title: Increasing Prevalence of Myopia in Europe and the Impact of Education.
abstract: OBJECTIVE
  To investigate whether myopia is becoming more common across Europe and explore whether increasing education levels, an important environmental risk factor for myopia, might explain any temporal trend.
  
  
  METHODS
  Meta-analysis of population-based, cross-sectional studies from the European Eye Epidemiology (E(3)) Consortium.
  
  
  METHODS
  The E(3) Consortium is a collaborative network of epidemiological studies of common eye diseases in adults across Europe. Refractive data were available for 61 946 participants from 15 population-based studies performed between 1990 and 2013; participants had a range of median ages from 44 to 78 years.
  
  
  METHODS
  Noncycloplegic refraction, year of birth, and highest educational level achieved were obtained for all participants. Myopia was defined as a mean spherical equivalent ≤-0.75 diopters. A random-effects meta-analysis of age-specific myopia prevalence was performed, with sequential analyses stratified by year of birth and highest level of educational attainment.
  
  
  METHODS
  Variation in age-specific myopia prevalence for differing years of birth and educational level.
  
  
  RESULTS
  There was a significant cohort effect for increasing myopia prevalence across more recent birth decades; age-standardized myopia prevalence increased from 17.8% (95% confidence interval [CI], 17.6-18.1) to 23.5% (95% CI, 23.2-23.7) in those born between 1910 and 1939 compared with 1940 and 1979 (P = 0.03). Education was significantly associated with myopia; for those completing primary, secondary, and higher education, the age-standardized prevalences were 25.4% (CI, 25.0-25.8), 29.1% (CI, 28.8-29.5), and 36.6% (CI, 36.1-37.2), respectively. Although more recent birth cohorts were more educated, this did not fully explain the cohort effect. Compared with the reference risk of participants born in the 1920s with only primary education, higher education or being born in the 1960s doubled the myopia prevalence ratio-2.43 (CI, 1.26-4.17) and 2.62 (CI, 1.31-5.00), respectively-whereas individuals born in the 1960s and completing higher education had approximately 4 times the reference risk: a prevalence ratio of 3.76 (CI, 2.21-6.57).
  
  
  CONCLUSIONS
  Myopia is becoming more common in Europe; although education levels have increased and are associated with myopia, higher education seems to be an additive rather than explanatory factor. Increasing levels of myopia carry significant clinical and economic implications, with more people at risk of the sight-threatening complications associated with high myopia.
authors.affiliation: Department of Ophthalmology, King's College London, St. Thomas' Hospital, London, United Kingdom; Department of Twin Research and Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, United Kingdom.
authors.forename: Katie M
authors.initials: KM
authors.lastname: Williams
authors.affiliation: Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway; Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Geir
authors.initials: G
authors.lastname: Bertelsen
authors.affiliation: Life Course, Epidemiology and Biostatistics Section, UCL Institute of Child Health, London, United Kingdom.
authors.forename: Phillippa
authors.initials: P
authors.lastname: Cumberland
authors.affiliation: University Medical Center, Department of Ophthalmology, Mainz, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Wolfram
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Virginie J M
authors.initials: VJ
authors.lastname: Verhoeven
authors.affiliation: Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Anastasopoulos
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Gabriëlle H S
authors.initials: GH
authors.lastname: Buitendijk
authors.affiliation: University Bordeaux, Bordeaux, France; ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Cougnard-Grégoire
authors.affiliation: Department of Ophthalmology, Eye and Nutrition Research Group UMR 1324 INRA, University Hospital Dijon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Creuzot-Garcher
authors.affiliation: Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.
authors.forename: Maja Gran
authors.initials: MG
authors.lastname: Erke
authors.affiliation: Centre for Experimental Medicine, Institute of Clinical Science, Queen's University Belfast, Belfast, United Kingdom.
authors.forename: Ruth
authors.initials: R
authors.lastname: Hogg
authors.affiliation: University Medical Center, Department of Ophthalmology, Mainz, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Höhn
authors.affiliation: Department of Twin Research and Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, United Kingdom.
authors.forename: Pirro
authors.initials: P
authors.lastname: Hysi
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Khawaja
authors.affiliation: University Bordeaux, Bordeaux, France; ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Korobelnik
authors.affiliation: Institute of Genetic Epidemiology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany.
authors.forename: Janina
authors.initials: J
authors.lastname: Ried
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Vingerling
authors.affiliation: Department of Ophthalmology, Eye and Nutrition Research Group UMR 1324 INRA, University Hospital Dijon, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Bron
authors.affiliation: University Bordeaux, Bordeaux, France; ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dartigues
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Astrid
authors.initials: A
authors.lastname: Fletcher
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Robert W A M
authors.initials: RW
authors.lastname: Kuijpers
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Luben
authors.affiliation: Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
authors.forename: Konrad
authors.initials: K
authors.lastname: Oxele
authors.affiliation: Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Fotis
authors.initials: F
authors.lastname: Topouzis
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Ophthalmology, Nordland Hospital, Norway, Bodø, Norway.
authors.forename: Therese
authors.initials: T
authors.lastname: von Hanno
authors.affiliation: University Medical Center, Department of Ophthalmology, Mainz, Germany.
authors.forename: Alireza
authors.initials: A
authors.lastname: Mirshahi
authors.affiliation: NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Foster
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Cornelia M
authors.initials: CM
authors.lastname: van Duijn
authors.affiliation: University Medical Center, Department of Ophthalmology, Mainz, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Pfeiffer
authors.affiliation: University Bordeaux, Bordeaux, France; ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Delcourt
authors.affiliation: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Caroline C W
authors.initials: CC
authors.lastname: Klaver
authors.affiliation: Life Course, Epidemiology and Biostatistics Section, UCL Institute of Child Health, London, United Kingdom; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom.
authors.forename: Jugnoo
authors.initials: J
authors.lastname: Rahi
authors.affiliation: Department of Ophthalmology, King's College London, St. Thomas' Hospital, London, United Kingdom; Department of Twin Research and Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, United Kingdom. Electronic address: chris.hammond@kcl.ac.uk.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hammond
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004522:Educational Status; D005006:Ethnicity; D005060:Europe / Q000453:epidemiology; D005062:European Union / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution