Elsevier

Ophthalmology

Volume 122, Issue 7, July 2015, Pages 1489-1497
Ophthalmology

Original article
Increasing Prevalence of Myopia in Europe and the Impact of Education

Presented in part at: the Association for Research in Vision and Ophthalmology Meeting, May 4–8, 2014, Orlando, Florida.
https://doi.org/10.1016/j.ophtha.2015.03.018Get rights and content
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open access

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 (E3) Consortium.

Participants

The E3 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.

Abbreviations and Acronyms

CI
confidence interval
D
diopters
E3
European Eye Epidemiology

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Supplemental material is available at www.aaojournal.org.

Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

The sponsor or funding organization has no role in the design or conduct of this research.

Author Contributions:

Conception and design: Williams, Cumberland, Rahi, Delcourt, Klaver, Hammond, Hogg, Hysi, Khawaja, Bron, Fletcher, Foster

Data collection: Williams, Verhoeven, Cumberland, Bertelsen, Wolfram, Anastasopoulos, Buitendijk, Cougnard-Grégoire, Creuzot-Garcher, Erke, Hogg, Höhn, Hysi, Khawaja, Korobelnik, Ried, Vingerling, Bron, Dartigues, Hofman, Kuijpers, Luben, Oxele, Topouzis, von Hanno, Mirshahi, van Duijn, Pfeiffer

Analysis and interpretation: Williams, Verhoeven, Cumberland, Bertelsen, Wolfram, Rahi, Delcourt, Klaver, Hammond, Anastasopoulos, Buitendijk, Cougnard-Grégoire, Creuzot-Garcher, Erke, Hogg, Höhn, Hysi, Khawaja, Korobelnik, Ried, Vingerling, Bron, Dartigues, Fletcher, Hofman, Kuijpers, Luben, Oxele, Topouzis, von Hanno, Mirshahi, Foster, van Duijn, Pfeiffer, Delcourt, Klaver, Rahi, Hammond

Obtained funding: none

Overall responsibility: Williams, Verhoeven, Cumberland, Bertelsen, Wolfram, Rahi, Delcourt, Klaver, Hammond, Anastasopoulos, Buitendijk, Cougnard-Grégoire, Creuzot-Garcher, Erke, Hogg, Höhn, Hysi, Khawaja, Korobelnik, Ried, Vingerling, Bron, Dartigues, Fletcher, Hofman, Kuijpers, Luben, Oxele, Topouzis, von Hanno, Mirshahi, Foster, van Duijn, Pfeiffer, Delcourt, Klaver, Rahi, Hammond