A review on the epidemiology of myopia in school children worldwide

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Abstract

Background

Due to high prevalence myopia has gained importance in epidemiological studies. Children with early onset are at particular risk of complications associated with myopia, as progression over time might result in high myopia and myopic macular degeneration. Both genetic and environmental factors play a role in the increasing prevalence of myopia. The aim of this study is to review the current literature on epidemiology and risk factors for myopia in school children (aged 6–19 years) around the world.

Main body

PubMed and Medline were searched for the following keywords: prevalence, incidence, myopia, refractive error, risk factors, children and visual impairment. English language articles published between Jan 2013 and Mar 2019 were included in the study. Studies were critically reviewed for study methodology and robustness of data. Eighty studies were included in this literature review.

Myopia prevalence remains higher in Asia (60%) compared with Europe (40%) using cycloplegic refraction examinations. Studies reporting on non-cycloplegic measurements show exceptionally high myopia prevalence rates in school children in East Asia (73%), and high rates in North America (42%). Low prevalence under 10% was described in African and South American children. In recent studies, risk factors for myopia in schoolchildren included low outdoor time and near work, dim light exposure, the use of LED lamps for homework, low sleeping hours, reading distance less than 25 cm and living in an urban environment.

Conclusion

Low levels of outdoor activity and near work are well-established risk factors for myopia; this review provides evidence on additional environmental risk factors. New epidemiological studies should be carried out on implementation of public health strategies to tackle and avoid myopia. As the myopia prevalence rates in non-cycloplegic studies are overestimated, we recommend considering only cycloplegic measurements.

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Most cited references 83

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Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050.

Brien A. Holden, Timothy Fricke, David Wilson … (2016)

Myopia is a common cause of vision loss, with uncorrected myopia the leading cause of distance vision impairment globally. Individual studies show variations in the prevalence of myopia and high myopia between regions and ethnic groups, and there continues to be uncertainty regarding increasing prevalence of myopia.

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Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial.

Mingguang He, Fan Xiang, Yangfa Zeng … (2015)

Myopia has reached epidemic levels in parts of East and Southeast Asia. However, there is no effective intervention to prevent the development of myopia.

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IMI – Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies

Daniel Ian Flitcroft, Mingguang He, Jost Jonas … (2019)

Purpose We provide a standardized set of terminology, definitions, and thresholds of myopia and its main ocular complications. Methods Critical review of current terminology and choice of myopia thresholds was done to ensure that the proposed standards are appropriate for clinical research purposes, relevant to the underlying biology of myopia, acceptable to researchers in the field, and useful for developing health policy. Results We recommend that the many descriptive terms of myopia be consolidated into the following descriptive categories: myopia, secondary myopia, axial myopia, and refractive myopia. To provide a framework for research into myopia prevention, the condition of “pre-myopia” is defined. As a quantitative trait, we recommend that myopia be divided into myopia (i.e., all myopia), low myopia, and high myopia. The current consensus threshold value for myopia is a spherical equivalent refractive error ≤ −0.50 diopters (D), but this carries significant risks of classification bias. The current consensus threshold value for high myopia is a spherical equivalent refractive error ≤ −6.00 D. “Pathologic myopia” is proposed as the categorical term for the adverse, structural complications of myopia. A clinical classification is proposed to encompass the scope of such structural complications. Conclusions Standardized definitions and consistent choice of thresholds are essential elements of evidence-based medicine. It is hoped that these proposals, or derivations from them, will facilitate rigorous, evidence-based approaches to the study and management of myopia.

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Author and article information

Contributors

Andrzej Grzybowski:

ORCID: http://orcid.org/0000-0002-3724-2391

ae.grzybowski@gmail.com

Piotr Kanclerz: p.kanclerz@gumed.edu.pl

Kazuo Tsubota: tsubota@z3.keio.jp

Carla Lanca: carla.lanca@seri.com.sg

Seang-Mei Saw: seang_mei_saw@nuhs.edu.sg

Journal

Journal ID (nlm-ta): BMC Ophthalmol

Journal ID (iso-abbrev): BMC Ophthalmol

Title: BMC Ophthalmology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2415

Publication date (Electronic): 14 January 2020

Publication date PMC-release: 14 January 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 27

Affiliations

[1 ]ISNI 0000 0001 2149 6795, GRID grid.412607.6, Department of Ophthalmology, , University of Warmia and Mazury, ; Olsztyn, Poland

[2 ]Foundation for Ophthalmology Development, Institute for Research in Ophthalmology, Gorczyczewskiego 2/3, 60-554 Poznan, Poland

[3 ]Private Practice, Gdańsk, Poland

[4 ]ISNI 0000 0004 1936 9959, GRID grid.26091.3c, Department of Ophthalmology, , Keio University School of Medicine, ; Tokyo, Japan

[5 ]Tsubota Laboratory, Inc., Tokyo, Japan

[6 ]ISNI 0000 0001 0706 4670, GRID grid.272555.2, Singapore Eye Research Institute, ; Singapore, Singapore

[7 ]ISNI 0000 0001 2180 6431, GRID grid.4280.e, Saw Swee Hock School of Public Health, , National University of Singapore, ; Singapore, Singapore

[8 ]ISNI 0000 0004 0385 0924, GRID grid.428397.3, Duke-NUS Medical School, ; Singapore, Singapore

Author information

Andrzej Grzybowski http://orcid.org/0000-0002-3724-2391

Article

Publisher ID: 1220

DOI: 10.1186/s12886-019-1220-0

PMC ID: 6961361

PubMed ID: 31937276

SO-VID: 26ad7ce4-9480-4927-8279-aa7e48855fbf

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.