Prevalence of refractive error in Europe: the European Eye Epidemiology (E3) Consortium

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Abstract

To estimate the prevalence of refractive error in adults across Europe. Refractive data (mean spherical equivalent) collected between 1990 and 2013 from fifteen population-based cohort and cross-sectional studies of the European Eye Epidemiology (E ³) Consortium were combined in a random effects meta-analysis stratified by 5-year age intervals and gender. Participants were excluded if they were identified as having had cataract surgery, retinal detachment, refractive surgery or other factors that might influence refraction. Estimates of refractive error prevalence were obtained including the following classifications: myopia ≤−0.75 diopters (D), high myopia ≤−6D, hyperopia ≥1D and astigmatism ≥1D. Meta-analysis of refractive error was performed for 61,946 individuals from fifteen studies with median age ranging from 44 to 81 and minimal ethnic variation (98 % European ancestry). The age-standardised prevalences (using the 2010 European Standard Population, limited to those ≥25 and <90 years old) were: myopia 30.6 % [95 % confidence interval (CI) 30.4–30.9], high myopia 2.7 % (95 % CI 2.69–2.73), hyperopia 25.2 % (95 % CI 25.0–25.4) and astigmatism 23.9 % (95 % CI 23.7–24.1). Age-specific estimates revealed a high prevalence of myopia in younger participants [47.2 % (CI 41.8–52.5) in 25–29 years-olds]. Refractive error affects just over a half of European adults. The greatest burden of refractive error is due to myopia, with high prevalence rates in young adults. Using the 2010 European population estimates, we estimate there are 227.2 million people with myopia across Europe.

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Most cited references 26

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Increased prevalence of myopia in the United States between 1971-1972 and 1999-2004.

Susan Vitale (2009)

To compare US population prevalence estimates for myopia in 1971-1972 and 1999-2004. The 1971-1972 National Health and Nutrition Examination Survey provided the earliest nationally representative estimates for US myopia prevalence; myopia was diagnosed by an algorithm using either lensometry, pinhole visual acuity, and presenting visual acuity (for presenting visual acuity > or =20/40) or retinoscopy (for presenting visual acuity -2.0 diopters [D]: 17.5% vs 13.4%, respectively [P -7.9 D: 22.4% vs 11.4%, respectively [P < .001]; < or =-7.9 D: 1.6% vs 0.2%, respectively [P < .001]). When using similar methods for each period, the prevalence of myopia in the United States appears to be substantially higher in 1999-2004 than 30 years earlier. Identifying modifiable risk factors for myopia could lead to the development of cost-effective interventional strategies.

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Genome-wide meta-analyses of multiancestry cohorts identify multiple new susceptibility loci for refractive error and myopia.

Virginie J M Verhoeven, Pirro G. Hysi, Robert Wojciechowski … (2013)

Refractive error is the most common eye disorder worldwide and is a prominent cause of blindness. Myopia affects over 30% of Western populations and up to 80% of Asians. The CREAM consortium conducted genome-wide meta-analyses, including 37,382 individuals from 27 studies of European ancestry and 8,376 from 5 Asian cohorts. We identified 16 new loci for refractive error in individuals of European ancestry, of which 8 were shared with Asians. Combined analysis identified 8 additional associated loci. The new loci include candidate genes with functions in neurotransmission (GRIA4), ion transport (KCNQ5), retinoic acid metabolism (RDH5), extracellular matrix remodeling (LAMA2 and BMP2) and eye development (SIX6 and PRSS56). We also confirmed previously reported associations with GJD2 and RASGRF1. Risk score analysis using associated SNPs showed a tenfold increased risk of myopia for individuals carrying the highest genetic load. Our results, based on a large meta-analysis across independent multiancestry studies, considerably advance understanding of the mechanisms involved in refractive error and myopia.

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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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Author and article information

Contributors

Christopher J. Hammond: +44 (0) 20 7188 9055 , chris.hammond@kcl.ac.uk

Journal

Journal ID (nlm-ta): Eur J Epidemiol

Journal ID (iso-abbrev): Eur. J. Epidemiol

Title: European Journal of Epidemiology

Publisher: Springer Netherlands (Dordrecht )

ISSN (Print): 0393-2990

ISSN (Electronic): 1573-7284

Publication date (Electronic): 18 March 2015

Publication date PMC-release: 18 March 2015

Publication date (Print): 2015

Volume: 30

Issue: 4

Pages: 305-315

Affiliations

[ ]Department of Ophthalmology, King’s College London, St Thomas’ Hospital, London, UK

[ ]Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, UK

[ ]Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands

[ ]Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands

[ ]UCL Institute of Child Health, London, UK

[ ]Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway

[ ]Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway

[ ]Department of Ophthalmology, University Medical Center, Mainz, Germany

[ ]Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK

[ ]Department of Ophthalmology, Nordland Hospital, Bodo, Norway

[ ]Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway

[ ]Queen’s University Belfast, Belfast, UK

[ ]Research Unit of Molecular Epidemiology, Institute of Epidemiology II and Institute of Genetic Epidemiology, Helmholtz Center, Munich, Germany

[ ]Univ. Bordeaux, 33000 Bordeaux, France

[ ]INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, 33000 Bordeaux, France

[ ]Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloníki, Greece

[ ]Department of Ophthalmology, Eye and Nutrition Research Group UMR 1324 INRA, Univerisity Hospital Dijon, Dijon, France

[ ]NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK

[ ]Institute of Human Genetics, Helmholtz Center, Munich, Germany

[ ]Institute of Human Genetics, Klinikum Rechts der Isar, Technische Universität, Munich, Germany

[ ]London School of Hygiene and Tropical Medicine, London, UK

Article

Publisher ID: 10

DOI: 10.1007/s10654-015-0010-0

PMC ID: 4385146

PubMed ID: 25784363

SO-VID: baf2a57c-d962-4a1f-9557-8fd4caba8cfc

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

History

Date received : 20 August 2014

Date accepted : 3 March 2015

Custom metadata

ScienceOpen disciplines: Public health

Keywords: refractive error,myopia,epidemiology,prevalence,consortium

Data availability:

ScienceOpen disciplines: Public health

Keywords: refractive error, myopia, epidemiology, prevalence, consortium

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