A review on the epidemiology of myopia in school children worldwide

Andrzej Grzybowski, Piotr Kanclerz, Kazuo Tsubota, Carla Lanca, Seang-Mei Saw, Andrzej Grzybowski, Piotr Kanclerz, Kazuo Tsubota, Carla Lanca, Seang-Mei Saw

Abstract

Background: Due to high prevalence myopia has gained importance in epidemiological studies. Children with early onset are at particular risk of complications associated with myopia, as progression over time might result in high myopia and myopic macular degeneration. Both genetic and environmental factors play a role in the increasing prevalence of myopia. The aim of this study is to review the current literature on epidemiology and risk factors for myopia in school children (aged 6-19 years) around the world.

Main body: PubMed and Medline were searched for the following keywords: prevalence, incidence, myopia, refractive error, risk factors, children and visual impairment. English language articles published between Jan 2013 and Mar 2019 were included in the study. Studies were critically reviewed for study methodology and robustness of data. Eighty studies were included in this literature review. Myopia prevalence remains higher in Asia (60%) compared with Europe (40%) using cycloplegic refraction examinations. Studies reporting on non-cycloplegic measurements show exceptionally high myopia prevalence rates in school children in East Asia (73%), and high rates in North America (42%). Low prevalence under 10% was described in African and South American children. In recent studies, risk factors for myopia in schoolchildren included low outdoor time and near work, dim light exposure, the use of LED lamps for homework, low sleeping hours, reading distance less than 25 cm and living in an urban environment.

Conclusion: Low levels of outdoor activity and near work are well-established risk factors for myopia; this review provides evidence on additional environmental risk factors. New epidemiological studies should be carried out on implementation of public health strategies to tackle and avoid myopia. As the myopia prevalence rates in non-cycloplegic studies are overestimated, we recommend considering only cycloplegic measurements.

Keywords: Children; Epidemiology; Myopia; Risk factors.

Conflict of interest statement

Dr. Grzybowski reports grants, personal fees and non-financial support from Bayer, non-financial support from Novartis, non-financial support from Alcon, non-financial support from Thea, personal fees and non-financial support from Valeant, non-financial support from Santen, outside the submitted work. Dr. Kanclerz reports non-financial support from Visim. Dr. Tsubota reports grant support from Jins, Inc., Toshiba Materials Co., Ltd., Asahi Glass, Rohto, Toray and Plus One Marketing; in addition, patents are pending with Jins, Inc., Asahi Glass, Toshiba Materials Co., Ltd. for myopia prevention-related devices. Dr. Carla Lanca and Dr. Seang-Mei Saw have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Geographical and age breakdown in myopia prevalence (cycloplegic measurements). Maps were adapted from Bing©GeoNames, HERE, MSFT, Microsoft, NavInfo, Thinkware Extract, Wikipedia
Fig. 2
Fig. 2
Geographical and age breakdown in myopia prevalence (non-cycloplegic measurements). Maps were adapted from Bing©GeoNames, HERE, MSFT, Microsoft, NavInfo, Thinkware Extract, Wikipedia

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