optom 2018; 102:43-50. [PMID: 30114725 DOI: 10.1111/cxo.12825] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 07/08/2018] [Accepted: 07/12/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Conjunctival ultraviolet autofluorescence (CUVAF) has been used as a biomarker of time spent outdoors. Smaller CUVAF area is associated with myopia in southern hemisphere cohorts. Further research is required to determine if this association is replicated in northern latitudes and whether average CUVAF intensity is a valuable metric. This prospective study explored the association between myopia, CUVAF (area and intensity) and additional indicators of sun exposure (vitamin D3 and self-reported sun exposure preferences) across seasons at a location of 55° north. METHODS Young adults (age 18-20) provided blood samples biannually (March/April and September/October) over an 18-month period (four phases) for the assessment of 25-hydroxyvitamin D (25(OH)D3 ) concentrations (liquid chromatography-tandem mass spectrometry). CUVAF (total area, average intensity) and self-reported sun exposure preferences were recorded at each phase. Axial length and corneal radius were measured. Refractive error was measured by autorefractor and spherical equivalent refraction used to classify participants into refractive groups: myopic (spherical equivalent refraction ≤ -0.50 DS) or non-myopic. RESULTS Fifty-four participants (24 myopes, 30 non-myopes) participated. CUVAF area was negatively associated with the presence of myopia (odds ratio = 0.94, 95 per cent confidence interval = 0.90-0.98, p = 0.002). Myopes = 4.5 mm2 (interquartile range [IQR] 0.95-6.4 mm2 ), non-myopes = 7.0 mm2 (IQR = 2.0-10.7 mm2 ). No significant association was found between CUVAF intensity and refractive group (p = 0.17). There was no significant association between sun exposure preferences or serum concentration of 25(OH)D3 and refractive status (all p ≥ 0.21). CUVAF measures were not associated with ocular biometry measures (all p ≥ 0.084). CUVAF area was unaffected by season (all p ≥ 0.45) and variations in CUVAF area over the study period did not exceed the repeatability of the measurement technique. CONCLUSION Myopia was associated with smaller areas of CUVAF indicative of less cumulative ultraviolet-B exposure. These findings suggest that CUVAF measures are a useful, non-invasive biomarker of the time spent outdoors in adults in northern hemisphere populations.
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Affiliation(s)
- Stephanie Kearney
- Department of Optometry and Vision Science, Optometry and Vision Science Research Group, University of Ulster, Coleraine, UK
| | - Lisa O'Donoghue
- Department of Optometry and Vision Science, Optometry and Vision Science Research Group, University of Ulster, Coleraine, UK
| | - Laura K Pourshahidi
- Department of Biomedical Sciences, Nutrition Innovation Centre for Food and Health, University of Ulster, Coleraine, UK
| | - Patrick Richardson
- Department of Optometry and Vision Science, Optometry and Vision Science Research Group, University of Ulster, Coleraine, UK
| | - Eamon Laird
- Department of Biochemistry and Immunology, Trinity College Dublin, Dublin, Ireland
| | - Martin Healy
- School of Medicine, Trinity College Dublin, Dublin, Ireland.,Department of Biochemistry, St James's Hospital, Dublin, Ireland
| | - Kathryn J Saunders
- Department of Optometry and Vision Science, Optometry and Vision Science Research Group, University of Ulster, Coleraine, UK
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Cuellar-Partida G, Williams KM, Yazar S, Guggenheim JA, Hewitt AW, Williams C, Wang JJ, Kho PF, Saw SM, Cheng CY, Wong TY, Aung T, Young TL, Tideman JWL, Jonas JB, Mitchell P, Wojciechowski R, Stambolian D, Hysi P, Hammond CJ, Mackey DA, Lucas RM, MacGregor S. Genetically low vitamin D concentrations and myopic refractive error: a Mendelian randomization study. Int J Epidemiol 2018; 46:1882-1890. [PMID: 28586461 DOI: 10.1093/ije/dyx068] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2017] [Indexed: 01/08/2023] Open
Abstract
Background Myopia prevalence has increased in the past 20 years, with many studies linking the increase to reduced time spent outdoors. A number of recent observational studies have shown an inverse association between vitamin D [25(OH)D] serum levels and myopia. However, in such studies it is difficult to separate the effects of time outdoors and vitamin D levels. In this work we use Mendelian randomization (MR) to assess if genetically determined 25(OH)D levels contribute to the degree of myopia. Methods We performed MR using results from a meta-analysis of refractive error (RE) genome-wide association study (GWAS) that included 37 382 and 8 376 adult participants of European and Asian ancestry, respectively, published by the Consortium for Refractive Error And Myopia (CREAM). We used single nucleotide polymorphisms (SNPs) in the DHCR7, CYP2R1, GC and CYP24A1 genes with known effects on 25(OH)D concentration as instrumental variables (IV). We estimated the effect of 25(OH)D on myopia level using a Wald-type ratio estimator based on the effect estimates from the CREAM GWAS. Results Using the combined effect attributed to the four SNPs, the estimate for the effect of 25(OH)D on refractive error was -0.02 [95% confidence interval (CI) -0.09, 0.04] dioptres (D) per 10 nmol/l increase in 25(OH)D concentration in Caucasians and 0.01 (95% CI -0.17, 0.19) D per 10 nmol/l increase in Asians. Conclusions The tight confidence intervals on our estimates suggest the true contribution of vitamin D levels to degree of myopia is very small and indistinguishable from zero. Previous findings from observational studies linking vitamin D levels to myopia were likely attributable to the effects of confounding by time spent outdoors.
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Affiliation(s)
- Gabriel Cuellar-Partida
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,University of Queensland Diamantina Institute, Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Katie M Williams
- Department of Ophthalmology.,Department of Ophthalmology and Twin Research, King's College London, London, UK
| | - Seyhan Yazar
- Lions Eye Institute, University of Western Australia, Perth, WA, Australia
| | | | - Alex W Hewitt
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - Cathy Williams
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jie Jin Wang
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW, Australia
| | - Pik-Fang Kho
- Department of Epidemiology, QIMR Berghofer Medical Research Institute, Brisbane, QLD,Australia
| | - Seang Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Terri L Young
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - J Willem L Tideman
- Department of Ophthalmology and Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jost B Jonas
- Beijing Institute of Ophthalmology, Capital University of Medical Science, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China.,Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Seegartenklinik Heidelberg, Germany
| | | | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW, Australia
| | | | - Dwight Stambolian
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Pirro Hysi
- Department of Ophthalmology and Twin Research, King's College London, London, UK
| | - Christopher J Hammond
- Department of Ophthalmology.,Department of Ophthalmology and Twin Research, King's College London, London, UK
| | - David A Mackey
- Lions Eye Institute, University of Western Australia, Perth, WA, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Stuart MacGregor
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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Tang SM, Lau T, Rong SS, Yazar S, Chen LJ, Mackey DA, Lucas RM, Pang CP, Yam JC. Vitamin D and its pathway genes in myopia: systematic review and meta-analysis. Br J Ophthalmol 2018; 103:8-17. [PMID: 30018147 DOI: 10.1136/bjophthalmol-2018-312159] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of the association of blood vitamin D (25-hydroxyvitamin D, 25(OH)D) concentration and vitamin D pathway genes with myopia. METHODS We searched the MEDLINE and EMBASE databases for studies published up to 29 January 2018. Cross-sectional or cohort studies which evaluated the blood 25(OH)D concentration, blood 25(OH)D3 concentration or vitamin D pathway genes, in relation to risk of myopia or refractive errors were included. Standard mean difference (SMD) of blood 25(OH)D concentrations between the myopia and non-myopia groups was calculated. The associations of blood 25(OH)D concentrations and polymorphisms in vitamin D pathway genes with myopia using summary ORs were evaluated. RESULTS We summarised seven studies involving 25 008 individuals in the meta-analysis. The myopia group had lower 25(OH)D concentration than the non-myopia group (SMD=-0.27 nmol/L, p=0.001). In the full analysis, the risk of myopia was inversely associated with blood 25(OH)D concentration after adjusting for sunlight exposure or time spent outdoors (adjusted odds ratio (AOR)=0.92 per 10 nmol/L, p<0.0001). However, the association was not statistically significant for the <18 years subgroup (AOR=0.91 per 10 nmol/L, p=0.13) and was significant only for 25(OH)D3 (likely to be mainly sunlight derived), but not total 25(OH)D (AOR=0.93 per 10 nmol/L, p=0.00007; AOR=0.91 per 10 nmol/L, p=0.15). We analysed four single nucleotide polymorphisms in the VDR gene from two studies; there was no significant association with myopia. CONCLUSIONS Lower 25(OH)D is associated with increased risk of myopia; the lack of a genetic association suggests that 25(OH)D level may be acting as a proxy for time outdoors.
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Affiliation(s)
- Shu Min Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Tiffany Lau
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Shi Song Rong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Seyhan Yazar
- Centre for Ophthalmology and Vision Science, University of Western Australia and the Lions Eye Institute, Perth, Western Australia, Australia
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - David A Mackey
- Centre for Ophthalmology and Vision Science, University of Western Australia and the Lions Eye Institute, Perth, Western Australia, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Hwang HS, Chun MY, Kim JS, Oh B, Yoo SH, Cho BJ. Risk Factors for High Myopia in Koreans: The Korea National Health and Nutrition Examination Survey. Curr Eye Res 2018; 43:1052-1060. [DOI: 10.1080/02713683.2018.1472286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ho Sik Hwang
- Department of Ophthalmology, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Min Young Chun
- Department of Global Medical Science, Sungshin Women’s University, Seoul, Korea
| | - Jin Sun Kim
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Bumjo Oh
- Department of Family Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Sang Ho Yoo
- Department of Medical Humanities and Ethics, Hanyang University College of Medicine, Seoul, Korea
| | - Bum-Joo Cho
- Department of Ophthalmology, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
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Chakraborty R, Ostrin LA, Nickla DL, Iuvone PM, Pardue MT, Stone RA. Circadian rhythms, refractive development, and myopia. Ophthalmic Physiol Opt 2018; 38:217-245. [PMID: 29691928 PMCID: PMC6038122 DOI: 10.1111/opo.12453] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/11/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Despite extensive research, mechanisms regulating postnatal eye growth and those responsible for ametropias are poorly understood. With the marked recent increases in myopia prevalence, robust and biologically-based clinical therapies to normalize refractive development in childhood are needed. Here, we review classic and contemporary literature about how circadian biology might provide clues to develop a framework to improve the understanding of myopia etiology, and possibly lead to rational approaches to ameliorate refractive errors developing in children. RECENT FINDINGS Increasing evidence implicates diurnal and circadian rhythms in eye growth and refractive error development. In both humans and animals, ocular length and other anatomical and physiological features of the eye undergo diurnal oscillations. Systemically, such rhythms are primarily generated by the 'master clock' in the surpachiasmatic nucleus, which receives input from the intrinsically photosensitive retinal ganglion cells (ipRGCs) through the activation of the photopigment melanopsin. The retina also has an endogenous circadian clock. In laboratory animals developing experimental myopia, oscillations of ocular parameters are perturbed. Retinal signaling is now believed to influence refractive development; dopamine, an important neurotransmitter found in the retina, not only entrains intrinsic retinal rhythms to the light:dark cycle, but it also modulates refractive development. Circadian clocks comprise a transcription/translation feedback control mechanism utilizing so-called clock genes that have now been associated with experimental ametropias. Contemporary clinical research is also reviving ideas first proposed in the nineteenth century that light exposures might impact refraction in children. As a result, properties of ambient lighting are being investigated in refractive development. In other areas of medical science, circadian dysregulation is now thought to impact many non-ocular disorders, likely because the patterns of modern artificial lighting exert adverse physiological effects on circadian pacemakers. How, or if, such modern light exposures and circadian dysregulation contribute to refractive development is not known. SUMMARY The premise of this review is that circadian biology could be a productive area worthy of increased investigation, which might lead to the improved understanding of refractive development and improved therapeutic interventions.
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Affiliation(s)
- Ranjay Chakraborty
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | | | | | - Machelle T. Pardue
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Decatur
| | - Richard A. Stone
- University of Pennsylvania School of Medicine, Philadelphia, USA
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Abstract
PURPOSE To systematically review epidemiologic and laboratory studies on the etiology of high myopia and its links to pathologic myopia. METHODS Regular Medline searches have been performed for the past 20 years, using "myopia" as the basic search term. The abstracts of all articles have been scrutinized for relevance, and where necessary, translations of articles in languages other than English were obtained. RESULTS Systematic review shows that there is an epidemic of myopia and high myopia in young adults in East and Southeast Asia, with similar but smaller trends in other parts of the world. This suggests an impending epidemic of pathologic myopia. High myopia in young adults in East and Southeast Asia is now predominantly associated with environmental factors, rather than genetic background. Recent clinical trials show that the onset of myopia can be reduced by increasing the time children spend outdoors, and methods to slow the progression of myopia are now available. CONCLUSION High myopia is now largely associated with environmental factors that have caused the epidemic of myopia in East and Southeast Asia. An important clinical question is whether the pathologic consequences of acquired high myopia are similar to those associated with classic genetic high myopia. Increased time outdoors can be used to slow the onset of myopia, whereas methods for slowing progression are now available clinically. These approaches should enable the current epidemics of myopia and high myopia to be turned around, preventing an explosion of pathologic myopia.
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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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Rey-Rodríguez DV, Álvarez-Peregrina C, Moreno-Montoya J. Prevalencia y factores asociados a miopía en jóvenes. REVISTA MEXICANA DE OFTALMOLOGÍA 2017. [DOI: 10.1016/j.mexoft.2016.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
Epidemiological studies have demonstrated that spending time outdoors during your childhood is protective against the development of myopia. It has been hypothesized that this protective effect is associated with light-induced increases in retinal dopamine levels, a critical neuromodulator that has long been postulated to be involved in the regulation of ocular growth. This paper, along with the paper entitled "What do animal studies tell us about the mechanism of myopia-protection by light?" discusses the evidence provided by animal models for this hypothesis.
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Shah RL, Huang Y, Guggenheim JA, Williams C. Time Outdoors at Specific Ages During Early Childhood and the Risk of Incident Myopia. Invest Ophthalmol Vis Sci 2017; 58:1158-1166. [PMID: 28245296 PMCID: PMC5341622 DOI: 10.1167/iovs.16-20894] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose Time outdoors during childhood is negatively associated with incident myopia. Consequently, additional time outdoors has been suggested as a public health intervention to reduce the prevalence of myopia. We investigated whether there were specific ages during early childhood when the time outdoors versus incident myopia association was strongest. Methods Children participating in the Avon Longitudinal Study of Parents and Children (ALSPAC) were studied from age 2 to 15 years. Parentally reported time outdoors and time spent reading were assessed longitudinally in early childhood (ages 2, 3, 4, 5, 7, and 9 years). Noncycloplegic autorefraction was carried out longitudinally in later childhood (ages 10, 11, 12, and 15 years). Information was available for 2833 participants. Cox proportional hazards regression was used to test for association between time outdoors and incident myopia. Results From 3 years of age onward, greater time outdoors was associated with a reduced risk of incident myopia. The hazard ratio for myopia changed progressively from 0.90 (95% CI 0.83–0.98, P = 0.012) at age 3 years, to 0.86 (95% CI 0.78–0.93, P = 0.001) at age 9 years, for each additional SD of time spent outdoors per day. These associations were independent of two major risk factors for myopia: time reading and number of myopic parents. Conclusions Additional time spent outdoors across the 3 to 9 years age range was associated with a reduced incidence of myopia between ages 10 and 15 years. There was a trend for the association to increase toward the older end of the 3 to 9 years range.
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Affiliation(s)
- Rupal L Shah
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Yu Huang
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom 2School of Optometry, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Jeremy A Guggenheim
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Cathy Williams
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Bio-environmental factors associated with myopia: An updated review. ACTA ACUST UNITED AC 2017; 92:307-325. [PMID: 28162831 DOI: 10.1016/j.oftal.2016.11.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/27/2016] [Accepted: 11/29/2016] [Indexed: 12/12/2022]
Abstract
Experimental studies in animals, as well as observational and intervention studies in humans, seem to support the premise that the development of juvenile myopia is promoted by a combination of the effect of genetic and environmental factors, with a complex interaction between them. The very rapid increase in myopia rates in some parts of the world, such as Southeast Asia, supports a significant environmental effect. Several lines of evidence suggest that humans might respond to various external factors, such as increased activity in near vision, increased educational pressure, decreased exposure to sunlight outdoors, dietary changes (including increased intake of carbohydrates), as well as low light levels indoors. All these factors could be associated with a higher prevalence of myopia.
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Rose KA, French AN, Morgan IG. Environmental Factors and Myopia: Paradoxes and Prospects for Prevention. Asia Pac J Ophthalmol (Phila) 2017; 5:403-410. [PMID: 27898443 DOI: 10.1097/apo.0000000000000233] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The prevalence of myopia in developed countries in East and Southeast Asia has increased to more than 80% in children completing schooling, whereas that of high myopia has increased to 10%-20%. This poses significant challenges for correction of refractive errors and the management of pathological high myopia. Prevention is therefore an important priority. Myopia is etiologically heterogeneous, with a low level of myopia of clearly genetic origins that appears without exposure to risk factors. The big increases have occurred in school myopia, driven by increasing educational pressures in combination with limited amounts of time spent outdoors. The rise in prevalence of high myopia has an unusual pattern of development, with increases in prevalence first appearing at approximately age 11. This pattern suggests that the increasing prevalence of high myopia is because of progression of myopia in children who became myopic at approximately age 6 or 7 because age-specific progression rates typical of East Asia will take these children to the threshold for high myopia in 5 to 6 years. This high myopia seems to be acquired, having an association with educational parameters, whereas high myopia in previous generations tended to be genetic in origin. Increased time outdoors can counter the effects of increased nearwork and reduce the impact of parental myopia, reducing the onset of myopia, and this approach has been validated in 3 randomized controlled trials. Other proposed risk factors need further work to demonstrate that they are independent and can be modified to reduce the onset of myopia.
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Affiliation(s)
- Kathryn Ailsa Rose
- From the *Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales; †Research School of Biology, Australian National University, Canberra, Australian Capital Territory, Australia; and ‡State Key Laboratory of Ophthalmology and Division of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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