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Ophthalmology. 2015 Jul;122(7):1489-97. doi: 10.1016/j.ophtha.2015.03.018. Epub 2015 May 13.

Increasing Prevalence of Myopia in Europe and the Impact of Education.

Author information

1
Department of Ophthalmology, King's College London, St. Thomas' Hospital, London, United Kingdom; Department of Twin Research and Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, United Kingdom.
2
Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway; Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
3
Life Course, Epidemiology and Biostatistics Section, UCL Institute of Child Health, London, United Kingdom.
4
University Medical Center, Department of Ophthalmology, Mainz, Germany.
5
Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
6
Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
7
University Bordeaux, Bordeaux, France; ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.
8
Department of Ophthalmology, Eye and Nutrition Research Group UMR 1324 INRA, University Hospital Dijon, France.
9
Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.
10
Centre for Experimental Medicine, Institute of Clinical Science, Queen's University Belfast, Belfast, United Kingdom.
11
Department of Twin Research and Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, United Kingdom.
12
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
13
Institute of Genetic Epidemiology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany.
14
London School of Hygiene and Tropical Medicine, London, United Kingdom.
15
Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
16
Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
17
Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Ophthalmology, Nordland Hospital, Norway, Bodø, Norway.
18
NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom.
19
Life Course, Epidemiology and Biostatistics Section, UCL Institute of Child Health, London, United Kingdom; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom.
20
Department of Ophthalmology, King's College London, St. Thomas' Hospital, London, United Kingdom; Department of Twin Research and Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, United Kingdom. Electronic address: chris.hammond@kcl.ac.uk.

Abstract

PURPOSE:

To investigate whether myopia is becoming more common across Europe and explore whether increasing education levels, an important environmental risk factor for myopia, might explain any temporal trend.

DESIGN:

Meta-analysis of population-based, cross-sectional studies from the European Eye Epidemiology (E(3)) Consortium.

PARTICIPANTS:

The E(3) Consortium is a collaborative network of epidemiological studies of common eye diseases in adults across Europe. Refractive data were available for 61 946 participants from 15 population-based studies performed between 1990 and 2013; participants had a range of median ages from 44 to 78 years.

METHODS:

Noncycloplegic refraction, year of birth, and highest educational level achieved were obtained for all participants. Myopia was defined as a mean spherical equivalent ≤-0.75 diopters. A random-effects meta-analysis of age-specific myopia prevalence was performed, with sequential analyses stratified by year of birth and highest level of educational attainment.

MAIN OUTCOME MEASURES:

Variation in age-specific myopia prevalence for differing years of birth and educational level.

RESULTS:

There was a significant cohort effect for increasing myopia prevalence across more recent birth decades; age-standardized myopia prevalence increased from 17.8% (95% confidence interval [CI], 17.6-18.1) to 23.5% (95% CI, 23.2-23.7) in those born between 1910 and 1939 compared with 1940 and 1979 (P = 0.03). Education was significantly associated with myopia; for those completing primary, secondary, and higher education, the age-standardized prevalences were 25.4% (CI, 25.0-25.8), 29.1% (CI, 28.8-29.5), and 36.6% (CI, 36.1-37.2), respectively. Although more recent birth cohorts were more educated, this did not fully explain the cohort effect. Compared with the reference risk of participants born in the 1920s with only primary education, higher education or being born in the 1960s doubled the myopia prevalence ratio-2.43 (CI, 1.26-4.17) and 2.62 (CI, 1.31-5.00), respectively-whereas individuals born in the 1960s and completing higher education had approximately 4 times the reference risk: a prevalence ratio of 3.76 (CI, 2.21-6.57).

CONCLUSIONS:

Myopia is becoming more common in Europe; although education levels have increased and are associated with myopia, higher education seems to be an additive rather than explanatory factor. Increasing levels of myopia carry significant clinical and economic implications, with more people at risk of the sight-threatening complications associated with high myopia.

PMID:
25983215
PMCID:
PMC4504030
DOI:
10.1016/j.ophtha.2015.03.018
[Indexed for MEDLINE]
Free PMC Article
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