Risk Factors in Childhood Myopia Progression

Öz

Objective: The aim of this study was to investigate the risk factors associated with myopia progression during childhood.

Methods: This study included 185 eyes of 185 pediatric patients. Baseline and one-year cycloplegic refraction measurements were recorded. A questionnaire was completed by the parents of all participants. A change in the spherical equivalent of refraction (SER) of < −0.50 diopters (D) between the two visits was considered significant myopic progression.

Results: A total of 185 pediatric patients were evaluated. The mean SER change was −0.38 ± 0.13 D in the non-significant myopic progression group and −0.95 ± 0.24 D in the significant myopic progression group (p < 0.001). A statistically significant difference was observed between the two groups in terms of daily study time and duration of mobile phone use, time spent outdoors, parental history of myopia, presence of allergic conjunctivitis, gestational age, and vegetable-based diet (p < 0.001, p = 0.032, p < 0.001, p = 0.007, p = 0.039, p = 0.006, p = 0.030, respectively). According to multivariate regression analysis, increased daily study time (OR =2.21, 95% CI :1.52–3.20, p < 0.001), increased daily mobile phone use (OR = 2.04, 95% CI :1.42–2.94, p < 0.001), higher gestational age (OR = 1.34, 95% CI: 1.04–1.73, p = 0.022), and parental myopia (OR = 2.46, 95% CI: 1.17–5.18, p = 0.018) were significantly associated with myopic progression.

Conclusions: Myopia progression is closely associated with environmental factors. Appropriate interventions targeting these factors may reduce the rate of progression.

Anahtar Kelimeler

• environmental factors
• myopia progression
• pediatric myopia
• refractive errors
• risk factors

Kaynakça

1. Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology 2016;123(5):1036-42. doi: 10.1016/j.ophtha.2016.01.006. google scholar
2. Saw SM, Gazzard G, Shih-Yen EC, Chua WH. Myopia and associated pathological complications. Ophthalmic Physiol Opt 2005;25(5):381-91. doi: 10.1111/ j.1475-1313.2005.00298.x. google scholar
3. Takashima T, Yokoyama T, Futagami S, Ohno-Matsui K, Tanaka H, Tokoro T, et al. The quality of life in patients with pathologic myopia. Jpn J Ophthalmol 2001;45(1):84–92. doi: 10.1016/s0021-5155(00)00305-1. google scholar
4. Naidoo KS, Fricke TR, Frick KD, Jong M, Naduvilath TJ, Resnikoff S, et al. Potential lost productivity resulting from the global burden of myopia: systematic review, meta-analysis, and modeling. Ophthalmology 2019;126(3):338–46. doi: 10.1016/ j.ophtha.2018.10.029. google scholar
5. Morgan I, Rose K. How genetic is school myopia? Prog Retin Eye Res 2005;24(1):1-38. doi: 10.1016/j.preteyeres.2004.06.004. google scholar
6. Goldschmidt E. The mystery of myopia. Acta Ophthalmol Scand 2003;81(5):431-6. doi: 10.1034/j.1600-0420.2003.00145.x. google scholar
7. Cai XB, Shen SR, Chen DF, Zhang Q, Jin ZB. An overview of myopia genetics. Exp Eye Res 2019:188:107778. doi: 10.1016/j.exer.2019.107778. google scholar
8. Saw SM, Chua WH, Hong CY, Wu HM, Chan WY, Chia KS, et al. Nearwork in early-onset myopia. Invest Ophthalmol Vis Sci 2002;43(2):332–9. google scholar

9. Rose KA, Morgan IG, Ip J, Kifley A, Huynh S, Smith W, et al. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology 2008;115(8):1279–85. doi: 10.1016/ j.ophtha.2007.12.019. google scholar
10. Biswas S, El Kareh A, Qureshi M, Lee DMX, Sun CH, Lam JSH, et al. The influence of the environment and lifestyle on myopia. J Physiol Anthropol 2024;43(1):7. doi: 10.1186/ s40101-024-00354-7. google scholar
11. Pärssinen O, Kauppinen M, Viljanen A. The progression of myopia from its onset at age 8-12 to adulthood and the influence of heredity and external factors on myopic progression. A 23-year follow-up study. Acta Ophthalmol 2014;92(8):730–9. doi: 10.1111/ aos.12387. google scholar
12. Lee YY, Lo CT, Sheu SJ, Lin JL. What factors are associated with myopia in young adults? A survey study in Taiwan Military Conscripts. Invest Ophthalmol Vis Sci 2013;54(2):1026– 33. doi: 10.1167/iovs.12-10480 google scholar
13. Czepita DA, Zejmo M. Environmental factors and myopia. Ann Acad Med Stetin 2011;57(3):88–92. google scholar
14. Ip JM, Saw SM, Rose KA, Morgan IG, Kifley A, Wang JJ, et al. Role of near work myopia: findings in a sample of Australian school children. Invest Ophthalmol Vis Sci 2008;49(7):2903-10. doi: 10.1167/iovs.07-0804. google scholar
15. Gwiazda J, Thorn F. Held R. Accommodation, accommodative convergence, and response AC/A ratios before and at the onset of myopia in children. Optom Vis Sci 2005;82(4):273-8. doi: 10.1097/01.opx.0000159363.07082.7d. google scholar Rosenfield M, Desai R, Portello JK. Do progressing myopes show reduced accommodative responses? Optom Vis Sci 2002; 79(4):268-73. doi: 10.1097/00006324-200204000-00014. google scholar
16. Martínez-Albert N, Bueno-Gimeno I, Gené-Sampedro A. Risk factors for myopia: A review. J Clin Med 2023;12(18):6062. doi: 10.3390/jcm12186062. google scholar
17. Foreman J, Salim AT, Praveen A, Fonseka D, Ting DSW, He MG, et al. Association between digital smart device use and myopia: a systematic review and meta-analysis. Lancet Digit Health 2021;3:e806-e818. doi:10.1016/S2589-7500(21)00135-7. google scholar
18. Liu S, Ye S, Xi W, Zhang X. Electronic devices and myopic refraction among children aged 6-14 years in urban areas of Tianjin, China. Ophthalmic Physiol Opt 2019;39(4):282-93. doi: 10.1111/opo.12620. google scholar
19. Ha A, Lee YJ, Lee M, Shim SR, Kim YK. Digital screen time and myopia. A systematic review and dose-response meta-analysis. JAMA Netw Open 2025;8(2): e2460026. doi:10.1001/ jamanetworkopen.2024.60026. google scholar Mccrann S, Laughman J, Butler JS, Paudel N, Flitcroft DI. Smartphone use as a possible risk factor for myopia. Clin Exp Optomol 2021;104(1):35-41. doi: 10.1111/cxo.13092. google scholar
20. Saxena R, Vashist P, Tandon R, Pandey RM, Bhardajaw A, Gupta V, et al. Incidence and progression of myopia and associated factors in urban school children in Delhi: The North India Myopia Study (NIM Study) PLoS One. 2017;12(12):e0189774. doi: 10.1371/ journal.pone.0189774. google scholar
21. Gupta S, Joshi A, Saxena H, Chatterjee A. Outdoor activity and myopia progression in children: A follow-up study using mixed-effects model. Indian J Ophthalmol 2021;69(12):3446-50. doi: 10.4103/ijo. IJO_3602_20. google scholar
22. French AN, Ashby RS, Morgan IG, Rose KA. Time outdoors and the prevention of myopia. Exp Eye Res 2013:114:58-68. doi: 10.1016/j.exer.2013.04.018. google scholar
23. Megaw PL, Boelen MG, Morgan IG, Boelen MK. Diurnal patterns of dopamine release in chicken retina. Neurochem Int 2006;48(1):17-23. doi: 10.1016/j.neuint.2005.08.004 google scholar
24. Mrugacz M, Zorena K, Pony-Uram M, Lendzioszek M, Pieńczykowska K, Bryl A. Interdependence of nutrition, physical activity, and myopia. Nutrients. 2024:16(19):3331. doi: 10.3390/nu16193331 google scholar
25. Jones-Jordan LA, Sinnott LT, Manny RE, Cotter SA, Kleinstein RN, Mutti DO, et al. Early childhood refractive error and parental history of myopia as predictors of myopia. Invest Ophthalmol Vis Sci 2010;51(1):115–21. doi: 10.1167/iovs.08-3210. google scholar
26. Liew SHM, Elsner H, Spector TD, Hammond CJ. The first ‘classical’ twin study? Analysis of refractive error using monozygotic and dizygotic twins published in 1922. Twin Res Hum Genet 2005;8(3):198-200. doi: 10.1375/1832427054253158. google scholar
27. Wu LJ, Wang YX, You QS, Duan JL, Luo YX, Liu LJ, et al. Risk factors of myopic shift among primary scholl children in Beijing, China: a prospective study. Int J Med Sci 2015;12(8):633-8. doi: 10.7150/ijms.12133. google scholar
28. Ma Y, Lin S, Zhu J, Zhao R, Zhang B, Yin Y, et al. Effect of parental myopi on change in refraction in Shanghai Preschoolers: A-1 year prospective study. Front Pediatr 2022:10:864233. doi: 10.3389/fped.2022.864233. google scholar
29. Chen Lu, Su M, Zhang BL, Li YC, Zheng W, Liu XY. A study of refractive state in premature infants without retinopathy of prematurity during their early life. Zhonghua Yan Ke Za Zhi 2009;45(7):607-11. google scholar
30. Ducloux A, Marillet S, Ingrand P, Bullimore MA, Bourne RRA, Leveziel N. Progression of myopia in teenagers and adults:a nationwide longitudinal study of a prevalent cohort. Br J Ophthalmol 2023;107(5):644-9. doi: 10.1136/bjophthalmol-2021-319568. google scholar
31. Hui LL, Leung GM, Lam TH, Schooling CM. Premature birth and age at onset of puberty. Epidemiology 2012;23(3):415-22. google scholar
32. Zhang Y, Zhang XJ, Yuan N, Zhang Y, Wang YM, Tang F, et al. Analysis of secondhand smoke exposure and myopia among children aged 6–8 years in Hong Kong. JAMA Netw Open 2023;6(5):e2313006. doi: 10.1001/jamanetworkopen.2023.13006. google scholar
33. Wei CC, Kung YJ, Chen CS, Chang CY, Lin CJ, Tien PT, et al. Allergic conjunctivitis-induced retinal inflammation promotes myopia progression. EBioMedicine 2018;28:274-86. doi: 10.1016/j.ebiom.2018.01.024. google scholar
34. Li LH, Lee JCY, Leung HH, Lam WC, Fu Z, Lo ACY. Lutein Supplementation for Eye Disease. Nutrients. 2020;12(6):1721. doi: 10.3390/nu12061721. google scholar