Tideman J Willem L, Polling Jan Roelof, Hofman Albert, Jaddoe Vincent Wv, Mackenbach Johan P, Klaver Caroline Cw
Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Br J Ophthalmol. 2018 Feb;102(2):243-247. doi: 10.1136/bjophthalmol-2017-310292. Epub 2017 Jun 12.
High myopia (≤-6 D) usually has its onset before 10 years of age and can lead to blinding complications later in life. We examined whether differences in myopia prevalences in socioeconomic risk groups could be explained by differences in lifestyle factors.
A total of 5711 six-year-old children participating in the prospective population-based birth cohort study Generation R underwent a stepwise ophthalmic examination, which included visual acuity and objective cycloplegic refraction to identify children with myopia (≤-0.5D). Daily activities, ethnicity, factors representing family socioeconomic status and housing were ascertained by questionnaire. Risk assessments of myopia and mediation analyses were performed using logistic regression; attenuation of risks was calculated by bootstrapping.
Prevalence of myopia was 2.4% (n=137). Myopic children spent more time indoors and less outdoors than non-myopic children (p<0.01), had lower vitamin D (p=0.01), had a higher body mass index and participated less in sports (p=0.03). Children of non-European descent (OR 2.60; 95% CI 1.84 to 3.68), low maternal education (OR 2.27; 95% CI 1.57 to 3.28) and low family income (OR 2.62; 95% CI 1.8 to 3.74) were more often myopic. Lifestyle factors explained the majority of the increased risk for ethnicity (82%; 95% CI 55 to 120), maternal education (69%; 95% CI 45 to 109) and family socioeconomic status (71%; 95% CI 46 to 104).
This study found environmental factors to be strong risk factors for myopia already at the age of 6 years. The myopia prevalence differences in socioeconomic groups were greatly determined by differences in distribution of these environmental risk factors, highlighting the importance of lifestyle adjustments in young children developing myopia.
高度近视（≤-6D）通常在10岁之前发病，可导致日后失明并发症。我们研究了社会经济风险群体中近视患病率的差异是否可以用生活方式因素的差异来解释。
共有5711名参与基于人群的前瞻性出生队列研究“R世代”的6岁儿童接受了逐步眼科检查，包括视力和客观睫状肌麻痹验光，以确定近视（≤-0.5D）儿童。通过问卷调查确定日常活动、种族、代表家庭社会经济地位和住房的因素。使用逻辑回归进行近视风险评估和中介分析；通过自抽样计算风险的衰减。
近视患病率为2.4%（n=137）。近视儿童比非近视儿童在室内花费的时间更多，在户外花费的时间更少（p<0.01），维生素D水平更低（p=0.01），体重指数更高，参加体育活动更少（p=0.03）。非欧洲血统的儿童（OR 2.60；95%CI 1.84至3.68）、母亲教育程度低（OR 2.27；95%CI 1.57至3.28）和家庭收入低（OR 2.62；95%CI 1.8至3.74）的儿童更常患近视。生活方式因素解释了种族（82%；95%CI 55至120）、母亲教育程度（69%；95%CI 45至109）和家庭社会经济地位（71%；95%CI 46至104）增加风险的大部分。
本研究发现环境因素在6岁时就是近视的强风险因素。社会经济群体中近视患病率的差异很大程度上取决于这些环境风险因素分布的差异，突出了生活方式调整对患近视幼儿的重要性。
