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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.

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.

Authors

Katie M. Williams, MPhil, FRCOphth, Geir Bertelsen, MD, PhD, Phillippa Cumberland, MSc, Christian Wolfram, Virginie J.M. Verhoeven, MD, MSc, Eleftherios Anastasopoulos, MD, Gabriëlle H.S. Buitendijk, MD, MSc, Audrey Cougnard-Grégoire, PhD, Catherine Creuzot-Garcher, MD, PhD, Maja Gran Erke, MD, PhD, Ruth Hogg, PhD, René Höhn, MD, Pirro Hysi, MD, PhD, Anthony P. Khawaja, MPhil, FRCOphth, Jean-François Korobelnik, MD, Janina Ried, PhD, Johannes R. Vingerling, MD, PhD, Alain Bron, MD.

Published in

Ophthalmology, the journal of the American Academy of Ophthalmology, May 2015

Access full paper at http://www.sciencedirect.com/science/article/pii/S0161642015002808

Abstract

To estimate the prevalence of refractive error in adults across Europe. Refractive data (mean spherical equivalent) collected between 1990 and 2013 from fifteen population-based cohort and cross-sectional studies of the European Eye Epidemiology (E3) Consortium were combined in a random effects meta-analysis stratified by 5-year age intervals and gender. Participants were excluded if they were identified as having had cataract surgery, retinal detachment, refractive surgery or other factors that might influence refraction. Estimates of refractive error prevalence were obtained including the following classifications: myopia ≤−0.75 diopters (D), high myopia ≤−6D, hyperopia ≥1D and astigmatism ≥1D. Meta-analysis of refractive error was performed for 61,946 individuals from fifteen studies with median age ranging from 44 to 81 and minimal ethnic variation (98 % European ancestry).

The age-standardised prevalences (using the 2010 European Standard Population, limited to those ≥25 and <90 years old) were: myopia 30.6 % [95 % confidence interval (CI) 30.4–30.9], high myopia 2.7 % (95 % CI 2.69–2.73), hyperopia 25.2 % (95 % CI 25.0–25.4) and astigmatism 23.9 % (95 % CI 23.7–24.1). Age-specific estimates revealed a high prevalence of myopia in younger participants [47.2 % (CI 41.8–52.5) in 25–29 years-olds].

Refractive error affects just over a half of European adults. The greatest burden of refractive error is due to myopia, with high prevalence rates in young adults. Using the 2010 European population estimates, we estimate there are 227.2 million people with myopia across Europe.

Authors

Katie M. Williams, Virginie J. M. Verhoeven, Phillippa Cumberland, Geir Bertelsen, Christian Wolfram, Gabriëlle H. S. Buitendijk, Albert Hofman, Cornelia M. van Duijn, Johannes R. Vingerling, Robert W. A. M. Kuijpers, René Höhn, Alireza Mirshahi, Anthony P. Khawaja, Robert N. Luben, Maja Gran Erke, Therese von Hanno, Omar Mahroo, Ruth Hogg, Christian Gieger, Audrey Cougnard-Grégoire, Eleftherios Anastasopoulos, Alain Bron, Jean-François Dartigues, Jean-François Korobelnik, Catherine Creuzot-Garcher, Fotis Topouzis, Cécile Delcourt, Jugnoo Rahi, Thomas Meitinger, Astrid Fletcher, Paul J. Foster, Norbert Pfeiffer, Caroline C. W. Klaver, and Christopher J. Hammond.

Published in

European Journal of Epidemiology (2015) 30:305–315.

Access full paper at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385146/