Article Text

other Versions

Download PDFPDF
Environmental factors explain socioeconomic prevalence differences in myopia in 6-year-old children
  1. J Willem L Tideman1,2,
  2. Jan Roelof Polling1,3,
  3. Albert Hofman2,
  4. Vincent WV Jaddoe2,4,
  5. Johan P Mackenbach5,
  6. Caroline CW Klaver1,2
  1. 1Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
  2. 2Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
  3. 3Optometry & Orthoptics, University of Applied Science, Utrecht, The Netherlands
  4. 4Department of Paediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
  5. 5Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Caroline CW Klaver, Erasmus Medical Center NA2808; PO Box 5201, 3008 AE Rotterdam, The Netherlands; c.c.w.klaver{at}


Purpose High myopia (≤−6 D) usually has its onset before 10 years of age and can lead to blinding complications later in life. We examined whether differences in myopia prevalences in socioeconomic risk groups could be explained by differences in lifestyle factors.

Methods A total of 5711 six-year-old children participating in the prospective population-based birth cohort study Generation R underwent a stepwise ophthalmic examination, which included visual acuity and objective cycloplegic refraction to identify children with myopia (≤−0.5D). Daily activities, ethnicity, factors representing family socioeconomic status and housing were ascertained by questionnaire. Risk assessments of myopia and mediation analyses were performed using logistic regression; attenuation of risks was calculated by bootstrapping.

Results Prevalence of myopia was 2.4% (n=137). Myopic children spent more time indoors and less outdoors than non-myopic children (p<0.01), had lower vitamin D (p=0.01), had a higher body mass index and participated less in sports (p=0.03). Children of non-European descent (OR 2.60; 95% CI 1.84 to 3.68), low maternal education (OR 2.27; 95% CI 1.57 to 3.28) and low family income (OR 2.62; 95% CI 1.8 to 3.74) were more often myopic. Lifestyle factors explained the majority of the increased risk for ethnicity (82%; 95% CI 55 to 120), maternal education (69%; 95% CI 45 to 109) and family socioeconomic status (71%; 95% CI 46 to 104).

Conclusion This study found environmental factors to be strong risk factors for myopia already at the age of 6 years. The myopia prevalence differences in socioeconomic groups were greatly determined by differences in distribution of these environmental risk factors, highlighting the importance of lifestyle adjustments in young children developing myopia.

  • myopia
  • children
  • lifestyle
  • mediation

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors Design and conduct of the study: JT and CCWK. Collection and management of the data: JT and JRP. Analysis and interpretation of the data: JT, JRP and CCWK. Preparation, review and approval of the manuscript: JT, JRP, VWVJ, AH, JPM and CCWK.

  • Funding The authors were supported by the following foundations: MaculaFonds, Novartis Fonds, ODAS, LSBS, Oogfonds and ANVVB that contributed through UitZicht (grant 2014-38). The funding organisations had no role in the design or conduct of this research. They provided unrestricted grants.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Medical Ethical Committee of the Erasmus Medical Center, Rotterdam.

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

  • Data sharing statement No additional unpublished data from the study are available.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.

Linked Articles

  • At a glance
    Keith Barton James Chodosh Jost B Jonas