Association of Age at Myopia Onset With Risk of High Myopia in Adulthood in a 12-Year Follow-up of a Chinese Cohort
Association of Age at Myopia Onset With Risk of High Myopia in Adulthood in a 12-Year Follow-up of a Chinese Cohort
复制标题
对中国队列进行 12 年随访，发现近视发病年龄与成年后高度近视风险之间的关系
DOI：
10.1001/jamaophthalmol.2020.3451
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发表时间：
2020-09-17
影响因子：
8.1
通讯作者：
He, Mingguang
中科院分区：
文献类型：
--
作者：
Hu, Yin;Ding, Xiaohu;He, Mingguang
成年后高度近视发生的风险与近视发生的特定年龄有什么关系？在443名近视患者的队列研究中，7岁或8岁近视患者发生高度近视的风险大于50%。9岁发病的风险大幅降低至约30%，10岁发病的风险为20%，12岁或以上发病的风险低于5%。这些数据表明，早期发病与成年后的高近视风险密切相关，每年发病的延迟大大降低了这种风险，支持了及时预防近视策略的必要性。早发性近视在成年期发展为高度近视是众所周知的。然而，对于近视发病的特定年龄与成年后发生高度近视的概率之间的关系，目前还没有准确的估计，并且需要一项每年就诊的长期随访研究。目的通过每年随访12年的数据，估计成人高度近视发生的风险与近视发病的特定年龄相关。2006年7月11日，研究人员在中国广州对双胞胎进行了一项基于人群的前瞻性队列研究。分析了从基线到2018年8月31日的数据。第一个出生的双胞胎完成了随访，直到17岁或更大，443名患有近视的参与者（排除后）被纳入分析。数据分析时间为2018年9月1日至2020年1月20日。主要结果和测量方法近视发病年龄通过预期年度睫状体麻痹屈光度（365名参与者[82.4%]）或问卷调查确定。成人屈光定义为最后一次随访时测量的睫状体麻痹屈光。结果在443名符合条件的参与者中（247名[55.8%]女性，平均[SD]近视发病年龄11.7[2.0]岁），54名（12.2%）在成年期发展为高度近视（球面等效，-6.00屈光度或更差，由睫状体麻痹性屈光决定）。在近视发病年龄为7或8岁的参与者中，26人中有14人（53.9%;95% CI, 33.4%-73.4%）在成年期发展为高度近视；在9岁发病的患者中，37人中有12人（32.4%;95% CI, 18.0%-49.8%）；在10岁发病的患者中，72例中有14例（19.4%;95% CI, 11.1%-30.5%）；在11岁发病的患者中，78例中有11例（14.1%;95% CI, 7.3%-23.8%）；在12岁及以上发病的患者中，230例中有3例（1.3%;95% CI, 0.2%-3.8%）。多因素logistic回归分析结果显示，随着近视发病年龄的推迟，成人高度近视的发生风险显著降低（优势比为0.44；95% CI为0.36-0.55;P < .001），从7、8岁的50%以上下降到9岁的30%左右和10岁的20%左右。结论与相关性这些发现提示，在学龄早期近视发病的儿童发生高度近视的风险相对较高。发病年龄每推迟一年，就会大大降低成年后发生高度近视的机会，这突出了确定有效预防策略的重要性，例如增加户外活动时间。这项国家队列研究基于每年随访12年的中国患者的数据集，估计了成人高度近视发生的风险与近视发病的特定年龄相关。
Question What is the risk of developing high myopia in adulthood in association with a specific age at myopia onset? Findings In this cohort study of 443 individuals with myopia, the risk of developing high myopia was greater than 50% for those with myopia onset at 7 or 8 years of age. The risk substantially decreased to approximately 30% for onset at 9 years of age, 20% for onset at 10 years of age, and less than 5% for onset at 12 years or older. Meaning These data suggest that early onset is strongly associated with high myopia risk in adulthood and that a delay in each year of onset substantially reduces this risk, supporting the need for prompt myopia prevention strategies.Importance Early-onset myopia is well known to progress to high myopia in adulthood. However, no accurate estimation of how a specific age at myopia onset is associated with the probability of developing high myopia in adulthood is available, and a very-long-term follow-up study with data from annual visits is needed. Objective To estimate the risk of developing high myopia in adulthood associated with a specific age at myopia onset from a data set with a 12-year annual follow-up. Design, Setting, and Participants This ongoing, population-based prospective cohort study of twins was conducted in Guangzhou, China, on July 11, 2006. Data from baseline to August 31, 2018, were analyzed. The first-born twins completed follow-up until 17 years or older, and the 443 participants (after exclusions) who developed myopia were included in the analysis. Data were analyzed from September 1, 2018, to January 20, 2020. Main Outcomes and Measures Age at myopia onset was determined by prospective annual cycloplegic refractions (365 participants [82.4%]) or with a questionnaire. Refraction in adulthood was defined as the cycloplegic refraction measured at the last follow-up visit. Results Among the 443 eligible participants (247 [55.8%] female; mean [SD] age at myopia onset, 11.7 [2.0] years), 54 (12.2%) developed high myopia (spherical equivalent, -6.00 diopters or worse determined by cycloplegic refractions) in adulthood. Among participants with age at myopia onset of 7 or 8 years, 14 of 26 (53.9%; 95% CI, 33.4%-73.4%) developed high myopia in adulthood; among those with onset at 9 years of age, 12 of 37 (32.4%; 95% CI, 18.0%-49.8%); among those with onset at 10 years of age, 14 of 72 (19.4%; 95% CI, 11.1%-30.5%); among those with onset at 11 years of age, 11 of 78 (14.1%; 95% CI, 7.3%-23.8%); and among those with onset at 12 years or older, 3 of 230 (1.3%; 95% CI, 0.2%-3.8%). Results of multivariate logistic regression analysis suggested that the risk of developing high myopia in adulthood decreased significantly with delay in the age at myopia onset (odds ratio, 0.44; 95% CI, 0.36-0.55;P < .001), from greater than 50% for 7 or 8 years of age to approximately 30% for 9 years of age and 20% for 10 years of age. Conclusions and Relevance These findings suggest that the risk of high myopia is relatively high in children with myopia onset during the early school ages. Each year of delay in the age at onset substantially reduces the chance of developing high myopia in adulthood, highlighting the importance of identifying effective prevention strategies under investigation, such as increasing outdoor time.This national cohort study estimates the risk of developing high myopia in adulthood in association with a specific age at myopia onset based on a data set of Chinese patients with 12-year annual follow-up.