MRC Centre of Epidemiology for Child Health, Institute of Child Health, University College London, London WC1N 1EH, UK.
Ophthalmology. 2011 May;118(5):797-804. doi: 10.1016/j.ophtha.2010.09.025. Epub 2010 Dec 24.
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.
Cohort study.
A total of 2487 randomly selected 44-year-old members of the 1958 British birth cohort (27% subsample).
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.
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).
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.
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.
研究假设认为，近视的眼球过度生长与整体生长有关，因此受生命早期生物和社会因素的影响，这些关联是近视患病率和严重程度最近出现的长期趋势的基础。
队列研究。
共 2487 名随机抽取的 44 岁 1958 年英国出生队列成员（27%的子样本）。
自出生以来，通过一系列临床检查或由经过培训的检查人员进行的面对面访谈，对成员进行了多样化和详细的生物、社会和生活方式数据收集。在 44 岁时，队列成员在非睫状肌麻痹条件下使用尼康 Retinomax 2（尼康公司，日本东京）进行自动折射。采用基于 4 个连续多变量“生命阶段”模型（受孕前；产前、围产期和产后；儿童期；和成年期）的生命历程流行病学方法，研究了生命早期的生物、社会和生活方式因素、生长模式以及“眼睛特异性”因素对近视的影响。
近视严重程度（所有、轻度/中度：等效球镜 -0.75 至-5.99 屈光度[D]；重度：≥-6.00 D 极近视与正视 -0.74 至+0.99 D）和近视发病时间（早期[<16 岁]与晚期）。
共有 1214 人（49%；95%置信区间，48.8-50.8）为近视（979 人[80.6%]为晚发性）。近视与低出生体重有关，与胎龄、性别、母亲年龄较大、父亲职业社会阶层较高以及母亲在妊娠早期吸烟有关。近视与近用工作和教育成绩的替代标志物独立相关，与发病时间和严重程度有关。在成年人中，身高较高、教育程度和社会经济地位较高与近视有关。
本研究确定了对儿童健康和生长有重要影响的新的潜在危险因素，这些趋势与近视的全球趋势一致：母亲生育年龄增大、宫内生长迟缓发生率和受影响儿童存活率增加、妊娠期间持续吸烟率增加以及社会经济地位变化。通过在大型未选择人群中应用生命历程和遗传流行病学方法，转变近视研究的范式，将改善近视的预防前景。
