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Original Investigation
January 2017

Association Between Myopia, Ultraviolet B Radiation Exposure, Serum Vitamin D Concentrations, and Genetic Polymorphisms in Vitamin D Metabolic Pathways in a Multicountry European Study

Author Affiliations
  • 1Department of Ophthalmology, King’s College London, London, United Kingdom
  • 2Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
  • 3School of Environmental Sciences, University of East Anglia, East Anglia, United Kingdom
  • 4Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
  • 5Centre for Experimental Medicine, Institute of Clinical Science, Queen’s University Belfast, Belfast, United Kingdom
  • 6Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
  • 7Eye Department, University of Bergen, Bergen, Norway
  • 8Department of Ophthalmology, Hôtel-Dieu de Paris, Paris Descartes University, Paris, France
  • 9Ophthalmology Clinic, University of Verona, Verona, Italy
  • 10Department of Ophthalmology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
  • 11Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom

Copyright 2016 American Medical Association. All Rights Reserved.

JAMA Ophthalmol. 2017;135(1):47-53. doi:10.1001/jamaophthalmol.2016.4752
Key Points

Question  What is the association between myopia and ultraviolet B radiation, serum vitamin D concentrations, and polymorphisms in vitamin D metabolism genes in a cross-sectional, population-based random sample of participants 65 years and older from north and south Europe?

Findings  In this secondary analysis of the European Eye Study, only ultraviolet B radiation exposure was associated with a reduced odds ratio for myopia, especially in adolescence and early adulthood, despite adjustment for years in education.

Meaning  This study, while not designed to determine cause and effect relationships, suggests that increased ultraviolet B exposure, a marker of sunlight exposure, is associated with reduced myopia.


Importance  Myopia is becoming increasingly common globally and is associated with potentially sight-threatening complications. Spending time outdoors is protective, but the mechanism underlying this association is poorly understood.

Objective  To examine the association of myopia with ultraviolet B radiation (UVB; directly associated with time outdoors and sunlight exposure), serum vitamin D concentrations, and vitamin D pathway genetic variants, adjusting for years in education.

Design, Setting, and Participants  A cross-sectional, population-based random sample of participants 65 years and older was chosen from 6 study centers from the European Eye Study between November 6, 2000, to November 15, 2002. Of 4187 participants, 4166 attended an eye examination including refraction, gave a blood sample, and were interviewed by trained fieldworkers using a structured questionnaire. Myopia was defined as a mean spherical equivalent of −0.75 diopters or less. Exclusion criteria included aphakia, pseudophakia, late age-related macular degeneration, and vision impairment due to cataract, resulting in 371 participants with myopia and 2797 without.

Exposures  Exposure to UVB estimated by combining meteorological and questionnaire data at different ages, single-nucleotide polymorphisms in vitamin D metabolic pathway genes, serum vitamin D3 concentrations, and years of education.

Main Outcomes and Measures  Odds ratios (ORs) of UVB, serum vitamin D3 concentrations, vitamin D single-nucleotide polymorphisms, and myopia estimated from logistic regression.

Result  Of the included 3168 participants, the mean (SD) age was 72.4 (5) years, and 1456 (46.0%) were male. An SD increase in UVB exposure at age 14 to 19 years (OR, 0.81; 95% CI, 0.71-0.92) and 20 to 39 years (OR, 0.7; 95% CI, 0.62-0.93) was associated with a reduced adjusted OR of myopia; those in the highest tertile of years of education had twice the OR of myopia (OR, 2.08; 95% CI, 1.41-3.06). No independent associations between myopia and serum vitamin D3 concentrations nor variants in genes associated with vitamin D metabolism were found. An unexpected finding was that the highest quintile of plasma lutein concentrations was associated with a reduced OR of myopia (OR, 0.57; 95% CI, 0.46-0.72).

Conclusions and Relevance  Increased UVB exposure was associated with reduced myopia, particularly in adolescence and young adulthood. The association was not altered by adjusting for education. We found no convincing evidence for a direct role of vitamin D in myopia risk. The relationship between high plasma lutein concentrations and a lower risk of myopia requires replication.