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Re: Holden et al.: Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050 (Ophthalmology 2016;123:1036-1042)

      To the Editor:
      I read with interest the systematic review and meta-analysis by Holden et al,
      • Holden B.A.
      • Fricke T.R.
      • Wilson D.A.
      • et al.
      Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050.
      particularly the authors' reason for not presenting disaggregated data by gender. The authors state that gender differences vary between reported studies, potentially indicating a complex gender effect.
      Prevalence rates of myopia are difficult to compare because the presentation of results varies between studies with analysis differing by population, gender, age, and timeframe, leading to potential detection bias. However, a number of well-constructed meta-analyses, including that of the authors, have been undertaken in differing populations and the increasing trend, ethnic differences, and gender difference have been reported consistently.
      A recently published systematic review of myopia prevalence in childhood presents the effect of gender on prevalence in different age groups and reports no gender difference in myopia prevalence at age 5 years with girls developing a greater prevalence of myopia around the age of 9 years. This gender difference continues and indeed increases into adolescence.
      • Rudnicka A.R.
      • Kapetanakis V.V.
      • Wathern A.K.
      • et al.
      Global variations and time trends in the prevalence of childhood myopia, a systematic review and quantitative meta-analysis: implications for aetiology and early prevention.
      A population-based study in the United States also reports a higher prevalence of myopia in women (40%) compared with men (33%), but only in the 20- to 39-year-old group of participants; no gender difference was found in the older age groups.
      • Vitale S.
      • Sperduto R.D.
      • Ferris III, F.L.
      Increase prevalence of myopia in the United States between 1971-9172 and 1999-2004.
      In an analysis of 15 European population cohort and cross-sectional studies, no gender difference in myopia prevalence was found; the median age of subjects in the European analysis was 62 years.
      • Williams K.M.
      • Verhoeven V.J.
      • Cumberland P.
      • et al.
      Prevalence of refractive error in Europe: the European Eye Epidemiology (E(3)) Consortium.
      Holden et al
      • Holden B.A.
      • Fricke T.R.
      • Wilson D.A.
      • et al.
      Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050.
      suggest variability in gender difference is owing to environmental influences, such as inequitable access to education, participation in physical activity, and close work. However, the reported gender difference exhibits a particular pattern with a greater prevalence of myopia in girls starting to appear around the age of 9 years, continuing through teenage years and early adulthood and diminishing to no or minimal gender difference around the age of 50 to 60 years. This pattern of gender difference is highly suggestive of a hormonal role in myopia development. It would aid in the understanding of myopia development if gender differences across the life-course could be presented. Would the authors consider analyzing their data to estimate gender differences by age group?

      References

        • Holden B.A.
        • Fricke T.R.
        • Wilson D.A.
        • et al.
        Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050.
        Ophthalmology. 2016; 123: 1036-1042
        • Rudnicka A.R.
        • Kapetanakis V.V.
        • Wathern A.K.
        • et al.
        Global variations and time trends in the prevalence of childhood myopia, a systematic review and quantitative meta-analysis: implications for aetiology and early prevention.
        Br J Ophthalmol. 2016 Jan 22; (pii: bjophthalmol-2015-307724. [Epub ahead of print])https://doi.org/10.1136/bjophthalmol-2015-307724
        • Vitale S.
        • Sperduto R.D.
        • Ferris III, F.L.
        Increase prevalence of myopia in the United States between 1971-9172 and 1999-2004.
        Arch Ophthalmol. 2009; 127: 1632-1639
        • Williams K.M.
        • Verhoeven V.J.
        • Cumberland P.
        • et al.
        Prevalence of refractive error in Europe: the European Eye Epidemiology (E(3)) Consortium.
        Eur J Epidemiol. 2015; 30: 305-315

      Linked Article

      • Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050
        OphthalmologyVol. 123Issue 5
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          Myopia is a common cause of vision loss, with uncorrected myopia the leading cause of distance vision impairment globally. Individual studies show variations in the prevalence of myopia and high myopia between regions and ethnic groups, and there continues to be uncertainty regarding increasing prevalence of myopia.
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      • Reply
        OphthalmologyVol. 124Issue 3
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          We appreciate Dr Bruce's interest in our paper and share her intrigue on the nature of the interaction between gender and myopia.1 Some papers included in our systematic review and meta-analysis provide age- and sex-specific data as Dr Bruce notes, but many do not. In addition to data availability, our analysis suggested that age, urbanization, location, and ethnicity had stronger effects than sex or gender on myopia prevalence, so we prioritized maintaining disaggregation and statistical strength accordingly.
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