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. 2019 Jan-Mar;12(1):55-63.
doi: 10.1016/j.optom.2018.02.002. Epub 2018 Mar 19.

Refractive error magnitude and variability: Relation to age

Elizabeth L Irving  1 , Carolyn M Machan  2 , Sharon Lam  2 , Patricia K Hrynchak  2 , Linda Lillakas  2
Affiliations

Refractive error magnitude and variability: Relation to age

Elizabeth L Irving et al. J Optom. 2019 Jan-Mar.

Abstract
in English, Spanish

Purpose: To investigate mean ocular refraction (MOR) and astigmatism, over the human age range and compare severity of refractive error to earlier studies from clinical populations having large age ranges.

Methods: For this descriptive study patient age, refractive error and history of surgery affecting refraction were abstracted from the Waterloo Eye Study database (WatES). Average MOR, standard deviation of MOR and astigmatism were assessed in relation to age. Refractive distributions for developmental age groups were determined. MOR standard deviation relative to average MOR was evaluated. Data from earlier clinically based studies with similar age ranges were compared to WatES.

Results: Right eye refractive errors were available for 5933 patients with no history of surgery affecting refraction. Average MOR varied with age. Children <1 yr of age were the most hyperopic (+1.79D) and the highest magnitude of myopia was found at 27yrs (-2.86D). MOR distributions were leptokurtic, and negatively skewed. The mode varied with age group. MOR variability increased with increasing myopia. Average astigmatism increased gradually to age 60 after which it increased at a faster rate. By 85+ years it was 1.25D. J0 power vector became increasingly negative with age. J45 power vector values remained close to zero but variability increased at approximately 70 years. In relation to comparable earlier studies, WatES data were most myopic.

Conclusions: Mean ocular refraction and refractive error distribution vary with age. The highest magnitude of myopia is found in young adults. Similar to prevalence, the severity of myopia also appears to have increased since 1931.

Objetivo: Estudiar la refracción ocular media (MOR) y el astigmatismo a lo largo del rango de la vida humana, y comparar la magnitud del error refractivo con estudios previos sobre poblaciones clínicas con rangos de edad amplios.

Métodos: Para este estudio descriptivo, se extrajeron de la base de datos Waterloo Eye Study (WatES) la edad del paciente, el error refractivo y el historial de cirugía con repercusión en la refracción. Se evaluaron la MOR media, la desviación estándar de MOR y el astigmatismo con relación a la edad. Se calcularon las distribuciones refractivas para los grupos de edad evolutiva. Se evaluó la desviación estándar de MOR con respecto a MOR media. Se compararon los datos de los estudios clínicos previos con los rangos de edad similares de WatES.

Resultados: Se dispuso de los errores refractivos del ojo derecho de 5.933 pacientes sin historial de cirugía con repercusión en la refracción. La MOR media sufrió variaciones con la edad. Los niños con edad <1 año reflejaron mayor hipermetropía (+1,79D), encontrándose el mayor valor de miopía a los 27 años (−2,86D). Las distribuciones de MOR fueron leptocúrticas, y negativamente sesgadas. La moda varió con el grupo de edad. La variabilidad de MOR se incrementó al aumentar la miopía. El astigmatismo medio aumentó gradualmente hasta los 60 años, pasados los cuales se incrementó a mayor velocidad. A los 85 años, o más, su valor fue de 1,25D. El vector de potencia J0 se modificó hacia valores más negativos con la edad. Los valores del vector de potencia J45 fueron cercanos a 0, aunque su variabilidad se incrementó a los 70 años, aproximadamente. Con relación a los estudios previos comparables, los datos WatES fueron más miópicos.

Conclusiones: La refracción ocular media y la distribución del error refractivo varían con la edad. La mayor magnitud de la miopía se encontró en los adultos jóvenes. Al igual que la prevalencia, la gravedad de la miopía parece haberse incrementado desde 1931.

Keywords: Age-related refractive error; Anisometropia; Anisometropía; Astigmatism; Astigmatismo; Error refractivo relacionado con la edad; Mean ocular refraction; Refracción ocular media; Refractive error variability; Variabilidad del error refractivo.

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Figures

Figure 1
Figure 1
(a) Average MOR (±SE) as a function of age for those patients with no surgery and for all patients, (b) average MOR (no surgery) for hyperopes (MOR > 0.50 D), emmetropes (MOR ≥ −0.50 D and ≤0.50 D) and myopes (MOR < −0.50 D) in 1 year age groups (except patients aged 85 years and older who were grouped together).
Figure 2
Figure 2
MOR distribution by age group (a) 0–3 yrs, (b) 4–6 yrs, (c) 7–19 yrs, (d) 20–40 yrs, (e) 41–65 yrs, (f) 66+ yrs.
Figure 3
Figure 3
(a) Standard deviation of MOR as a function of age and (b) standard deviation of MOR as a function of average MOR.
Figure 4
Figure 4
(a) Average positive Cylinder Power (±SE) as a function of age and (b–e) average J0 and J45 (±SE) for left and right eyes as a function of age. Patients aged 85 years and older are grouped together.
Figure 5
Figure 5
Comparison of the WatES (Canada 2008) mean MOR values as a function of age to other clinically based studies including Tassman (United States 1931, cycloplegia <40 yrs, aphakia excluded), Slataper (United States ∼1950, exact dates of data collection not specified, multiple drops of atropine cycloplegia, <−6 D & >+8 D excluded), Saunders (United Kingdom) within 18 month period ∼1980) and Goldblum (Germany 2003 and earlier, cyclopegia of <14 yrs, autorefraction, based on weighted averages calculated from distribution data) all plotted in 10 year age groups.
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