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      Prevalence and Risk Factors of Myopia in Spain

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          Abstract

          Objective

          To analyse the prevalence of myopia among a sample of more than 6000 children in Spain as well as to determine the impact of risk factors in its progression.

          Methodology

          A total of 6,152 children aged from 5 to 7 were examined. The participants underwent an eye examination that included visual acuity, refraction without cycloplegia, and tests of accommodative and binocular function. In addition, a questionnaire regarding their lifestyle, family history, and geographical data was carried out. Finally, data were analysed using the SPSS version 25 program.

          Results

          The prevalence of myopia in the sample of children studied has increased from 17% in 2016 to 20% in 2017. Likewise, the number of children with high myopia has also increased, from 1.7% in 2016 to 3.6% in 2017. 43.3% of the participants spent more than 3 hours a day doing near activities, and 48.9% of this group spent more than 50% of this time using electronic devices. In addition, only 9.7% spent more than 2.5 hours outdoors each day.

          Conclusion

          Myopia prevalence appears to be increasing in Spain. Lifestyle factors appear to be increasing the risk of myopia.

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          Most cited references32

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          The relationship between glaucoma and myopia: the Blue Mountains Eye Study.

          P. Mitchell, F Hourihan, J Sandbach … (1999)
          To quantify the relationship between myopia and open-angle glaucoma, ocular hypertension (OH), and intraocular pressure (IOP) in a representative older population. Cross-sectional population-based study of 3654 Australians 49 to 97 years of age. Subjects with any myopia (> or =-1.0 diopter [D]) were identified by a standardized subjective refraction and categorized into low myopia (> or =-1.0 D to or =-3.0 D). Glaucoma was diagnosed from characteristic visual field loss, combined with optic disc cupping and rim thinning, without reference to IOP. Ocular hypertension was diagnosed when applanation IOP was greater than 21 mmHg in either eye in the absence of glaucomatous visual field and optic disc changes. General estimating equation models were used to assess associations between eyes with myopia and either glaucoma or OH. Glaucoma was present in 4.2% of eyes with low myopia and 4.4% of eyes with moderate-to-high myopia compared to 1.5% of eyes without myopia. The relationship between glaucoma and myopia was maintained after adjusting for known glaucoma risk factors, odds ratio (OR) of 2.3, and 95% confidence intervals (CI) of 1.3 to 4.1 for low myopia. It was stronger for eyes with moderate-to-high myopia (OR, 3.3; CI, 1.7-6.4). Only a borderline relationship was found with OH, OR of 1.8 (CI, 1.2-2.9) for low myopia, and OR of 0.9 (CI, 0.4-2.0) for moderate-to-high myopia. Mean IOP was approximately 0.5 mmHg higher in myopic eyes compared to nonmyopic eyes. This study has confirmed a strong relationship between myopia and glaucoma. Myopic subjects had a twofold to threefold increased risk of glaucoma compared with that of nonmyopic subjects. The risk was independent of other glaucoma risk factors and IOP.
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            The prevalence of refractive errors among adults in the United States, Western Europe, and Australia.

            John H Kempen, Paul Mitchell, M Arfan Ikram … (2004)
            To estimate the prevalence of refractive errors in persons 40 years and older. Counts of persons with phakic eyes with and without spherical equivalent refractive error in the worse eye of +3 diopters (D) or greater, -1 D or less, and -5 D or less were obtained from population-based eye surveys in strata of gender, race/ethnicity, and 5-year age intervals. Pooled age-, gender-, and race/ethnicity-specific rates for each refractive error were applied to the corresponding stratum-specific US, Western European, and Australian populations (years 2000 and projected 2020). Six studies provided data from 29 281 persons. In the US, Western European, and Australian year 2000 populations 40 years or older, the estimated crude prevalence for hyperopia of +3 D or greater was 9.9%, 11.6%, and 5.8%, respectively (11.8 million, 21.6 million, and 0.47 million persons). For myopia of -1 D or less, the estimated crude prevalence was 25.4%, 26.6%, and 16.4% (30.4 million, 49.6 million, and 1.3 million persons), respectively, of whom 4.5%, 4.6%, and 2.8% (5.3 million, 8.5 million, and 0.23 million persons), respectively, had myopia of -5 D or less. Projected prevalence rates in 2020 were similar. Refractive errors affect approximately one third of persons 40 years or older in the United States and Western Europe, and one fifth of Australians in this age group.
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              Time outdoors and the prevention of myopia.

              Amanda N French, Regan Ashby, Ian G Morgan … (2013)
              Recent epidemiological evidence suggests that children who spend more time outdoors are less likely to be, or to become myopic, irrespective of how much near work they do, or whether their parents are myopic. It is currently uncertain if time outdoors also blocks progression of myopia. It has been suggested that the mechanism of the protective effect of time outdoors involves light-stimulated release of dopamine from the retina, since increased dopamine release appears to inhibit increased axial elongation, which is the structural basis of myopia. This hypothesis has been supported by animal experiments which have replicated the protective effects of bright light against the development of myopia under laboratory conditions, and have shown that the effect is, at least in part, mediated by dopamine, since the D2-dopamine antagonist spiperone reduces the protective effect. There are some inconsistencies in the evidence, most notably the limited inhibition by bright light under laboratory conditions of lens-induced myopia in monkeys, but other proposed mechanisms possibly associated with time outdoors such as relaxed accommodation, more uniform dioptric space, increased pupil constriction, exposure to UV light, changes in the spectral composition of visible light, or increased physical activity have little epidemiological or experimental support. Irrespective of the mechanisms involved, clinical trials are now underway to reduce the development of myopia in children by increasing the amount of time they spend outdoors. These trials would benefit from more precise definition of thresholds for protection in terms of intensity and duration of light exposures. These can be investigated in animal experiments in appropriate models, and can also be determined in epidemiological studies, although more precise measurement of exposures than those currently provided by questionnaires is desirable. Copyright © 2013 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Miguel Angel M. A. Sanchez-Tena:
                ORCID: https://orcid.org/0000-0002-2583-1789
                Journal
                Journal ID (nlm-ta): J Ophthalmol
                Journal ID (iso-abbrev): J Ophthalmol
                Journal ID (publisher-id): JOPH
                Title: Journal of Ophthalmology
                Publisher: Hindawi
                ISSN (Print): 2090-004X
                ISSN (Electronic): 2090-0058
                Publication date Collection: 2019
                Publication date (Electronic): 18 August 2019
                Volume: 2019
                Electronic Location Identifier: 3419576
                Affiliations
                Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid 20822, Spain
                Author notes

                Guest Editor: Malgorzata Mrugacz

                Author information
                https://orcid.org/0000-0003-1097-4581
                https://orcid.org/0000-0002-2583-1789
                https://orcid.org/0000-0002-6743-8264
                Article
                DOI: 10.1155/2019/3419576
                PMC ID: 6721398
                PubMed ID: 31531234
                SO-VID: 3afbfede-bd6e-40f2-bd02-2a7cbf7c76b5
                Copyright © Copyright © 2019 Cristina C. Alvarez-Peregrina et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 15 February 2019
                Date revision received : 28 May 2019
                Date accepted : 1 July 2019
                Funding
                Funded by: Fundación Alain Afflelou
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Ophthalmology & Optometry
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry

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