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J Optom. 2019 Jan - Mar;12(1):55-63. doi: 10.1016/j.optom.2018.02.002. Epub 2018 Mar 19.

Refractive error magnitude and variability: Relation to age.

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University of Waterloo, School of Optometry and Vision Science, Waterloo, Canada. Electronic address:
University of Waterloo, School of Optometry and Vision Science, Waterloo, Canada.



To investigate mean ocular refraction (MOR) and astigmatism, over the human age range and compare severity of refractive error to earlier studies from clinical populations having large age ranges.


For this descriptive study patient age, refractive error and history of surgery affecting refraction were abstracted from the Waterloo Eye Study database (WatES). Average MOR, standard deviation of MOR and astigmatism were assessed in relation to age. Refractive distributions for developmental age groups were determined. MOR standard deviation relative to average MOR was evaluated. Data from earlier clinically based studies with similar age ranges were compared to WatES.


Right eye refractive errors were available for 5933 patients with no history of surgery affecting refraction. Average MOR varied with age. Children <1 yr of age were the most hyperopic (+1.79D) and the highest magnitude of myopia was found at 27yrs (-2.86D). MOR distributions were leptokurtic, and negatively skewed. The mode varied with age group. MOR variability increased with increasing myopia. Average astigmatism increased gradually to age 60 after which it increased at a faster rate. By 85+ years it was 1.25D. J0 power vector became increasingly negative with age. J45 power vector values remained close to zero but variability increased at approximately 70 years. In relation to comparable earlier studies, WatES data were most myopic.


Mean ocular refraction and refractive error distribution vary with age. The highest magnitude of myopia is found in young adults. Similar to prevalence, the severity of myopia also appears to have increased since 1931.


Age-related refractive error; Anisometropia; Anisometropía; Astigmatism; Astigmatismo; Error refractivo relacionado con la edad; Mean ocular refraction; Refracción ocular media; Refractive error variability; Variabilidad del error refractivo

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