Myopia prevalence and ocular biometry in children and adolescents at different altitudes: a cross-sectional study in Chongqing and Tibet, China

• Published in: BMJ open Vol. 14; no. 5; p. e078018
• Main Authors: Xiang, Yongguo, Cheng, Hong, Sun, Kexin, Zheng, Shijie, Du, Miaomiao, Gao, Ning, Zhang, Tong, Yang, Xin, Xia, Jiuyi, Huang, Rongxi, Wan, Wenjuan, Hu, Ke
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 01.05.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Adolescent; Age; Altitude; Astigmatism; Axial Length, Eye - diagnostic imaging; Biometrics; Biometry; Child; China - epidemiology; Cornea; Cornea - anatomy & histology; Cornea - diagnostic imaging; Cornea - pathology; Corneal and external diseases; Cross-Sectional Studies; EPIDEMIOLOGIC STUDIES; Female; Humans; Intraocular Pressure - physiology; Investigations; Male; Medical ophthalmology; Middle schools; Myopia; Myopia - epidemiology; Ophthalmology; Paediatric ophthalmology; Pediatrics; Prevalence; Refraction, Ocular - physiology; Regression analysis; Secondary schools; Statistical analysis; Students; Teenagers; Tibet - epidemiology; Visual Acuity; Tibet; China; Tibetan Plateau; Japan; Medical ophthalmology; Corneal and external diseases; EPIDEMIOLOGIC STUDIES; Paediatric ophthalmology
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-078018

ObjectiveTo investigate the differences in myopia prevalence and ocular biometry in children and adolescents in Chongqing and Tibet, China.DesignCross-sectional study.SettingThe study included children and adolescents aged 6–18 years in Chongqing, a low-altitude region, and in Qamdo, a high-altitude region of Tibet.ParticipantsA total of 448 participants in Qamdo, Tibet, and 748 participants in Chongqing were enrolled in this study.MethodsAll participants underwent uncorrected visual acuity assessment, non-cycloplegic refraction, axial length (AL) measurement, intraocular pressure (IOP) measurement and corneal tomography. And the participants were grouped according to age (6–8, 9–11, 12–14 and 15–18 years group), and altitude of location (primary school students: group A (average altitude: 325 m), group B (average altitude: 2300 m), group C (average altitude: 3250 and 3170 m) and group D (average altitude: 3870 m)).ResultsThere was no statistical difference in mean age (12.09±3.15 vs 12.2±3.10, p=0.549) and sex distribution (males, 50.4% vs 47.6%, p=0.339) between the two groups. The Tibet group presented greater spherical equivalent (SE, −0.63 (−2.00, 0.13) vs −0.88 (−2.88, –0.13), p<0.001), shorter AL (23.45±1.02 vs 23.92±1.19, p<0.001), lower prevalence of myopia (39.7% vs 47.6%, p=0.008) and flatter mean curvature power of the cornea (Km, 43.06±1.4 vs 43.26±1.36, p=0.014) than the Chongqing group. Further analysis based on age subgroups revealed that the Tibet group had a lower prevalence of myopia and higher SE in the 12–14, and 15–18 years old groups, shorter AL in the 9–11, 12–14 and 15–18 years old groups, and lower AL to corneal radius of curvature ratio (AL/CR) in all age subgroups compared with the Chongqing group, while Km was similar between the two groups in each age subgroup. Simple linear regression analysis showed that SE decreased with age in both the Tibet and Chongqing groups, with the Tibet group exhibiting a slower rate of decrease (p<0.001). AL and AL/CR increased with age in both the Tibet and Chongqing groups, but the rate of increase was slower in the Tibet group (p<0.001 of both). Multiple linear regression analysis revealed that AL had the greatest effect on SE in both groups, followed by Km. In addition, the children and adolescents in Tibet presented thinner corneal thickness (CCT, p<0.001), smaller white to white distance (WTW, p<0.001), lower IOP (p<0.001) and deeper anterior chamber depth (ACD, p=0.015) than in Chongqing. Comparison of altitude subgroups showed that the prevalence of myopia (p=0.002), SE (p=0.031), AL (p=0.001) and AL/CR (p<0.001) of children at different altitudes was statistically different but the Km (p=0.189) were similar. The highest altitude, Tengchen County, exhibited the lowest prevalence of myopia and greatest SE among children, and the mean AL also decreased with increasing altitude.ConclusionsMyopia prevalence in Tibet was comparable with that in Chongqing for students aged 6–8 and 9–11 years but was lower and myopia progressed more slowly for students aged 12–14 and 15–18 years than in Chongqing, and AL was the main contributor for this difference, which may be related to higher ultraviolet radiation exposure and lower IOP in children and adolescents at high altitude in Tibet. Differences in AL and AL/CR between Tibet and Chongqing children and adolescents manifested earlier than in SE, underscoring the importance of AL measurement in myopia screening.