Elsevier

Ophthalmology

Volume 118, Issue 5, May 2011, Pages 797-804
Ophthalmology

Original article
Myopia Over the Lifecourse: Prevalence and Early Life Influences in the 1958 British Birth Cohort

https://doi.org/10.1016/j.ophtha.2010.09.025Get rights and content

Purpose

To investigate the hypothesis that the excessive growth of the eye in myopia is associated with general growth and thus influenced by early life biological and social factors, and that these associations underlie recent secular trends of increasing prevalence and severity of myopia.

Participants

A total of 2487 randomly selected 44-year-old members of the 1958 British birth cohort (27% subsample).

Methods

Diverse and detailed biological, social, and lifestyle data have been collected by following members since birth through a series of clinical examinations or face-to-face interviews carried out by trained examiners. At 44 years, cohort members underwent autorefraction using the Nikon Retinomax 2 (Nikon Corp., Tokyo, Japan) under non-cycloplegic conditions. A lifecourse epidemiologic approach, based on 4 sequential multivariable “life stage” models (preconceptional; prenatal, perinatal, and postnatal; childhood; and adult), was used to examine the influence of early life biological, social and lifestyle factors, growth patterns, and “eye-specific” factors on myopia.

Main Outcome Measures

Myopia severity (all, mild/moderate: spherical equivalent −0.75 to −5.99 diopters [D]; severe: ≥−6.00 D extreme vs. emmetropia −0.74 to +0.99 D) and myopia onset (early [<16 years] vs. later).

Results

A total of 1214 individuals (49%; 95% confidence interval, 48.8–50.8) were myopic (late onset in 979 [80.6%]). Myopia was positively associated with low birthweight for gestational age, gender, greater maternal age, higher paternal occupational social class, and maternal smoking in early pregnancy. Myopia was independently associated with proxy markers of near work and educational performance, with some differences by onset and severity. In adults, greater height and higher educational attainment and socioeconomic status were associated with myopia.

Conclusions

Trends in the key influences on child health and growth identified as novel putative risk factors in this study are consistent with global trends of increasing myopia: increasing births to older mothers, increasing rates of intrauterine growth retardation and survival of affected children, increasing persistence of smoking in pregnancy, and changing socioeconomic status. Prospects for prevention of myopia would be improved by a paradigm shift in myopia research, with lifecourse and genetic epidemiologic approaches applied in tandem in large unselected populations.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Study Population

The 1958 British birth cohort originally comprised everyone born in Britain in 1 week in 1958.22 Diverse and detailed biological, social, and lifestyle data have been collected by following members since birth, through a series of clinical examinations or face-to-face interviews carried out by trained examiners. Specifically, ophthalmic data have been collected at 7, 11, 16, and 44 years.22 This population therefore offers a unique context for lifecourse investigations of ophthalmic disease.23

Frequency of Refractive Error

A total of 1214 cohort members (49%, 95% confidence interval [CI], 48.8–50.8) were myopic (spherical equivalent ≥−0.75 D extreme). Of these, 979 (80.6%) had late-onset myopia and 235 (19.4%) had early-onset myopia (<16 years). Only 61 individuals (2.4%, 95% CI, 1.8–3.1) had severe myopia (≥−6 D), all nonsyndromic. A total of 1053 individuals (42.3%, 95% CI, 40.4–44.3) were emmetropic (no refractive error) and 220 individuals (8.8%, 95% CI, 7.7–10.0) were hypermetropic (long-sighted, mean

Discussion

Our findings suggest that at least 1 in 3 working-age adults in the United Kingdom have clinically significant myopia. Most have an onset (or first manifestation) in very late adolescence or early adult life. Myopia risk, severity, and timing of onset are associated with key environmental influences on prenatal growth and health, sometimes in potentially opposing directions of effect. For example, higher socioeconomic status is associated with increased risk of myopia but is protective against

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    Manuscript no. 2010-163.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Funding: The biomedical survey was supported by the Medical Research Council (grant G0000934, Health of the Public initiative, principal grant holders C. Power and D. Strachan). This work was undertaken at Great Ormond Street Hospital/University College London Institute of Child Health, which received a proportion of its funding from the Department of Health's National Institute of Health Research Biomedical Research Center's funding scheme. The Center for Pediatric Epidemiology and Biostatistics also benefits from funding support from the Medical Research Council in its capacity as the Medical Research Council Center of Epidemiology for Child Health. J. Rahi holds a joint appointment with Moorfields Eye Hospital/Institute of Ophthalmology, University College London, which also received a proportion of its funding from the Department of Health's National Institute of Health Research Biomedical Research Center's funding scheme. P. Cumberland is supported by the Ulverscroft Foundation.

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