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Association of low birth weight with myopic refractive error and lower visual acuity in adulthood: results from the population-based Gutenberg Health Study (GHS)
  1. Achim Fieß1,
  2. Alexander Karl-Georg Schuster1,
  3. Stefan Nickels1,
  4. Heike M Elflein1,
  5. Andreas Schulz2,
  6. Manfred E Beutel3,
  7. Maria Blettner4,
  8. Norbert Pfeiffer1
  1. 1Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
  2. 2Preventive Cardiology and Preventive Medicine/Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
  3. 3Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
  4. 4Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
  1. Correspondence to Dr Achim Fieß, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany; achim.fiess{at}


Purpose Low birth weight (BW) is linked to impaired organ development in childhood, including altered ocular morphological and functional development. The aim of this study was to evaluate whether low BW has long-term effects on visual acuity and refraction in adulthood.

Methods The Gutenberg Health Study is a population-based, observational cohort study in Germany, including 15 010 participants aged between 35 and 74 years. These participants were divided into three different BW groups (low: <2500 g; normal: between 2500 and 4000 g; and high: >4000 g). Best-corrected visual acuity and objective refraction were examined. We used multivariable linear regression models with adjustment for age, sex, socioeconomic status and self-reported glaucoma, age-related macular degeneration, corneal disease and cataract to assess associations between BW and the main outcome measures, best-corrected visual acuity, spherical equivalent and astigmatism.

Results Overall, 8369 participants reported their BW. In a multivariable analysis, an association for low BW with spherical equivalent (B=−0.28 per dioptre, P=0.005) and best-corrected visual acuity (B=0.02 logarithm of the minimum angle of resolution, P=0.006) compared with normal BW was observed. For participants with high BW, an association was observed with spherical equivalent (B=0.29 per dioptre, P<0.001), while none with visual acuity.

Conclusions Our data demonstrated that low BW is linked to visual acuity and refractive long-term outcomes long after childhood. Individuals with low BW are more likely to have lower visual acuity and a higher myopic refractive error in adulthood. Adults with high BW are more likely to have a more hyperopic refractive error.

  • birth weight
  • visual acuity
  • refraction
  • sphere
  • population-based cohort study

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  • Contributors Conceived and designed the study: MEB, MB, NP, AF, AK-GS and SN. Analysed the data: AF, AK-GS, AS SN and HME. Wrote the paper: AF. Revised it critically: AK-GS, SN, HME, AS, MEB, MB and NP. All authors read and approved the final manuscript.

  • Funding The Gutenberg Health Study is funded through the government of Rhineland-Palatinate (‘Stiftung Rheinland-Pfalz für Innovation’, contract AZ 961-386261/733), the research programmes ‘Wissen schafft Zukunft’ and ‘Center for Translational Vascular Biology (CTVB)’ of the Johannes Gutenberg-University of Mainz, and its contract with Boehringer Ingelheim and PHILIPS Medical Systems, including an unrestricted grant for the Gutenberg Health Study.

  • Competing interests AK-GS received educational support by Santen Pharmaceutical Co., Ltd., (Osaka, Japan) and research funding by Novartis, Bayer Healthcare and Heidelberg Engineering. NP receives financial support and grants by Novartis, Ivantis, Santen, Thea, Boehringer Ingelheim Deutschland GmbH & Co. KG, Alcon, Sanoculis. SN received reimbursement of travel expenses from Novartis Pharma GmbH. MEB received speakers honorary from Pfizer Deutschland GmbH, Shire Deutschland GmbH and currently research grants from the governments of Rhineland-Palatinate and Nordrhein-Westfalen, the German Association of Psychoanalysis and Psychotherapy (DGPT), the German Research Foundation, the German Ministry of Research, the German Cancer Aid and the European Union.

  • Patient consent Obtained.

  • Ethics approval The study protocol and study documents were approved by the local ethics committee of the Medical Chamber of Rhineland-Palatinate, Germany (reference no. 837.020.07; original vote: 22 March 2007, latest update: 20 October 2015).

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

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