Generational difference of refractive error in the baseline study of the Beijing Myopia Progression Study

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Abstract

Aims

To report the refractive error difference (RED) between parents and their children and the estimated single generational myopic shift in an urban area in China.

Methods

395 children aged 6–17 years and their parents, who had been enrolled in the Beijing Myopia Progression Study were included. Cycloplegic and non-cycloplegic refraction of the children and parents were performed, respectively. RED was defined as the difference between the average parental spherical equivalent (SE) and the average SE of their children. Binomial fitted curves of RED were plotted as a function of the children's age. Generational myopic shift was defined as the estimated RED according to the prediction model at the age of 18 years.

Results

395 families were enrolled. The RED was positively correlated with the children's age (r _spearman=0.58, p<0.001). The RED (median (25th and 75th percentile)) was −1.88 (−3.23 to −1.00) dioptres (D) in children at 6.0–7.9 years of age, and it increased to 1.53 (−0.12 to 3.44) D in children at 16.0–17.9 years of age. The SE of the children approached the average SE of their parents at the age of 11 years. At the age of 18 years, the children's estimated myopic shift would be 1.94 D.

Conclusions

In this sample, children's refractive errors at the age of 11 years were already similar to their parents. Moreover, the estimated myopia in children at the age of 18 years would be up to 2.0 D higher than their parents. This remarkable single-generation myopic shift indicates that there are likely effects of environmental factors on myopia development in urban Chinese children.

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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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How genetic is school myopia?

Ian Morgan, K. Rose (2004)

Myopia is of diverse aetiology. A small proportion of myopia is clearly familial, generally early in onset and of high level, with defined chromosomal localisations and in some cases, causal genetic mutations. However, in economically developed societies, most myopia appears during childhood, particularly during the school years. The chromosomal localisations characterised so far for high familial myopia do not seem to be relevant to school myopia. Family correlations in refractive error and axial length are consistent with a genetic contribution to variations in school myopia, but potentially confound shared genes and shared environments. High heritability values are obtained from twin studies, but rest on contestable assumptions, and require further critical analysis, particularly in view of the low heritability values obtained from parent-offspring correlations where there has been rapid environmental change between generations. Since heritability is a population-specific parameter, the values obtained on twins cannot be extrapolated to define the genetic contribution to variation in the general population. In addition, high heritability sets no limit to the potential for environmentally induced change. There is in fact strong evidence for rapid, environmentally induced change in the prevalence of myopia, associated with increased education and urbanisation. These environmental impacts have been found in all major branches of the human family, defined in modern molecular terms, with the exception of the Pacific Islanders, where the evidence is too limited to draw conclusions. The idea that populations of East Asian origin have an intrinsically higher prevalence of myopia is not supported by the very low prevalence reported for them in rural areas, and by the high prevalence of myopia reported for Indians in Singapore. A propensity to develop myopia in "myopigenic" environments thus appears to be a common human characteristic. Overall, while there may be a small genetic contribution to school myopia, detectable under conditions of low environmental variation, environmental change appears to be the major factor increasing the prevalence of myopia around the world. There is, moreover, little evidence to support the idea that individuals or populations differ in their susceptibility to environmental risk factors.

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Parental myopia, near work, school achievement, and children's refractive error.

Helen Jones, M Moeschberger, Karla Zadnik … (2002)

To quantify the degree of association between juvenile myopia and parental myopia, near work, and school achievement. Refractive error, parental refractive status, current level of near activities (assumed working distance-weighted hours per week spent studying, reading for pleasure, watching television, playing video games or working on the computer), hours per week spent playing sports, and level of school achievement (scores on the Iowa Tests of Basic Skills [ITBS]) were assessed in 366 eighth grade children who participated in the Orinda Longitudinal Study of Myopia in 1991 to 1996. Children with myopia were more likely to have parents with myopia; to spend significantly more time studying, more time reading, and less time playing sports; and to score higher on the ITBS Reading and Total Language subtests than emmetropic children (chi(2) and Wilcoxon rank-sum tests; P < 0.024). Multivariate logistic regression models showed no substantial confounding effects between parental myopia, near work, sports activity, and school achievement, suggesting that each factor has an independent association with myopia. The multivariate odds ratio (95% confidence interval) for two compared with no parents with myopia was 6.40 (2.17-18.87) and was 1.020 (1.008-1.032) for each diopter-hour per week of near work. Interactions between parental myopia and near work were not significant (P = 0.67), indicating no increase in the risk associated with near work with an increasing number of parents with myopia. Heredity was the most important factor associated with juvenile myopia, with smaller independent contributions from more near work, higher school achievement, and less time in sports activity. There was no evidence that children inherit a myopigenic environment or a susceptibility to the effects of near work from their parents.

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Author and article information

Journal

Journal ID (nlm-ta): Br J Ophthalmol

Journal ID (iso-abbrev): Br J Ophthalmol

Journal ID (hwp): bjophthalmol

Journal ID (publisher-id): bjo

Title: The British Journal of Ophthalmology

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 0007-1161

ISSN (Electronic): 1468-2079

Publication date (Print): June 2013

Publication date (Electronic): 16 April 2013

Volume: 97

Issue: 6

Pages: 765-769

Affiliations

[1 ]Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University , Beijing, China

[2 ]The Affiliated Eye Hospital and School of Optometry and Ophthalmology, Wenzhou Medical College , Wenzhou, Zhejiang, China

[3 ]Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong , Hong Kong, China

[4 ]Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong , Hong Kong, China

[5 ]College of Optometry , Mid Western University , Glendale, Arizona, USA

[6 ]Handan Eye Hospital , Handan, Hebei, China

[7 ]Department of Biological and Vision Sciences, SUNY College of Optometry , New York, New York, USA

Author notes

[Correspondence to ] Dr Yuan Bo Liang, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Science Key Lab. No. 1 Dong Jiao Min Xiang Street, Dongcheng District, Beijing, People’s Republic of China, 100730; yuanboliang@ 123456gmail.com

YBL and ZL contributed equally

Article

Publisher ID: bjophthalmol-2012-302468

DOI: 10.1136/bjophthalmol-2012-302468

PMC ID: 3664384

PubMed ID: 23590854

SO-VID: dbe462a1-cb8b-439c-8500-0e8367b23402

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode