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Early life factors for myopia in the British Twins Early Development Study
  1. Katie M Williams1,2,
  2. Eva Kraphol3,
  3. Ekaterina Yonova-Doing2,
  4. Pirro G Hysi1,2,
  5. Robert Plomin3,
  6. Christopher J Hammond1,2
  1. 1 Section of Academic Ophthalmology, School of Life Course Sciences, FoLSM, King's College London, London, UK
  2. 2 Department of Twin Research & Genetic Epidemiology, School of Life Course Sciences, FoLSM, King's College London, London, UK
  3. 3 MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
  1. Correspondence to Dr Christopher J Hammond, Section of Academic Ophthalmology, School of Life Course Sciences, FoLSM, King’s College London, London WC2R 2LS, UK; chris.hammond{at}


Purpose Myopia is an increasingly prevalent condition globally. A greater understanding of contemporaneous, early life factors associated with myopia risk is urgently required, particularly in younger onset myopia as this correlates with higher severity and increased complications in adult life.

Methods Analysis of a subset of the longitudinal, UK-based Twins Early Development Study (n=1991) recruited at birth between 1994 and 1996. Subjective refraction was obtained from the twin’s optometrists; mean age 16.3 years (SD 1.7). Myopia was defined as mean spherical equivalent ≤−0.75 dioptres. A life course epidemiology approach was used to appropriately weight candidate myopia risk factors during critical periods of eye growth. Adjusted ORs for myopia were estimated using multivariable logistic regression models at each life stage, together with variance explained (r2) and area under the receiver operator characteristic curve (AUROC) statistic of predictive models.

Results Factors significantly associated with myopia included level of maternal education (OR 1.33, 95% CI 1.11 to 1.59), fertility treatment (OR 0.63, 95% CI 0.43 to 0.92), summer birth (OR 1.93, 95% CI 1.28 to 2.90) and hours spent playing computer games (OR 1.03, 95% CI 1.01 to 1.06). The total variance explained by this model was 4.4 % (p<0.001) and the AUROC was 0.68 (95% CI 0.64 to 0.72). Consistent associations were observed with socioeconomic status, educational attainment, reading enjoyment and cognitive variables, particularly verbal cognition, at multiple points over the life course.

Conclusions This study identifies known and novel associations with myopia during childhood development; associated factors identified in early life reflect sociological and lifestyle trends such as rates of maternal education, fertility treatment, early schooling and computer games.

  • epidemiology
  • optics and refraction
  • child health (paediatrics)
  • genetics

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  • Contributors KW designed and performed the research, performed data analysis and wrote the paper; EK, EY-D and PGH assisted with data analysis and writing the paper; RP assisted with research design, data analysis and paper preparation; CJH assisted with research design, data analysis and writing the paper.

  • Funding TEDS is supported by a programme grant to RP from the UK Medical Research Council (MR/M021475/1 and previously G0901245), with additional support from the US National Institutes of Health (AG046938). The research leading to these results has also received funding from the European Research Council under the European Union's Seventh Framework Programme (FP7/2007-2013)/ grant agreement n° 602768. RP is supported by a Medical Research Council Professorship award (G19/2). KMW is supported by a UK Medical Research Council Clinical Research Training Fellowship.

  • Disclaimer The sponsor or funding organisation has no role in the design or conduct of this research.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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