Intergenerational change in China's epidemic of myopia: The impact of the social environment

Purpose: To explore intergenerational changes in the myopia epidemic in China in a sample of twins and their parents. Methods: Longitudinal cohort study. A total of 686 children with baseline age from 7 to 15 years were followed annually from 2006 to 2018. Cycloplegic refractions and ocular biometry of the children and non-cycloplegic refractions and ocular biometry of the parents were measured. Results: The myopia prevalence in the young adult children was 78.0%, while it was 42.1% in the parents. The prevalence of high myopia (9.6% vs 5.2%) and moderate myopia (38.8% vs 9.9%) was higher in the children, while the percentage of mild hyperopia (9.5% vs 16.3%) and emmetropia (10.6% vs 40.0%) was lower. No significant difference was found in extremely high myopia (2.2% vs 1.9%) and severe hyperopia (1.9% vs 1.6%). The distribution of refraction in the younger generation had a marked plateau in the zone of -6.0 D to -0.5 D, rather than the tighter peak around -1.0 D in parents. The correlation between the percentile position in the distributions of refraction of the parents and children was low (about 0.30). The distribution of axial length changed significantly, but there was little change in lens power, corneal power and corneal radius of curvature. Conclusions: Major increases in the prevalence and severity of myopia between generations in China are largely due to increased axial elongation in the children. These increases are consistent with the known causal impacts of increased educational pressures and decreased time outdoors.