Six Year Refractive Change among White Children and Young Adults: Evidence for Significant Increase in Myopia among White UK Children

Abstract

ObjectiveTo determine six-year spherical refractive error change among white children and young adults in the UK and evaluate differences in refractive profiles between contemporary Australian children and historical UK data.DesignPopulation-based prospective study.ParticipantsThe Northern Ireland Childhood Errors of Refraction (NICER) study Phase 1 examined 1068 children in two cohorts aged 6–7 years and 12–13 years. Prospective data for six-year follow-up (Phase 3) are available for 212 12–13 year olds and 226 18–20 year olds in each cohort respectively.MethodsCycloplegic refractive error was determined using binocular open-field autorefraction (Shin-Nippon NVision-K 5001, cyclopentolate 1%). Participants were defined by spherical equivalent refraction (SER) as myopic SER ≤-0.50D, emmetropic -0.50D<SER<+2.00 or hyperopic SER≥+2.00D.Main Outcome MeasuresProportion and incidence of myopia.ResultsThe proportion of myopes significantly increased between 6–7 years (1.9%) and 12–13 years (14.6%) (p<0.001) but not between 12–13 and 18–20 years (16.4% to 18.6%, p = 0.51). The estimated annual incidence of myopia was 2.2% and 0.7% for the younger and older cohorts respectively. There were significantly more myopic children in the UK at age 12–13 years in the NICER study (16.4%) than reported in Australia (4.4%) (p<0.001). However by 17 years the proportion of myopia neared equivalence in the two populations (NICER 18.6%, Australia 17.7%, p = 0.75). The proportion of myopic children aged 12–13 years in the present study (2006–2008) was 16.4%, significantly greater than that reported for children aged 10–16 years in the 1960’s (7.2%, p = 0.01). The proportion of hyperopes in the younger NICER cohort decreased significantly over the six year period (from 21.7% to 14.2%, p = 0.04). Hyperopes with SER ≥+3.50D in both NICER age cohorts demonstrated persistent hyperopia.ConclusionsThe incidence and proportion of myopia are relatively low in this contemporary white UK population in comparison to other worldwide studies. The proportion of myopes in the UK has more than doubled over the last 50 years in children aged between 10–16 years and children are becoming myopic at a younger age. Differences between the proportion of myopes in the UK and in Australia apparent at 12–13 years were eliminated by 17 years of age.

Myopia Development Among Young Schoolchildren: The Myopia Investigation Study in Taipei

“…[13][14][15][16][17][18][19][20][21][22][23][24][25][26] According to the results of population-based studies using autorefraction, East Asian children appeared to have a higher incidence of myopia than Caucasian children. [13][14][15]17,18,[22][23][24] A 1-year longitudinal cohort study in Hong Kong revealed a mean annual incident rate of 14.41% among 3149 children aged between 5 and 16 years at baseline. 18 The annual incidence rates were reported by Saw et al 13 to be 15.9%, 12.8%, and 10.8% for 7-, 8-, and 9-year-old Singaporean children (n ¼ 569), respectively.…”

“…By contrast, Caucasian children were reported to have low and similar annual incidence of myopia in the United States (4.3% for 8-to 9-year-olds), 14 Australia (1.3% for 6-to 7-year-olds; 2.9% for 12-to 13-year-olds), 22 and the United Kingdom (2.2% for 6-to 7-year-olds; 0.7% for 12-to 13-year-olds). 23 Of interest, the annual incidence rates for the children of East Asian ethnicity living in the Sydney Metropolitan region (6.9% for 6-to 7-year-olds; 7.3% for 12-to 13-year-olds) 22 are comparable to those for rural populations of China and lower than those for children living in other metropolitan cities in East Asia, such as Hong Kong, Singapore, or Taipei, which indicates that environmental and lifestyle differences may play an important role in the development of childhood myopia.…”

“…[14][15][16][17][18][19][20][21][22][23][24][25][26] In Northern Ireland, the annual incidence of myopia among Caucasian children aged 6 to 7 years was 2.2%. 23 In Singapore, the 10-month cumulative incidence was as high as 33.6% among predominantly Chinese ethnic children aged 7, 9, and 12 years. 21 Several cross-sectional surveys involving schoolchildren of different ages in Taiwan have reported significant increases in myopia prevalence.…”

Spending an additional 40 min outdoors each day reduces the incidence of myopia among primary school children in China

“…2 One in five teenagers are myopic in the UK. 3 Interventions shown to reduce myopia include atropine eye-drops, glasses (bifocal, varifocal, peripherally defocused) and lifestyle interventions such as increased exercise and time outdoors. 4 In this large interventional study, a school-based outdoor exercise programme reduced myopia by 9.5% and prevented 78 children from requiring glasses.…”

Convergence accommodation in orthoptic practice

“…[33][34][35] Clear retinal images are implicated in normal emmetropisation, but if poor binocular vision causes sub-normal accommodation (as is also common in refractive error 33,[36][37][38][39][40][41][42] ), then it may impair emmetropisation due to increased blur for near, even when refractive error is corrected for distance. This is a possible direction for further study.…”