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Ophthalmology. 2019 Jan;126(1):127-136. doi: 10.1016/j.ophtha.2018.06.029. Epub 2018 Aug 23.

Environmental Risk Factors Can Reduce Axial Length Elongation and Myopia Incidence in 6- to 9-Year-Old Children.

Author information

1
Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
2
Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Orthoptics & Optometry, University of Applied Sciences, Faculty of Health, Utrecht, The Netherlands.
3
Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Paediatrics, Erasmus Medical Centre, Rotterdam, The Netherlands.
4
Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands.
5
Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Ophthalmology, Radboud Medical Centre, Nijmegen, The Netherlands. Electronic address: c.c.w.klaver@erasmusmc.nl.

Abstract

PURPOSE:

To identify risk factors for axial length (AL) elongation and incident school myopia.

DESIGN:

Population-based prospective birth-cohort study.

PARTICIPANTS:

Four thousand seven hundred thirty-four children examined at 6 and 9 years of age from the Generation R Study in Rotterdam, The Netherlands.

METHODS:

Axial length and corneal radius (CR) were measured with an IOLMaster 500 and daily life activities and demographic characteristics were obtained by questionnaire. Three thousand three hundred sixty-two children (71%) were eligible for cycloplegic refractive error measurements. Linear regression models on AL elongation were used to create a risk score based on the regression coefficients resulting from environmental and ocular factors. The predictive value of the prediction score for myopia (≤-0.5 diopter) was estimated using receiver operating characteristic curves. To test if regression coefficients differed for baseline AL-to-CR ratio, interaction terms were calculated with baseline AL-to-CR ratio and environmental factors.

MAIN OUTCOME MEASURES:

Axial length elongation and incident myopia.

RESULTS:

From 6 to 9 years of age, average AL elongation was 0.21±0.009 mm/year and myopia developed in 223 of 2136 children (10.4%), leading to a myopia prevalence at 9 years of age of 12.0%. Seven parameters were associated independently (P < 0.05) with faster AL elongation: parental myopia, 1 or more books read per week, time spent reading, no participation in sports, non-European ethnicity, less time spent outdoors, and baseline AL-to-CR ratio. The discriminative accuracy for incident myopia based on these risk factors was 0.78. Axial length-to-CR ratio at baseline showed statistically significant interaction with number of books read per week (P < 0.01) and parental myopia (P < 0.01). Almost all predictors showed the highest association with AL elongation in the highest quartile of AL-to-CR ratio; incidental myopia in this group was 24% (124/513).

CONCLUSIONS:

Determination of a risk score can help to identify school children at high risk of myopia. Our results suggest that behavioral changes can offer protection particularly in these children.

PMID:
30146089
DOI:
10.1016/j.ophtha.2018.06.029
[Indexed for MEDLINE]

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