Current Prevalence of Myopia and Association of Myopia with Environmental Factors among Schoolchildren in Japan

Erisa Yotsukura, Hidemasa Torii, Mikako Inokuchi, Mitsuaki Tokumura, Miki Uchino, Kyosei Nakamura, Mari Hyodo, Kiwako Mori, Xiaoyan Jiang, Shin Ichi Ikeda, Shinichiro Kondo, Kazuno Negishi, Toshihide Kurihara, Kazuo Tsubota

Research output: Contribution to journalArticle

Abstract

Importance: Given the estimates of increasing prevalence of myopia, especially in Asia, it is important to determine the current prevalence of myopia among populations of schoolchildren in Japan. Objective: To investigate the current prevalence rate of myopia and the association between environmental factors and myopia in Japanese schoolchildren. Design, Setting, and Participants: This cross-sectional study assessed 1478 participants, including 726 elementary school students and 752 junior high school students, at 2 schools in Tokyo, Japan, who underwent eye examinations from April 1 to May 31, 2017, that included measurement of the refractive errors by autorefractometry with noncycloplegic refraction and ocular biometric factors. After excluding those who had been treated with atropine or orthokeratology (n = 11), had a history of eye disease (n = 2), had no parental consent (n = 41), and were absent (n = 8), 1416 schoolchildren were analyzed. Main Outcomes and Measures: The primary outcome was the prevalence of myopia and high myopia. Secondary outcomes were environmental factors that were associated with myopia. Results: A total of 1416 schoolchildren (mean [SD] age, 10.8 [2.7] years; 792 [55.9%] male) were studied. The prevalence rates of myopia (spherical equivalent ≤-0.5 diopters [D]) were 76.5% (95% CI, 73.4%-79.7%) among the elementary school students and 94.9% (95% CI, 93.3%-96.5%) among the junior high school students. The prevalence rates of high myopia (spherical equivalent ≤-6.0 D) were 4.0% (95% CI, 2.5%-5.4%) among the elementary school students and 11.3% (95% CI, 8.8%-13.7%) among the junior high school students. The prevalence rates of high myopia classified based on axial length of 26.0 mm or longer were 1.2% (95% CI, 0.4%-2.0%) among elementary school students and 15.2% (95% CI, 12.5%-17.8%) among junior high school students. Multiple regression analysis showed that higher-order aberrations and dry eye disease were associated with refractive error in elementary school students (spherical aberration: β = 6.152; 95% CI, 3.161-9.143; P <.001; dry eye disease: β = -0.626; 95% CI, -1.189 to -0.063; P =.03) and with axial length in junior high school students (spherical-like aberration: β = 26.546; 95% CI, 18.708-34.385; P <.001; dry eye disease: β = 0.354; 95% CI, 0.131-0.578; P <.002). Conclusions and Relevance: Although the use of noncycloplegic autorefraction with a cutoff of -0.50 D could lead to overestimation of results, these findings suggest that the current prevalence rates of myopia among elementary and junior high school students in Asia are high, especially if the results from these 2 schools are generalizable to all schoolchildren in Japan and Asia..

Original languageEnglish
JournalJAMA Ophthalmology
DOIs
Publication statusAccepted/In press - 2019 Jan 1

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Myopia
Japan
Students
Eye Diseases
Refractive Errors
Ocular Refraction
Parental Consent
Tokyo
Atropine
Cross-Sectional Studies
Regression Analysis
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

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Current Prevalence of Myopia and Association of Myopia with Environmental Factors among Schoolchildren in Japan. / Yotsukura, Erisa; Torii, Hidemasa; Inokuchi, Mikako; Tokumura, Mitsuaki; Uchino, Miki; Nakamura, Kyosei; Hyodo, Mari; Mori, Kiwako; Jiang, Xiaoyan; Ikeda, Shin Ichi; Kondo, Shinichiro; Negishi, Kazuno; Kurihara, Toshihide; Tsubota, Kazuo.

In: JAMA Ophthalmology, 01.01.2019.

Research output: Contribution to journalArticle

Yotsukura, Erisa ; Torii, Hidemasa ; Inokuchi, Mikako ; Tokumura, Mitsuaki ; Uchino, Miki ; Nakamura, Kyosei ; Hyodo, Mari ; Mori, Kiwako ; Jiang, Xiaoyan ; Ikeda, Shin Ichi ; Kondo, Shinichiro ; Negishi, Kazuno ; Kurihara, Toshihide ; Tsubota, Kazuo. / Current Prevalence of Myopia and Association of Myopia with Environmental Factors among Schoolchildren in Japan. In: JAMA Ophthalmology. 2019.
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abstract = "Importance: Given the estimates of increasing prevalence of myopia, especially in Asia, it is important to determine the current prevalence of myopia among populations of schoolchildren in Japan. Objective: To investigate the current prevalence rate of myopia and the association between environmental factors and myopia in Japanese schoolchildren. Design, Setting, and Participants: This cross-sectional study assessed 1478 participants, including 726 elementary school students and 752 junior high school students, at 2 schools in Tokyo, Japan, who underwent eye examinations from April 1 to May 31, 2017, that included measurement of the refractive errors by autorefractometry with noncycloplegic refraction and ocular biometric factors. After excluding those who had been treated with atropine or orthokeratology (n = 11), had a history of eye disease (n = 2), had no parental consent (n = 41), and were absent (n = 8), 1416 schoolchildren were analyzed. Main Outcomes and Measures: The primary outcome was the prevalence of myopia and high myopia. Secondary outcomes were environmental factors that were associated with myopia. Results: A total of 1416 schoolchildren (mean [SD] age, 10.8 [2.7] years; 792 [55.9{\%}] male) were studied. The prevalence rates of myopia (spherical equivalent ≤-0.5 diopters [D]) were 76.5{\%} (95{\%} CI, 73.4{\%}-79.7{\%}) among the elementary school students and 94.9{\%} (95{\%} CI, 93.3{\%}-96.5{\%}) among the junior high school students. The prevalence rates of high myopia (spherical equivalent ≤-6.0 D) were 4.0{\%} (95{\%} CI, 2.5{\%}-5.4{\%}) among the elementary school students and 11.3{\%} (95{\%} CI, 8.8{\%}-13.7{\%}) among the junior high school students. The prevalence rates of high myopia classified based on axial length of 26.0 mm or longer were 1.2{\%} (95{\%} CI, 0.4{\%}-2.0{\%}) among elementary school students and 15.2{\%} (95{\%} CI, 12.5{\%}-17.8{\%}) among junior high school students. Multiple regression analysis showed that higher-order aberrations and dry eye disease were associated with refractive error in elementary school students (spherical aberration: β = 6.152; 95{\%} CI, 3.161-9.143; P <.001; dry eye disease: β = -0.626; 95{\%} CI, -1.189 to -0.063; P =.03) and with axial length in junior high school students (spherical-like aberration: β = 26.546; 95{\%} CI, 18.708-34.385; P <.001; dry eye disease: β = 0.354; 95{\%} CI, 0.131-0.578; P <.002). Conclusions and Relevance: Although the use of noncycloplegic autorefraction with a cutoff of -0.50 D could lead to overestimation of results, these findings suggest that the current prevalence rates of myopia among elementary and junior high school students in Asia are high, especially if the results from these 2 schools are generalizable to all schoolchildren in Japan and Asia..",
author = "Erisa Yotsukura and Hidemasa Torii and Mikako Inokuchi and Mitsuaki Tokumura and Miki Uchino and Kyosei Nakamura and Mari Hyodo and Kiwako Mori and Xiaoyan Jiang and Ikeda, {Shin Ichi} and Shinichiro Kondo and Kazuno Negishi and Toshihide Kurihara and Kazuo Tsubota",
year = "2019",
month = "1",
day = "1",
doi = "10.1001/jamaophthalmol.2019.3103",
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TY - JOUR

T1 - Current Prevalence of Myopia and Association of Myopia with Environmental Factors among Schoolchildren in Japan

AU - Yotsukura, Erisa

AU - Torii, Hidemasa

AU - Inokuchi, Mikako

AU - Tokumura, Mitsuaki

AU - Uchino, Miki

AU - Nakamura, Kyosei

AU - Hyodo, Mari

AU - Mori, Kiwako

AU - Jiang, Xiaoyan

AU - Ikeda, Shin Ichi

AU - Kondo, Shinichiro

AU - Negishi, Kazuno

AU - Kurihara, Toshihide

AU - Tsubota, Kazuo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Importance: Given the estimates of increasing prevalence of myopia, especially in Asia, it is important to determine the current prevalence of myopia among populations of schoolchildren in Japan. Objective: To investigate the current prevalence rate of myopia and the association between environmental factors and myopia in Japanese schoolchildren. Design, Setting, and Participants: This cross-sectional study assessed 1478 participants, including 726 elementary school students and 752 junior high school students, at 2 schools in Tokyo, Japan, who underwent eye examinations from April 1 to May 31, 2017, that included measurement of the refractive errors by autorefractometry with noncycloplegic refraction and ocular biometric factors. After excluding those who had been treated with atropine or orthokeratology (n = 11), had a history of eye disease (n = 2), had no parental consent (n = 41), and were absent (n = 8), 1416 schoolchildren were analyzed. Main Outcomes and Measures: The primary outcome was the prevalence of myopia and high myopia. Secondary outcomes were environmental factors that were associated with myopia. Results: A total of 1416 schoolchildren (mean [SD] age, 10.8 [2.7] years; 792 [55.9%] male) were studied. The prevalence rates of myopia (spherical equivalent ≤-0.5 diopters [D]) were 76.5% (95% CI, 73.4%-79.7%) among the elementary school students and 94.9% (95% CI, 93.3%-96.5%) among the junior high school students. The prevalence rates of high myopia (spherical equivalent ≤-6.0 D) were 4.0% (95% CI, 2.5%-5.4%) among the elementary school students and 11.3% (95% CI, 8.8%-13.7%) among the junior high school students. The prevalence rates of high myopia classified based on axial length of 26.0 mm or longer were 1.2% (95% CI, 0.4%-2.0%) among elementary school students and 15.2% (95% CI, 12.5%-17.8%) among junior high school students. Multiple regression analysis showed that higher-order aberrations and dry eye disease were associated with refractive error in elementary school students (spherical aberration: β = 6.152; 95% CI, 3.161-9.143; P <.001; dry eye disease: β = -0.626; 95% CI, -1.189 to -0.063; P =.03) and with axial length in junior high school students (spherical-like aberration: β = 26.546; 95% CI, 18.708-34.385; P <.001; dry eye disease: β = 0.354; 95% CI, 0.131-0.578; P <.002). Conclusions and Relevance: Although the use of noncycloplegic autorefraction with a cutoff of -0.50 D could lead to overestimation of results, these findings suggest that the current prevalence rates of myopia among elementary and junior high school students in Asia are high, especially if the results from these 2 schools are generalizable to all schoolchildren in Japan and Asia..

AB - Importance: Given the estimates of increasing prevalence of myopia, especially in Asia, it is important to determine the current prevalence of myopia among populations of schoolchildren in Japan. Objective: To investigate the current prevalence rate of myopia and the association between environmental factors and myopia in Japanese schoolchildren. Design, Setting, and Participants: This cross-sectional study assessed 1478 participants, including 726 elementary school students and 752 junior high school students, at 2 schools in Tokyo, Japan, who underwent eye examinations from April 1 to May 31, 2017, that included measurement of the refractive errors by autorefractometry with noncycloplegic refraction and ocular biometric factors. After excluding those who had been treated with atropine or orthokeratology (n = 11), had a history of eye disease (n = 2), had no parental consent (n = 41), and were absent (n = 8), 1416 schoolchildren were analyzed. Main Outcomes and Measures: The primary outcome was the prevalence of myopia and high myopia. Secondary outcomes were environmental factors that were associated with myopia. Results: A total of 1416 schoolchildren (mean [SD] age, 10.8 [2.7] years; 792 [55.9%] male) were studied. The prevalence rates of myopia (spherical equivalent ≤-0.5 diopters [D]) were 76.5% (95% CI, 73.4%-79.7%) among the elementary school students and 94.9% (95% CI, 93.3%-96.5%) among the junior high school students. The prevalence rates of high myopia (spherical equivalent ≤-6.0 D) were 4.0% (95% CI, 2.5%-5.4%) among the elementary school students and 11.3% (95% CI, 8.8%-13.7%) among the junior high school students. The prevalence rates of high myopia classified based on axial length of 26.0 mm or longer were 1.2% (95% CI, 0.4%-2.0%) among elementary school students and 15.2% (95% CI, 12.5%-17.8%) among junior high school students. Multiple regression analysis showed that higher-order aberrations and dry eye disease were associated with refractive error in elementary school students (spherical aberration: β = 6.152; 95% CI, 3.161-9.143; P <.001; dry eye disease: β = -0.626; 95% CI, -1.189 to -0.063; P =.03) and with axial length in junior high school students (spherical-like aberration: β = 26.546; 95% CI, 18.708-34.385; P <.001; dry eye disease: β = 0.354; 95% CI, 0.131-0.578; P <.002). Conclusions and Relevance: Although the use of noncycloplegic autorefraction with a cutoff of -0.50 D could lead to overestimation of results, these findings suggest that the current prevalence rates of myopia among elementary and junior high school students in Asia are high, especially if the results from these 2 schools are generalizable to all schoolchildren in Japan and Asia..

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