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Kneepkens SCM, de Vlieger J, Tideman JWL, Enthoven CA, Polling JR, Klaver CCW. Myopia risk behaviour related to the COVID-19 lockdown in Europe: The generation R study. Ophthalmic Physiol Opt 2023; 43:402-409. [PMID: 36772877 DOI: 10.1111/opo.13100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE To battle the spreading of the COVID-19 virus, nationwide lockdowns were implemented during 2020 and 2021. Reports from China revealed that their strict home confinements led to an increase in myopia incidence. The Netherlands implemented a more lenient lockdown, which allowed children to go outside. We evaluated the association between COVID-19 restrictions, myopia risk behaviour and myopia progression in Dutch teenagers. METHOD A total of 1101 participants (mean age 16.3 ± 3.65 yrs) completed questionnaires about their activities before, during and after lockdown (March-October 2020). We used a repeated-measures ANOVA to compare time use between these time periods. Ocular measurements were acquired before the COVID-19 pandemic when participants were 13 years old; only 242 participants had ocular measurements at 18 years of age at the time of this analysis. Linear regression analyses were used to evaluate the association between lifestyle factors and myopia progression. RESULTS Children were on average 16.2 (1.03) years of age during lockdown. Total nearwork increased from 8.11 h/day to 11.79 h/day, and remained higher after lockdown at 9.46 h/day (p < 0.001). Non-educational nearwork increased by 2.22 h/day (+49%) during lockdown and was associated with faster axial length progression (B 0.002 mm/h/year; SE 0.001 p = 0.03). Before and during lockdown, the mean time spent outdoors was similar (1.78 h/day and 1.80 h/day, respectively). After lockdown, time spent outdoors decreased to 1.56 h/day (p < 0.001). CONCLUSION The Dutch lockdown significantly increased digitised nearwork in adolescents but did not affect outdoor exposure. The changes in time spent performing nearwork remained after the lockdown measures had ended. We expect that the COVID-19 pandemic may lead to an increase in myopia prevalence and progression in European children.
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Affiliation(s)
- Sander C M Kneepkens
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jimmy de Vlieger
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J Willem L Tideman
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,Martini Hospital, Groningen, The Netherlands
| | - Clair A Enthoven
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Psychology, Education and Child Studies, Erasmus University, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Roelof Polling
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,University of Applied Sciences, Utrecht, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Radboud University Medical Center, Nijmegen, The Netherlands.,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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Enthoven CA, El Marroun H, Koopman-Verhoeff ME, Jansen W, Lambregtse-van den Berg MP, Sondeijker F, Hillegers MHJ, Bijma HH, Jansen PW. Clustering of characteristics associated with unplanned pregnancies: the generation R study. BMC Public Health 2022; 22:1957. [PMID: 36274127 PMCID: PMC9590126 DOI: 10.1186/s12889-022-14342-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Unplanned or unintended pregnancies form a major public health concern because they are associated with unfavorable birth outcomes as well as social adversity, stress and depression among parents-to-be. Several risk factors for unplanned pregnancies in women have previously been identified, but studies usually take a unidimensional approach by focusing on only one or few factors, disregarding the possibility that predictors might cluster. Furthermore, data on predictors in men are largely overlooked. The purpose of this study is to determine predictors of unplanned versus planned pregnancy, to determine predictors of ambivalent feelings regarding pregnancy, and to investigate how characteristics of men and women with an unplanned pregnancy cluster together. Methods This study was embedded in Generation R, a multiethnic population-based prospective cohort from fetal life onwards. Pregnancy intention was reported by 7702 women and 5367 partners. Information on demographic, mental, physical, social, and sexual characteristics was obtained. Logistic regression, multinomial regression and cluster analyses were performed to determine characteristics that were associated with an unplanned pregnancy, with ambivalent feelings regarding the unplanned pregnancy and the co-occurrence of characteristics in women and men with unplanned pregnancy. Results Twenty nine percent of the pregnancies were unplanned. Logistic regression analyses showed that 42 of 44 studied predictors were significantly associated with unplanned pregnancy. The most important predictors were young age, migration background, lower educational level, lower household income, financial difficulties, being single, lower cognitive ability, drug use prior to pregnancy, having multiple sexual partners in the year prior to the pregnancy, younger age of first sexual contact and a history of abortion. Multinomial regression analyses showed that a Turkish or Moroccan background, Islamic religion, little financial opportunities, being married, having ≥3 children, high educational level, more mental health and social problems and older age of first sexual contact were associated with prolonged ambivalent feelings regarding pregnancy. Different combinations of characteristics were observed in the four clusters of women and men with unplanned pregnancy. Conclusions Many predictors are related with unplanned pregnancies, ambivalent feelings toward the pregnancy, and we identified very heterogeneous groups of women and men with unplanned pregnancies. This calls for heterogeneous measures to prevent unplanned pregnancies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14342-y.
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Affiliation(s)
- Clair A. Enthoven
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, Zuid-Holland The Netherlands ,grid.6906.90000000092621349Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Zuid-Holland The Netherlands ,grid.5645.2000000040459992XThe Generation R Study Group, Erasmus University Medical Center, Rotterdam, Zuid-Holland The Netherlands
| | - Hanan El Marroun
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, Zuid-Holland The Netherlands ,grid.6906.90000000092621349Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Zuid-Holland The Netherlands
| | - M. Elisabeth Koopman-Verhoeff
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, Zuid-Holland The Netherlands ,grid.5645.2000000040459992XThe Generation R Study Group, Erasmus University Medical Center, Rotterdam, Zuid-Holland The Netherlands ,grid.5132.50000 0001 2312 1970Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - Wilma Jansen
- Department of Social Development, Rotterdam, Zuid-Holland The Netherlands ,grid.5645.2000000040459992XDepartment of Public Health, Erasmus University Medical Center, Rotterdam, Zuid-Holland The Netherlands
| | - Mijke P. Lambregtse-van den Berg
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, Zuid-Holland The Netherlands ,grid.5645.2000000040459992XDepartment of Psychiatry, Erasmus University Medical Center, Rotterdam, Zuid-Holland The Netherlands
| | - Frouke Sondeijker
- grid.426562.10000 0001 0709 4781Department of Youth, parenting and education, Verwey-Jonker institute, Utrecht, The Netherlands
| | - Manon H. J. Hillegers
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, Zuid-Holland The Netherlands
| | - Hilmar H. Bijma
- grid.416135.40000 0004 0649 0805Department of Obstetrics and Gynecology, Division of Obstetrics and Fetal Medicine, Erasmus MC Sophia, Rotterdam, the Netherlands
| | - Pauline W. Jansen
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, Zuid-Holland The Netherlands ,grid.6906.90000000092621349Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Zuid-Holland The Netherlands
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Iyer V, Enthoven CA, van Dommelen P, van Samkar A, Groenewoud JH, Jaddoe VVW, Reijneveld SA, Klaver CCW. Rates of spectacle wear in early childhood in the Netherlands. BMC Pediatr 2022; 22:409. [PMID: 35820880 PMCID: PMC9275042 DOI: 10.1186/s12887-022-03467-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background Refractive errors are relatively common all around the world. In particular, early onset myopia is associated with a significant burden in later life. Little is known about refractive errors in preschool children. The aim of this study was to assess the prevalence of spectacle wear, visual acuity and refractive errors in young Dutch children. Methods We analyzed data of three prospective population-based studies: 99,660 3- to 5-year-olds undergoing vision screening at preventive child healthcare organizations, 6934 6-year-olds from the Generation R study, and 2974 7-year-olds from the RAMSES study. Visual acuity was measured with Landolt-C or LEA charts, spectacle wear was assessed, and refractive errors at age 6 and 7 were measured with cycloplegic refraction. Results The prevalence of spectacle wear ranged from 1.5 to 11.8% between 3 to 7 years with no significant gender differences. Among children with spectacle wear at 6 years (N = 583) and 7 years (N = 350) 29.8 and 34.6% had myopia respectively, of which 21.1 and 21.6% combined with astigmatism; 19.6 and 6.8% had hyperopia, 37.2 and 11.1% hyperopia and astigmatism, and 12.5 and 32.7% astigmatism only. Conclusions Spectacle wear in European children starts early in preschool and increases to a relatively frequent visual aid at school age. Advocating early detection and monitoring of refraction errors is warranted in order to prevent visual morbidities later in life. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03467-z.
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Affiliation(s)
- Vasanthi Iyer
- Department of Child Health, TNO, PO Box 3005, Leiden, 2301DA, The Netherlands
| | - Clair A Enthoven
- Department of Ophthalmology, Erasmus Medical Center, Postbus 2040, Rotterdam, 3000CA, The Netherlands.,Department of Epidemiology, Erasmus Medical Center, Postbus 2040, Rotterdam, 3000CA, The Netherlands.,The Generation R Study Group, Erasmus Medical Center, Postbus 2040, Rotterdam, 3000CA, The Netherlands
| | - Paula van Dommelen
- Department of Child Health, TNO, PO Box 3005, Leiden, 2301DA, The Netherlands
| | - Ashwin van Samkar
- Resident in Elderly Medicine, Omring, Azalealaan 18, Lutjebroek, 1614SN, The Netherlands
| | | | - Vincent V W Jaddoe
- The Generation R Study Group, Erasmus Medical Center, Postbus 2040, Rotterdam, 3000CA, The Netherlands
| | - Sijmen A Reijneveld
- Department of Child Health, TNO, PO Box 3005, Leiden, 2301DA, The Netherlands.,Department of Health Sciences, University Medical Center Groningen, University of Groningen, Postbus 30.001, Groningen, 9700RB, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, Postbus 2040, Rotterdam, 3000CA, The Netherlands. .,Department of Epidemiology, Erasmus Medical Center, Postbus 2040, Rotterdam, 3000CA, The Netherlands. .,Department of Ophthalmology, Radboudumc, Postbus 9101, Nijmegen, 6500HB, The Netherlands. .,Institute of Molecular and Clinical Ophthalmology, Mittlere Street 91, 4056, Basel, Switzerland.
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Haarman AEG, Tedja MS, Brussee C, Enthoven CA, van Rijn GA, Vingerling JR, Keunen JEE, Boon CJF, Geerards AJM, Luyten GPM, Verhoeven VJM, Klaver CCW. Prevalence of Myopic Macular Features in Dutch Individuals of European Ancestry With High Myopia. JAMA Ophthalmol 2021; 140:115-123. [PMID: 34913968 PMCID: PMC8678902 DOI: 10.1001/jamaophthalmol.2021.5346] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Question What is the prevalence of myopic macular degeneration in Dutch individuals of European ancestry with high myopia? Findings In this cross-sectional study of 626 individuals with European ancestry with high myopia, the prevalence of myopic macular degeneration was 25.9% and increased with older age, lower spherical equivalent of refractive error, and higher axial length. Meaning Myopic retinal features were frequent in this highly myopic study population, but not different than patients of Asian ancestry with similar risk profiles. Importance High myopia incidence and prevalence is increasing worldwide, and the visual burden caused by myopia is expected to rise accordingly. Studies investigating the occurrence of myopic complications in individuals of European ancestry with high myopia are scarce, hampering insights into the frequency of myopic retinal complications in European individuals and their visual burden. Objective To assess the frequency of myopic macular features in individuals of European ancestry with high myopia. Design, Setting, and Participants This cross-sectional analysis of the Dutch Myopia Study (MYST) and individuals with high myopia from the Rotterdam Study (RS) included 626 patients with high myopia (spherical equivalent of refractive error [SER] ≤−6 diopters [D] or axial length [AL] ≥26 mm) who underwent an extensive ophthalmic examination including multimodal retinal imaging. In addition to this combination of a population-based cohort study and mix-based high myopia study, a systematic literature review was also performed to compare findings with studies of individuals of Asian ancestry. Exposures High myopia, age, and AL. Main Outcomes and Measures Frequency of myopic macular and optic disc features: tessellated fundus, myopic macular degeneration (MMD), staphyloma, peripapillary intrachoroidal cavitation, peripapillary atrophy (PPA), and “plus” lesions (choroidal neovascularization, Fuchs spot, and lacquer cracks). Results The mean (SD) SER of the combined study population (MYST and RS) was −9.9 (3.2) D; the mean (SD) age was 51.4 (15.1) years, and 387 (61.8%) were women. The prevalence of MMD was 25.9% and increased with older age (P for trend <.001), lower SER (odds ratio [OR], 0.70; 95% CI, 0.65-0.76; P < .001), and higher AL (OR, 2.53; 95% CI, 2.13-3.06; P < .001). Choroidal neovascularization or Fuchs spot was present in 2.7% (n = 17), both lesions in 0.3% (n = 2), and lacquer cracks in 1.4% (n = 9). Staphyloma, PPA, and MMD were highly prevalent in visual impaired and blind eyes (frequency was 73.9% [20 of 27], 90.5% [19 of 21], and 63.0% [17 of 27] of unilateral blind eyes for MMD, staphyloma, and PPA, respectively). Seven previous studies in Asian populations reported a variable MMD frequency ranging from 8.3% to 64%, but frequencies were similar for comparable risk profiles based on age and SER. Conclusions and Relevance In this cross-sectional study of a highly myopic Dutch population of European ancestry, myopic retinal features were frequent; were associated with age, SER, and AL; and occurred in all visually severely impaired eyes. The absence of treatment options for most of these retinal complications emphasizes the need for effective strategies to prevent high myopia.
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Affiliation(s)
- Annechien E G Haarman
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, the Netherlands.,Erasmus Medical Center, Department of Epidemiology, Rotterdam, the Netherlands
| | - Milly S Tedja
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, the Netherlands.,Erasmus Medical Center, Department of Epidemiology, Rotterdam, the Netherlands
| | - Corina Brussee
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, the Netherlands.,Erasmus Medical Center, Department of Epidemiology, Rotterdam, the Netherlands
| | - Clair A Enthoven
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, the Netherlands.,Erasmus Medical Center, Department of Epidemiology, Rotterdam, the Netherlands
| | - Gwyneth A van Rijn
- Leiden University Medical Center, Department of Ophthalmology, Leiden, the Netherlands
| | | | - Jan E E Keunen
- Radboudumc, Department of Ophthalmology, Nijmegen, the Netherlands
| | - Camiel J F Boon
- Leiden University Medical Center, Department of Ophthalmology, Leiden, the Netherlands.,Amsterdam University Medical Center, Department of Ophthalmology, Amsterdam, the Netherlands
| | | | - Gré P M Luyten
- Leiden University Medical Center, Department of Ophthalmology, Leiden, the Netherlands
| | - Virginie J M Verhoeven
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, the Netherlands.,Erasmus Medical Center, Department of Epidemiology, Rotterdam, the Netherlands.,Erasmus Medical Center, Department of Clinical Genetics, Rotterdam, the Netherlands
| | - Caroline C W Klaver
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, the Netherlands.,Erasmus Medical Center, Department of Epidemiology, Rotterdam, the Netherlands.,Radboudumc, Department of Ophthalmology, Nijmegen, the Netherlands.,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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Enthoven CA, Mölenberg FJM, Tideman JWL, Polling JR, Labrecque JA, Raat H, van Lenthe FJ, Klaver CCW. Physical Activity Spaces Not Effective against Socioeconomic Inequalities in Myopia Incidence: The Generation R Study. Optom Vis Sci 2021; 98:1371-1378. [PMID: 34759237 PMCID: PMC8677612 DOI: 10.1097/opx.0000000000001809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 07/05/2021] [Indexed: 12/31/2022] Open
Abstract
SIGNIFICANCE Our findings show that non-Dutch background, lower maternal education, and lower net household income level may be new risk factors for myopia development in the Netherlands. Newly introduced physical activity spaces may not be effective enough in increasing outdoor exposure in children to reduce eye growth. PURPOSE The aims of this study were to evaluate socioeconomic inequalities in myopia incidence, eye growth, outdoor exposure, and computer use and to investigate if newly introduced physical activity spaces can reduce eye growth in school-aged children. METHODS Participants (N = 2643) from the Dutch population-based birth cohort Generation R were examined at ages 6 and 9 years. Socioeconomic inequalities in myopia incidence, eye growth, and lifestyle were determined using regression analyses. Information on physical activity spaces located in Rotterdam was obtained. Differences in eye growth between those who became exposed to new physical activity spaces (n = 230) and those nonexposed (n = 1866) were evaluated with individual-level fixed-effects models. RESULTS Myopia prevalence was 2.2% at age 6 years and 12.2% at age 9 years. Outdoor exposure was 11.4 h/wk at age 6 years and 7.4 h/wk at age 9 years. Computer use was 2.1 h/wk at age 6 years and 5.2 h/wk at age 9 years. Myopia incidence was higher in children with non-Dutch background, and families with lower household income and lower maternal education (odds ratio [OR], 1.081 [95% confidence interval, 1.052 to 1.112]; OR, 1.035 [95% confidence interval, 1.008 to 1.063]; OR, 1.028 [95% confidence interval, 1.001 to 1.055], respectively). Children living <600 m of a physical activity space did not have increased outdoor exposure, except those from families with lower maternal education (β = 1.33 h/wk; 95% confidence interval, 0.15 to 2.51 h/wk). Newly introduced physical activity spaces were not associated with reduction of eye growth. CONCLUSIONS Children from socioeconomically disadvantaged families became more often myopic than those from socioeconomically advantaged families. We did not find evidence that physical activity spaces protect against myopia for the population at large, but subgroups may benefit.
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Affiliation(s)
- Clair A. Enthoven
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Famke J. M. Mölenberg
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - J. Willem L. Tideman
- Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jan Roelof Polling
- Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Orthoptics and Optometry, University of Applied Sciences, Utrecht, the Netherlands
| | - Jeremy A. Labrecque
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Frank J. van Lenthe
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Human Geography and Spatial Planning, Faculty of Geoscience, Utrecht University, Utrecht, the Netherlands
| | - Caroline C. W. Klaver
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, Gelderland, the Netherlands
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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Affiliation(s)
- Clair A Enthoven
- Department of Psychology, Education and Child Studies, Erasmus University, Rotterdam, the Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ivonne P M Derks
- Department of Psychology, Education and Child Studies, Erasmus University, Rotterdam, the Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jan Roelof Polling
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Orthoptics and Optometry, University of Applied Sciences Utrecht, Utrecht, the Netherlands
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Iyer V, Enthoven CA, van Dommelen P, Samkar AV, Groenewoud JH, Reijneveld SA, Jaddoe VWV, Klaver CCW. Spectacle wear and refractive errors in Dutch children. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Myopia is a refractive error that is increasing dramatically all over the world. Early onset is associated with a significant visual burden later in life, but little is known about refractive errors in preschool children. The aim of this study was to assess prevalence of spectacle wear, visual acuity and refractive errors in young Dutch children and to make global comparisons.
Methods
We analyzed data of three prospective population-based studies: 99,660 3- to 5-year-olds undergoing vision screening at preventive child healthcare organizations, 6,934 6-year-olds from the Generation R study, and 2,974 7-year-olds from the RAMSES study. Visual acuity was measured with Landolt-C or LEA charts, spectacle wear was assessed, and refractive errors at age 6 and 7 were measured with cycloplegic refraction. Spectacle wear was compared with international studies.
Results
The prevalence of spectacle wear was 1.5%, 2.3%, 6.6%, 8.2% and 11.8% at 36, 45, 60, 72 and 84 months, respectively, with no major sex differences. Among children with spectacle wear at 72 months (N = 583) and 84 months (N = 351) 29.8% and 34.6% had myopia respectively, of which 21.1% and 21.6% combined with astigmatism, 19.6% and 6.8% had hyperopia, 37.2% and 11.1% hyperopia and astigmatism, and 12.5% and 33.3% astigmatism only. The prevalence of spectacle wear globally varied between 1.5% to 21%.
Conclusions
Spectacle wear in these European children started early in preschool and increased to substantial figures at school age. Among children with spectacle wear, >30% were already myopic, illustrating the urgency to implement myopia prevention strategies in child health centers.
Key messages
Early onset myopia is a public health issue. Of the 6- to 7-year-olds with spectacles 30-34% were already myopic. Monitoring of refractive errors and preventive lifestyle interventions are warranted.
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Affiliation(s)
- V Iyer
- Child Health/Education, TNO, Leiden, Netherlands
| | - CA Enthoven
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - A van Samkar
- Resident Geriatric Medicine, Omring, Lutjebroek, Netherlands
| | - JH Groenewoud
- University of Applied Sciences, Rotterdam, Netherlands
| | - SA Reijneveld
- Department of Health Sciences, University Medical Center, Groningen, Netherlands
| | - VWV Jaddoe
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, Netherlands
| | - CCW Klaver
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Ophthalmology, Radboud Medical Center, Nijmegen, Netherlands
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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8
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Haarman AEG, Enthoven CA, Tedja MS, Polling JR, Tideman JWL, Keunen JEE, Boon CJF, Felix JF, Raat H, Geerards AJM, Luyten GPM, van Rijn GA, Verhoeven VJM, Klaver CCW. Phenotypic Consequences of the GJD2 Risk Genotype in Myopia Development. Invest Ophthalmol Vis Sci 2021; 62:16. [PMID: 34406332 PMCID: PMC8375003 DOI: 10.1167/iovs.62.10.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose To study the relatively high effect of the refractive error gene GJD2 in human myopia, and to assess its relationship with refractive error, ocular biometry and lifestyle in various age groups. Methods The population-based Rotterdam Study (RS), high myopia case-control study MYopia STudy, and the birth-cohort study Generation R were included in this study. Spherical equivalent (SER), axial length (AL), axial length/corneal radius (AL/CR), vitreous depth (VD), and anterior chamber depth (ACD) were measured using standard ophthalmologic procedures. Biometric measurements were compared between GJD2 (rs524952) genotype groups; education and environmental risk score (ERS) were calculated to estimate gene-environment interaction effects, using the Synergy index (SI). Results RS adults carrying two risk alleles had a lower SER and longer AL, ACD and VD (AA versus TT, 0.23D vs. 0.70D; 23.79 mm vs. 23.52 mm; 2.72 mm vs. 2.65 mm; 16.12 mm vs. 15.87 mm; all P < 0.001). Children carrying two risk alleles had larger AL/CR at ages 6 and 9 years (2.88 vs. 2.87 and 3.00 vs. 2.96; all P < 0.001). Education and ERS both negatively influenced myopia and the biometric outcomes, but gene-environment interactions did not reach statistical significance (SI 1.25 [95% confidence interval {CI}, 0.85-1.85] and 1.17 [95% CI, 0.55-2.50] in adults and children). Conclusions The elongation of the eye caused by the GJD2 risk genotype follows a dose-response pattern already visible at the age of 6 years. These early effects are an example of how a common myopia gene may drive myopia.
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Affiliation(s)
- Annechien E G Haarman
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, The Netherlands
| | - Clair A Enthoven
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, The Netherlands
- Erasmus Medical Center, the Generation R Study Group, Rotterdam, The Netherlands
| | - Milly S Tedja
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, The Netherlands
| | - Jan R Polling
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
- Department of Optometry and Orthoptics, Hogeschool Utrecht, University of Applied Science, Utrecht, The Netherlands
| | - J Willem L Tideman
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
| | - Jan E E Keunen
- University Medical Center St Radboud, Department of Ophthalmology, Nijmegen, The Netherlands
| | - Camiel J F Boon
- Leiden University Medical Center, Department of Ophthalmology, The Netherlands
- Amsterdam University Medical Center, Department of Ophthalmology, University of Amsterdam, The Netherlands
| | - Janine F Felix
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, The Netherlands
- Erasmus Medical Center, the Generation R Study Group, Rotterdam, The Netherlands
- Erasmus Medical Center, Department of Pediatrics, Rotterdam, The Netherlands
| | - H Raat
- Erasmus University Medical Centre, Department of Public Health, Rotterdam, The Netherlands
| | | | | | - Gwyneth A van Rijn
- Leiden University Medical Center, Department of Ophthalmology, The Netherlands
| | - Virginie J M Verhoeven
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
- Erasmus Medical Center, Department of Clinical Genetics, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, The Netherlands
- University Medical Center St Radboud, Department of Ophthalmology, Nijmegen, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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9
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Enthoven CA, Polling JR, Verzijden T, Tideman JWL, Al-Jaffar N, Jansen PW, Raat H, Metz L, Verhoeven VJM, Klaver CCW. Smartphone Use Associated with Refractive Error in Teenagers: The Myopia App Study. Ophthalmology 2021; 128:1681-1688. [PMID: 34245754 DOI: 10.1016/j.ophtha.2021.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To investigate the association between smartphone use and refractive error in teenagers using the Myopia app. DESIGN Cross-sectional population-based study. PARTICIPANTS A total of 525 teenagers 12 to 16 years of age from 6 secondary schools and from the birth cohort study Generation R participated. METHODS A smartphone application (Myopia app; Innovattic) was designed to measure smartphone use and face-to-screen distance objectively and to pose questions about outdoor exposure. Participants underwent cycloplegic refractive error and ocular biometry measurements. Mean daily smartphone use was calculated in hours per day and continuous use as the number of episodes of 20 minutes on screen without breaks. Linear mixed models were conducted with smartphone use, continuous use, and face-to-screen distance as determinants and spherical equivalent of refraction (SER) and axial length-to-corneal radius (AL:CR) ratio as outcome measures stratified by median outdoor exposure. MAIN OUTCOME MEASURES Spherical equivalent of refraction in diopters and AL:CR ratio. RESULTS The teenagers on average were 13.7 ± 0.85 years of age, and myopia prevalence was 18.9%. During school days, total smartphone use on average was 3.71 ± 1.70 hours/day and was associated only borderline significantly with AL:CR ratio (β = 0.008; 95% confidence interval [CI], -0.001 to 0.017) and not with SER. Continuous use on average was 6.42 ± 4.36 episodes of 20-minute use without breaks per day and was associated significantly with SER and AL:CR ratio (β = -0.07 [95% CI, -0.13 to -0.01] and β = 0.004 [95% CI, 0.001-0.008], respectively). When stratifying for outdoor exposure, continuous use remained significant only for teenagers with low exposure (β = -0.10 [95% CI, -0.20 to -0.01] and β = 0.007 [95% CI, 0.001-0.013] for SER and AL:CR ratio, respectively). Smartphone use during weekends was not associated significantly with SER and AL:CR ratio, nor was face-to-screen distance. CONCLUSIONS Dutch teenagers spent almost 4 hours per day on their smartphones. Episodes of 20 minutes of continuous use were associated with more myopic refractive errors, particularly in those with low outdoor exposure. This study suggested that frequent breaks should become a recommendation for smartphone use in teenagers. Future large longitudinal studies will allow more detailed information on safe screen use in youth.
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Affiliation(s)
- Clair A Enthoven
- Department of Ophthalmology and Epidemiology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands; The Generation R Study Group, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Jan Roelof Polling
- Department of Ophthalmology and Epidemiology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands; Orthoptics and Optometry, University of Applied Sciences, Utrecht, Utrecht, The Netherlands
| | - Timo Verzijden
- Department of Ophthalmology and Epidemiology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - J Willem L Tideman
- Department of Ophthalmology and Epidemiology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Nora Al-Jaffar
- Department of Ophthalmology and Epidemiology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Pauline W Jansen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands; Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | | | - Virginie J M Verhoeven
- Department of Ophthalmology and Epidemiology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands; Clinical Genetics, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology and Epidemiology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands; Department of Ophthalmology, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland.
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10
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Affiliation(s)
- Caroline C W Klaver
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Radboud University Medical Centre, Nijmegen, Gelderland, The Netherlands.,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Jan Roelof Polling
- Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,University of Applied Sciences, Utrecht, The Netherlands
| | - Clair A Enthoven
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
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11
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Abstract
Purpose To determine the risk between degree of myopia and myopic macular degeneration (MMD), retinal detachment (RD), cataract, open angle glaucoma (OAG), and blindness. Methods A systematic review and meta-analyses of studies published before June 2019 on myopia complications. Odds ratios (OR) per complication and spherical equivalent (SER) degree (low myopia SER < -0.5 to > -3.00 diopter [D]; moderate myopia SER ≤ -3.00 to > -6.00 D; high myopia SER ≤ -6.00 D) were calculated using fixed and random effects models. Results Low, moderate, and high myopia were all associated with increased risks of MMD (OR, 13.57, 95% confidence interval [CI], 6.18-29.79; OR, 72.74, 95% CI, 33.18-159.48; OR, 845.08, 95% CI, 230.05-3104.34, respectively); RD (OR, 3.15, 95% CI, 1.92-5.17; OR, 8.74, 95% CI, 7.28-10.50; OR, 12.62, 95% CI, 6.65-23.94, respectively); posterior subcapsular cataract (OR, 1.56, 95% CI, 1.32-1.84; OR, 2.55, 95% CI, 1.98-3.28; OR, 4.55, 95% CI, 2.66-7.75, respectively); nuclear cataract (OR, 1.79, 95% CI, 1.08-2.97; OR, 2.39, 95% CI, 1.03-5.55; OR, 2.87, 95% CI, 1.43-5.73, respectively); and OAG (OR, 1.59, 95% CI, 1.33-1.91; OR, 2.92, 95% CI, 1.89-4.52 for low and moderate/high myopia, respectively). The risk of visual impairment was strongly related to longer axial length, higher myopia degree, and age older than 60 years (OR, 1.71, 95% CI, 1.07-2.74; OR, 5.54, 95% CI, 3.12-9.85; and OR, 87.63, 95% CI, 34.50-222.58 for low, moderate, and high myopia in participants aged >60 years, respectively). Conclusions Although high myopia carries the highest risk of complications and visual impairment, low and moderate myopia also have considerable risks. These estimates should alert policy makers and health care professionals to make myopia a priority for prevention and treatment.
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12
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Thee EF, Meester-Smoor MA, Luttikhuizen DT, Colijn JM, Enthoven CA, Haarman AEG, Rizopoulos D, Klaver CCW. Performance of Classification Systems for Age-Related Macular Degeneration in the Rotterdam Study. Transl Vis Sci Technol 2020; 9:26. [PMID: 32818087 PMCID: PMC7396180 DOI: 10.1167/tvst.9.2.26] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/19/2020] [Indexed: 01/10/2023] Open
Abstract
Purpose To compare frequently used classification systems for age-related macular degeneration (AMD) in their abilty to predict late AMD. Methods In total, 9066 participants from the population-based Rotterdam Study were followed up for progression of AMD during a study period up to 30 years. AMD lesions were graded on color fundus photographs after confirmation on other image modalities and grouped at baseline according to six classification systems. Late AMD was defined as geographic atrophy or choroidal neovascularization. Incidence rate (IR) and cumulative incidence (CuI) of late AMD were calculated, and Kaplan-Meier plots and area under the operating characteristics curves (AUCs) were constructed. Results A total of 186 persons developed incident late AMD during a mean follow-up time of 8.7 years. The AREDS simplified scale showed the highest IR for late AMD at 104 cases/1000 py for ages <75 years. The Rotterdam classification showed the highest IR at 89 cases/1000 py >75 years. The 3-Continent harmonization classification provided the most stable progression. Drusen area >10% ETDRS grid (hazard ratio 30.05, 95% confidence interval [CI] 19.25–46.91) was most prognostic of progression. The highest AUC of late AMD (0.8372, 95% CI: 0.8070-0.8673) was achieved when all AMD features present at baseline were included. Conclusions Highest turnover rates from intermediate to late AMD were provided by the AREDS simplified scale and the Rotterdam classification. The 3-Continent harmonization classification showed the most stable progression. All features, especially drusen area, contribute to late AMD prediction. Translational Relevance Findings will help stakeholders select appropriate classification systems for screening, deep learning algorithms, or trials.
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Affiliation(s)
- Eric F Thee
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Magda A Meester-Smoor
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Daniel T Luttikhuizen
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johanna M Colijn
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Clair A Enthoven
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Annechien E G Haarman
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Radboudumc, Nijmegen, the Netherlands.,Institute of Molecular and Clinical Ophthalmology, University of Basel, Switzerland
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13
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Enthoven CA, Tideman JWL, Polling JR, Yang-Huang J, Raat H, Klaver CCW. The impact of computer use on myopia development in childhood: The Generation R study. Prev Med 2020; 132:105988. [PMID: 31954142 DOI: 10.1016/j.ypmed.2020.105988] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/10/2019] [Accepted: 01/12/2020] [Indexed: 10/25/2022]
Abstract
Environmental factors are important in the development of myopia. There is still limited evidence as to whether computer use is a risk factor. The aim of this study is to investigate the association between computer use and myopia in the context of other near work activities. Within the birth cohort study Generation R, we studied 5074 children born in Rotterdam between 2002 and 2006. Refractive error and axial length was measured at ages 6 and 9. Information on computer use and outdoor exposure was obtained at age 3, 6 and 9 years using a questionnaire, and reading time and reading distance were assessed at age 9 years. Myopia prevalence (spherical equivalent ≤-0.5 dioptre) was 11.5% at 9 years. Mean computer use was associated with myopia at age 9 (OR = 1.005, 95% CI = 1.001-1.009), as was reading time and reading distance (OR = 1.031; 95% CI = 1.007-1.055 (5-10 h/wk); OR = 1.113; 95% CI = 1.073-1.155 (>10 h/wk) and OR = 1.072; 95% CI = 1.048-1.097 respectively). The combined effect of near work (computer use, reading time and reading distance) showed an increased odds ratio for myopia at age 9 (OR = 1.072; 95% CI = 1.047-1.098), while outdoor exposure showed a decreased odds ratio (OR = 0.996; 95% CI = 0.994-0.999) and the interaction term was significant (P = 0.036). From our results, we can conclude that within our sample of children, increased computer use is associated with myopia development. The effect of combined near work was decreased by outdoor exposure. The risks of digital devices on myopia and the protection by outdoor exposure should become widely known. Public campaigns are warranted.
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Affiliation(s)
- Clair A Enthoven
- Erasmus University Medical Centre, Rotterdam, the Netherlands; The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - J Willem L Tideman
- Erasmus University Medical Centre, Rotterdam, the Netherlands; The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jan Roelof Polling
- Erasmus University Medical Centre, Rotterdam, the Netherlands; University of Applied Sciences, Utrecht, the Netherlands
| | - Junwen Yang-Huang
- Erasmus University Medical Centre, Rotterdam, the Netherlands; The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Hein Raat
- Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Caroline C W Klaver
- Erasmus University Medical Centre, Rotterdam, the Netherlands; Radboud University Medical Centre, Nijmegen, Gelderland, the Netherlands; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland.
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14
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Pozarickij A, Enthoven CA, Ghorbani Mojarrad N, Plotnikov D, Tedja MS, Haarman AEG, Tideman JWL, Polling JR, Northstone K, Williams C, Klaver CCW, Guggenheim JA. Evidence That Emmetropization Buffers Against Both Genetic and Environmental Risk Factors for Myopia. Invest Ophthalmol Vis Sci 2020; 61:41. [PMID: 32097480 PMCID: PMC7329625 DOI: 10.1167/iovs.61.2.41] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/23/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose To test the hypothesis that emmetropization buffers against genetic and environmental risk factors for myopia by investigating whether risk factor effect sizes vary depending on children's position in the refractive error distribution. Methods Refractive error was assessed in participants from two birth cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC) (noncycloplegic autorefraction) and Generation R (cycloplegic autorefraction). A genetic risk score for myopia was calculated from genotypes at 146 loci. Time spent reading, time outdoors, and parental myopia were ascertained from parent-completed questionnaires. Risk factors were coded as binary variables (0 = low, 1 = high risk). Associations between refractive error and each risk factor were estimated using either ordinary least squares (OLS) regression or quantile regression. Results Quantile regression: effects associated with all risk factors (genetic risk, parental myopia, high time spent reading, low time outdoors) were larger for children in the extremes of the refractive error distribution than for emmetropes and low ametropes in the center of the distribution. For example, the effect associated with having a myopic parent for children in quantile 0.05 vs. 0.50 was as follows: ALSPAC: age 15, -1.19 D (95% CI -1.75 to -0.63) vs. -0.13 D (-0.19 to -0.06), P = 0.001; Generation R: age 9, -1.31 D (-1.80 to -0.82) vs. -0.19 D (-0.26 to -0.11), P < 0.001. Effect sizes for OLS regression were intermediate to those for quantiles 0.05 and 0.50. Conclusions Risk factors for myopia were associated with much larger effects in children in the extremes of the refractive error distribution, providing indirect evidence that emmetropization buffers against both genetic and environmental risk factors.
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Affiliation(s)
- Alfred Pozarickij
- School of Optometry & Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Clair A. Enthoven
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Denis Plotnikov
- School of Optometry & Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Milly S. Tedja
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annechien E G. Haarman
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J. Willem L. Tideman
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan Roelof Polling
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Orthoptics & Optometry, University of Applied Sciences, Faculty of Health, Utrecht, The Netherlands
| | - Kate Northstone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Cathy Williams
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Caroline C. W. Klaver
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Jeremy A. Guggenheim
- School of Optometry & Vision Sciences, Cardiff University, Cardiff, United Kingdom
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15
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Enthoven CA, Tideman JWL, Polling JR, Tedja MS, Raat H, Iglesias AI, Verhoeven VJM, Klaver CCW. Interaction between lifestyle and genetic susceptibility in myopia: the Generation R study. Eur J Epidemiol 2019; 34:777-784. [PMID: 30945054 PMCID: PMC6602996 DOI: 10.1007/s10654-019-00512-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/12/2019] [Indexed: 01/08/2023]
Abstract
Myopia is a refractive error of the eye caused by a complex interplay between nature and nurture. The aim of this study was to investigate whether environmental risk factors can influence the genetic effect in children developing myopia. A total of 3422 children participating in the birth-cohort study Generation R underwent an extensive eye examination at 9 years with measurements of refractive error and axial length corneal radius ratio (AL/CR). Environmental risk factors were evaluated using a questionnaire, and environmental risk scores (ERS) were calculated using backward regression analyses.
Genetic risk scores (GRS) were calculated based on all currently known risk variants for myopia. Gene-environment interaction (G×E) was investigated using linear and logistic regression analyses. The predictive value of G×E and parental myopia was estimated using receiver operating characteristic curves. Myopia prevalence was 12%. Both GRS (P < 0.01) and ERS (P < 0.01) were significantly associated with myopia and AL/CR, as was G×E interaction (P < 0.01 for myopia; P = 0.07 for AL/CR). The predictive value of parental myopia was 0.67 (95% CI 0.65–0.70), similar to the values of GRS (0.67; 95% CI 0.64–0.70; P = 0.98) and ERS (0.69; 95% CI 0.66–0.72; P = 0.98). Adding G×E interaction significantly improved the predictive value to 0.73 (95% CI 0.70–0.75; P < 0.01). This study provides evidence that nature and nurture are equally important for myopia and AL/CR; however, the combination has the strongest influence. Since myopia genes are common in the population, adjustment of lifestyle should be a major focus in the prevention of myopia.
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Affiliation(s)
- Clair A Enthoven
- Department of Ophthalmology, Erasmus University Medical Centre, Room Na-2808, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jan Willem Lodewijk Tideman
- Department of Ophthalmology, Erasmus University Medical Centre, Room Na-2808, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jan Roelof Polling
- Department of Ophthalmology, Erasmus University Medical Centre, Room Na-2808, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Orthoptics & Optometry, University of Applied Sciences, Utrecht, The Netherlands
| | - Milly S Tedja
- Department of Ophthalmology, Erasmus University Medical Centre, Room Na-2808, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Adriana I Iglesias
- Department of Ophthalmology, Erasmus University Medical Centre, Room Na-2808, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Virginie J M Verhoeven
- Department of Ophthalmology, Erasmus University Medical Centre, Room Na-2808, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus University Medical Centre, Room Na-2808, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands. .,Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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