Myopia over the lifecourse: prevalence and early life influences in the 1958 British birth cohort.

PURPOSE To investigate the hypothesis that the excessive growth of the eye in myopia is associated with general growth and thus influenced by early life biological and social factors, and that these associations underlie recent secular trends of increasing prevalence and severity of myopia. DESIGN Cohort study. PARTICIPANTS A total of 2487 randomly selected 44-year-old members of the 1958 British birth cohort (27% subsample). METHODS Diverse and detailed biological, social, and lifestyle data have been collected by following members since birth through a series of clinical examinations or face-to-face interviews carried out by trained examiners. At 44 years, cohort members underwent autorefraction using the Nikon Retinomax 2 (Nikon Corp., Tokyo, Japan) under non-cycloplegic conditions. A lifecourse epidemiologic approach, based on 4 sequential multivariable "life stage" models (preconceptional; prenatal, perinatal, and postnatal; childhood; and adult), was used to examine the influence of early life biological, social and lifestyle factors, growth patterns, and "eye-specific" factors on myopia. MAIN OUTCOME MEASURES Myopia severity (all, mild/moderate: spherical equivalent -0.75 to -5.99 diopters [D]; severe: ≥-6.00 D extreme vs. emmetropia -0.74 to +0.99 D) and myopia onset (early [<16 years] vs. later). RESULTS A total of 1214 individuals (49%; 95% confidence interval, 48.8-50.8) were myopic (late onset in 979 [80.6%]). Myopia was positively associated with low birthweight for gestational age, gender, greater maternal age, higher paternal occupational social class, and maternal smoking in early pregnancy. Myopia was independently associated with proxy markers of near work and educational performance, with some differences by onset and severity. In adults, greater height and higher educational attainment and socioeconomic status were associated with myopia. CONCLUSIONS Trends in the key influences on child health and growth identified as novel putative risk factors in this study are consistent with global trends of increasing myopia: increasing births to older mothers, increasing rates of intrauterine growth retardation and survival of affected children, increasing persistence of smoking in pregnancy, and changing socioeconomic status. Prospects for prevention of myopia would be improved by a paradigm shift in myopia research, with lifecourse and genetic epidemiologic approaches applied in tandem in large unselected populations.

[1]  G Gazzard,et al.  Outdoor activity and myopia in Singapore teenage children , 2009, British Journal of Ophthalmology.

[2]  B. Jacobsson,et al.  Advanced Maternal Age and Adverse Perinatal Outcome , 2004, Obstetrics and gynecology.

[3]  D. Fung,et al.  IQ and the association with myopia in children. , 2004, Investigative ophthalmology & visual science.

[4]  G. Ying,et al.  Associations between childhood refraction and parental smoking. , 2006, Investigative ophthalmology & visual science.

[5]  R. Klein,et al.  Changes in refraction over 10 years in an adult population: the Beaver Dam Eye study. , 2002, Investigative ophthalmology & visual science.

[6]  S. Greenland,et al.  Causation and causal inference in epidemiology. , 2005, American journal of public health.

[7]  Leslie J. Sim,et al.  BOARD ON CHILDREN, YOUTH, AND FAMILIES , 2009 .

[8]  H. Salihu,et al.  Epidemiology of prenatal smoking and perinatal outcomes. , 2007, Early human development.

[9]  N. Congdon,et al.  Evidence for an "epidemic" of myopia. , 2004, Annals of the Academy of Medicine, Singapore.

[10]  J. Ingelfinger Prematurity and the legacy of intrauterine stress. , 2007, The New England journal of medicine.

[11]  P. Mitchell,et al.  Myopia and the urban environment: findings in a sample of 12-year-old Australian school children. , 2008, Investigative ophthalmology & visual science.

[12]  Ian Morgan,et al.  How genetic is school myopia? , 2005, Progress in Retinal and Eye Research.

[13]  T. Spector,et al.  Estimating heritability and shared environmental effects for refractive error in twin and family studies. , 2009, Investigative ophthalmology & visual science.

[14]  T. Cole,et al.  Statistical issues in life course epidemiology. , 2006, American journal of epidemiology.

[15]  S. Saw,et al.  Height and its relationship to refraction and biometry parameters in Singapore Chinese children. , 2002, Investigative ophthalmology & visual science.

[16]  J. Eriksson,et al.  The fetal origins hypothesis—10 years on , 2005, BMJ : British Medical Journal.

[17]  C. Power,et al.  Cohort profile: 1958 British birth cohort (National Child Development Study). , 2006, International journal of epidemiology.

[18]  C. Power,et al.  Are inequalities in height narrowing? Comparing effects of social class on height in two generations , 2004, Archives of Disease in Childhood.

[19]  T. Wong,et al.  Prevalence and risk factors for refractive errors in adult Chinese in Singapore. , 2000, Investigative ophthalmology & visual science.

[20]  Phil A. Silva,et al.  REFRACTIVE ERROR, IQ AND READING ABILITY: A LOIUGITUDINAL STUDY FROM AGE SEVEN TO 11 , 1988, Developmental medicine and child neurology.

[21]  R. Weale,et al.  Epidemiology of refractive errors and presbyopia. , 2003, Survey of ophthalmology.

[22]  J. Angle,et al.  The epidemiology of myopia. , 1980, American journal of epidemiology.

[23]  J. Eriksson,et al.  Trajectories of growth among children who have coronary events as adults. , 2005, The New England journal of medicine.

[24]  T. Cole,et al.  Body mass index and height from childhood to adulthood in the 1958 British born cohort. , 1997, The American journal of clinical nutrition.

[25]  H. Ohmi,et al.  Recent trend of increase in proportion of low birthweight infants in Japan. , 2001, International journal of epidemiology.

[26]  J. Javitt,et al.  The socioeconomic aspects of laser refractive surgery. , 1994, Archives of ophthalmology.

[27]  T. Cole The secular trend in human physical growth: a biological view. , 2003, Economics and human biology.

[28]  Paul Mitchell,et al.  The prevalence of refractive errors among adults in the United States, Western Europe, and Australia. , 2004, Archives of ophthalmology.

[29]  K. Mohammad,et al.  The age- and gender-specific prevalences of refractive errors in Tehran: the Tehran Eye Study , 2004, Ophthalmic epidemiology.

[30]  L. Joss-Moore,et al.  The developmental origins of adult disease , 2009, Current opinion in pediatrics.

[31]  S. Coren,et al.  Adult sensory capacities as a function of birth risk factors. , 1996, Journal of clinical and experimental neuropsychology.

[32]  Peter H Whincup,et al.  Ethnic differences in the prevalence of myopia and ocular biometry in 10- and 11-year-old children: the Child Heart and Health Study in England (CHASE). , 2010, Investigative ophthalmology & visual science.

[33]  T. Cole,et al.  Leg and trunk length at 43 years in relation to childhood health, diet and family circumstances; evidence from the 1946 national birth cohort. , 2002, International journal of epidemiology.

[34]  H. Goldstein,et al.  Acquired myopia in 11-year-old children. , 1977, British medical journal.

[35]  J. Katz,et al.  Incidence and progression of myopia in Singaporean school children. , 2005, Investigative ophthalmology & visual science.

[36]  Clyde Hertzman,et al.  Birth weight, childhood socioeconomic environment, and cognitive development in the 1958 British birth cohort study , 2002, BMJ : British Medical Journal.

[37]  D. Mutti,et al.  Age-related decreases in the prevalence of myopia: longitudinal change or cohort effect? , 2000, Investigative ophthalmology & visual science.

[38]  Arne Ohlendorf,et al.  The effect of ambient illuminance on the development of deprivation myopia in chicks. , 2009, Investigative ophthalmology & visual science.

[39]  E. Hyppönen,et al.  Parental growth at different life stages and offspring birthweight: an intergenerational cohort study. , 2004, Paediatric and perinatal epidemiology.

[40]  B Thylefors,et al.  A global initiative for the elimination of avoidable blindness. , 1998, Community eye health.

[41]  Susan Vitale,et al.  Prevalence of refractive error in the United States, 1999-2004. , 2008, Archives of ophthalmology.

[42]  S. Saw,et al.  Childhood myopia and parental smoking , 2004, British Journal of Ophthalmology.

[43]  M. Kramer,et al.  Small-for-gestational-age births among black and white women: temporal trends in the United States. , 2003, American journal of public health.

[44]  Earl L. Smith,et al.  Myopia: Recent Advances in Molecular Studies; Prevalence, Progression and Risk Factors; Emmetropization; Therapies; Optical Links; Peripheral Refraction; Sclera and Ocular Growth; Signalling Cascades; and Animal Models. , 2008 .

[45]  R. Klein,et al.  Measuring Refraction in Adults in Epidemiological Studies I N Epidemiological Studies Of , 2022 .

[46]  Paul Mitchell,et al.  Outdoor activity reduces the prevalence of myopia in children. , 2008, Ophthalmology.

[47]  P. Mitchell,et al.  The increasing prevalence of myopia: implications for Australia , 2001, Clinical & experimental ophthalmology.

[48]  S. Huttly,et al.  The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. , 1997, International journal of epidemiology.

[49]  L Dandona,et al.  Refractive error blindness. , 2001, Bulletin of the World Health Organization.

[50]  D. Strachan,et al.  Loss and representativeness in a biomedical survey at age 45 years: 1958 British birth cohort , 2008, Journal of Epidemiology & Community Health.

[51]  Y. Ben-Shlomo,et al.  A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives , 2002 .

[52]  D. Mutti,et al.  Parental history of myopia, sports and outdoor activities, and future myopia. , 2007, Investigative ophthalmology & visual science.