The epidemics of myopia: Aetiology and prevention
There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80–90%, and an accompanying high prevalence of high myopia in young adults (10–20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epide...
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| Published in | Progress in retinal and eye research Vol. 62; pp. 134 - 149 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Elsevier Ltd
01.01.2018
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| Subjects | |
| Online Access | Get full text |
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| Abstract | There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80–90%, and an accompanying high prevalence of high myopia in young adults (10–20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epidemics are linked, since the increasingly early onset of myopia, combined with high progression rates, naturally generates an epidemic of high myopia, with high prevalences of “acquired” high myopia appearing around the age of 11–13. The major risk factors identified are intensive education, and limited time outdoors. The localization of the epidemic appears to be due to the high educational pressures and limited time outdoors in the region, rather than to genetically elevated sensitivity to these factors. Causality has been demonstrated in the case of time outdoors through randomized clinical trials in which increased time outdoors in schools has prevented the onset of myopia. In the case of educational pressures, evidence of causality comes from the high prevalence of myopia and high myopia in Jewish boys attending Orthodox schools in Israel compared to their sisters attending religious schools, and boys and girls attending secular schools. Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge. Reforms to the organization of school systems to reduce intense early competition for accelerated learning pathways may also be important.
•There is an epidemic of myopia in the developed countries of East and Southeast Asia.•A related epidemic of high myopia is due to early onset myopia and rapid myopic progression.•There is a new and highly prevalent form of high myopia, which is acquired rather than genetic.•Intense education and limited time outdoors play major causal roles in both epidemics.•These modifiable risk factors are already being used in schools to contain the epidemics. |
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| AbstractList | There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80-90%, and an accompanying high prevalence of high myopia in young adults (10-20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epidemics are linked, since the increasingly early onset of myopia, combined with high progression rates, naturally generates an epidemic of high myopia, with high prevalences of "acquired" high myopia appearing around the age of 11-13. The major risk factors identified are intensive education, and limited time outdoors. The localization of the epidemic appears to be due to the high educational pressures and limited time outdoors in the region, rather than to genetically elevated sensitivity to these factors. Causality has been demonstrated in the case of time outdoors through randomized clinical trials in which increased time outdoors in schools has prevented the onset of myopia. In the case of educational pressures, evidence of causality comes from the high prevalence of myopia and high myopia in Jewish boys attending Orthodox schools in Israel compared to their sisters attending religious schools, and boys and girls attending secular schools. Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge. Reforms to the organization of school systems to reduce intense early competition for accelerated learning pathways may also be important. There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80-90%, and an accompanying high prevalence of high myopia in young adults (10-20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epidemics are linked, since the increasingly early onset of myopia, combined with high progression rates, naturally generates an epidemic of high myopia, with high prevalences of "acquired" high myopia appearing around the age of 11-13. The major risk factors identified are intensive education, and limited time outdoors. The localization of the epidemic appears to be due to the high educational pressures and limited time outdoors in the region, rather than to genetically elevated sensitivity to these factors. Causality has been demonstrated in the case of time outdoors through randomized clinical trials in which increased time outdoors in schools has prevented the onset of myopia. In the case of educational pressures, evidence of causality comes from the high prevalence of myopia and high myopia in Jewish boys attending Orthodox schools in Israel compared to their sisters attending religious schools, and boys and girls attending secular schools. Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge. Reforms to the organization of school systems to reduce intense early competition for accelerated learning pathways may also be important.There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80-90%, and an accompanying high prevalence of high myopia in young adults (10-20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epidemics are linked, since the increasingly early onset of myopia, combined with high progression rates, naturally generates an epidemic of high myopia, with high prevalences of "acquired" high myopia appearing around the age of 11-13. The major risk factors identified are intensive education, and limited time outdoors. The localization of the epidemic appears to be due to the high educational pressures and limited time outdoors in the region, rather than to genetically elevated sensitivity to these factors. Causality has been demonstrated in the case of time outdoors through randomized clinical trials in which increased time outdoors in schools has prevented the onset of myopia. In the case of educational pressures, evidence of causality comes from the high prevalence of myopia and high myopia in Jewish boys attending Orthodox schools in Israel compared to their sisters attending religious schools, and boys and girls attending secular schools. Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge. Reforms to the organization of school systems to reduce intense early competition for accelerated learning pathways may also be important. There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80–90%, and an accompanying high prevalence of high myopia in young adults (10–20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epidemics are linked, since the increasingly early onset of myopia, combined with high progression rates, naturally generates an epidemic of high myopia, with high prevalences of “acquired” high myopia appearing around the age of 11–13. The major risk factors identified are intensive education, and limited time outdoors. The localization of the epidemic appears to be due to the high educational pressures and limited time outdoors in the region, rather than to genetically elevated sensitivity to these factors. Causality has been demonstrated in the case of time outdoors through randomized clinical trials in which increased time outdoors in schools has prevented the onset of myopia. In the case of educational pressures, evidence of causality comes from the high prevalence of myopia and high myopia in Jewish boys attending Orthodox schools in Israel compared to their sisters attending religious schools, and boys and girls attending secular schools. Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge. Reforms to the organization of school systems to reduce intense early competition for accelerated learning pathways may also be important. •There is an epidemic of myopia in the developed countries of East and Southeast Asia.•A related epidemic of high myopia is due to early onset myopia and rapid myopic progression.•There is a new and highly prevalent form of high myopia, which is acquired rather than genetic.•Intense education and limited time outdoors play major causal roles in both epidemics.•These modifiable risk factors are already being used in schools to contain the epidemics. |
| Author | Ashby, Regan S. Guo, Xinxing Ding, Xiaohu French, Amanda N. He, Mingguang Rose, Kathryn A. Morgan, Ian G. |
| Author_xml | – sequence: 1 givenname: Ian G. orcidid: 0000-0002-4548-3574 surname: Morgan fullname: Morgan, Ian G. email: ian.morgan@anu.edu.au organization: Division of Biochemistry and Molecular Biology, Research School of Biology, Australian National University, Canberra, ACT, Australia – sequence: 2 givenname: Amanda N. orcidid: 0000-0001-8114-8127 surname: French fullname: French, Amanda N. organization: Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia – sequence: 3 givenname: Regan S. orcidid: 0000-0002-8027-6490 surname: Ashby fullname: Ashby, Regan S. organization: Centre for Research in Therapeutic Solutions, Biomedical Sciences, Faulty of Education, Science, Technology and Mathematics, University of Canberra, Canberra, Australia – sequence: 4 givenname: Xinxing surname: Guo fullname: Guo, Xinxing organization: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, China – sequence: 5 givenname: Xiaohu surname: Ding fullname: Ding, Xiaohu organization: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, China – sequence: 6 givenname: Mingguang orcidid: 0000-0002-6912-2810 surname: He fullname: He, Mingguang organization: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yatsen University, Guangzhou, China – sequence: 7 givenname: Kathryn A. surname: Rose fullname: Rose, Kathryn A. organization: Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28951126$$D View this record in MEDLINE/PubMed |
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| Snippet | There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80–90%, and an accompanying high prevalence of... There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80-90%, and an accompanying high prevalence of... |
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| SubjectTerms | Asia - epidemiology Atropine Control Disease Progression Dopamine Education Environment High myopia Humans Myopia Myopia - epidemiology Myopia - etiology Myopia, Degenerative - epidemiology Optical devices Orthokeratology Pathological myopia Prevalence Prevention Risk Factors Schools Time outdoors |
| Title | The epidemics of myopia: Aetiology and prevention |
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