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. 2019 Nov 1;137(11):1233-1239.
doi: 10.1001/jamaophthalmol.2019.3103.

Current Prevalence of Myopia and Association of Myopia With Environmental Factors Among Schoolchildren in Japan

Erisa Yotsukura  1   2 , Hidemasa Torii  1   2 , Mikako Inokuchi  3   4 , Mitsuaki Tokumura  3   4 , Miki Uchino  1 , Kyosei Nakamura  2 , Mari Hyodo  2 , Kiwako Mori  1   2 , Xiaoyan Jiang  2 , Shin-Ichi Ikeda  2 , Shinichiro Kondo  2 , Kazuno Negishi  1 , Toshihide Kurihara  1   2 , Kazuo Tsubota  1
Affiliations

Current Prevalence of Myopia and Association of Myopia With Environmental Factors Among Schoolchildren in Japan

Erisa Yotsukura et al. JAMA Ophthalmol. .

Abstract

Importance: Given the estimates of increasing prevalence of myopia, especially in Asia, it is important to determine the current prevalence of myopia among populations of schoolchildren in Japan.

Objective: To investigate the current prevalence rate of myopia and the association between environmental factors and myopia in Japanese schoolchildren.

Design, setting, and participants: This cross-sectional study assessed 1478 participants, including 726 elementary school students and 752 junior high school students, at 2 schools in Tokyo, Japan, who underwent eye examinations from April 1 to May 31, 2017, that included measurement of the refractive errors by autorefractometry with noncycloplegic refraction and ocular biometric factors. After excluding those who had been treated with atropine or orthokeratology (n = 11), had a history of eye disease (n = 2), had no parental consent (n = 41), and were absent (n = 8), 1416 schoolchildren were analyzed.

Main outcomes and measures: The primary outcome was the prevalence of myopia and high myopia. Secondary outcomes were environmental factors that were associated with myopia.

Results: A total of 1416 schoolchildren (mean [SD] age, 10.8 [2.7] years; 792 [55.9%] male) were studied. The prevalence rates of myopia (spherical equivalent ≤-0.5 diopters [D]) were 76.5% (95% CI, 73.4%-79.7%) among the elementary school students and 94.9% (95% CI, 93.3%-96.5%) among the junior high school students. The prevalence rates of high myopia (spherical equivalent ≤-6.0 D) were 4.0% (95% CI, 2.5%-5.4%) among the elementary school students and 11.3% (95% CI, 8.8%-13.7%) among the junior high school students. The prevalence rates of high myopia classified based on axial length of 26.0 mm or longer were 1.2% (95% CI, 0.4%-2.0%) among elementary school students and 15.2% (95% CI, 12.5%-17.8%) among junior high school students. Multiple regression analysis showed that higher-order aberrations and dry eye disease were associated with refractive error in elementary school students (spherical aberration: β = 6.152; 95% CI, 3.161-9.143; P < .001; dry eye disease: β = -0.626; 95% CI, -1.189 to -0.063; P = .03) and with axial length in junior high school students (spherical-like aberration: β = 26.546; 95% CI, 18.708-34.385; P < .001; dry eye disease: β = 0.354; 95% CI, 0.131-0.578; P < .002).

Conclusions and relevance: Although the use of noncycloplegic autorefraction with a cutoff of -0.50 D could lead to overestimation of results, these findings suggest that the current prevalence rates of myopia among elementary and junior high school students in Asia are high, especially if the results from these 2 schools are generalizable to all schoolchildren in Japan and Asia.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Torii reported receiving grants from the Japan Society for the Promotion of Science and grants from Takeda Science Foundation during the conduct of the study. Dr Kondo reported receiving personal fees from Tsubota Laboratory Inc. outside the submitted work. Dr Kurihara reported receiving personal fees from Tsubota Laboratory Inc and Bayer Yakuhin Ltd. outside the submitted work and receiving grants from Fuji Xerox Co Ltd, Kowa Company Ltd, Novartis Pharmaceuticals Japan, Santen Pharmaceutical Co Ltd and Rohto Pharmaceutical Co Ltd. Dr Tsubota reported receiving a grant from Japan Society for the Promotion of Science during the conduct of the study and serving as chief executive officer for Tsubota Laboratory; having a patent issued for Myopia Prevention Article; having a patent issued for Irradiation Device; and having a patent pending for Optical Member (for violet light transmitting eyeglass lens), outside the submitted work. No other disclosures were reported.

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