Association of Parental Myopia With Higher Risk of Myopia Among Multiethnic Children Before School Age | Ophthalmology | JAMA Ophthalmology | JAMA Network
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    Original Investigation
    March 19, 2020

    Association of Parental Myopia With Higher Risk of Myopia Among Multiethnic Children Before School Age

    Author Affiliations
    • 1USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles
    • 2Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
    • 3Department of Ophthalmology, University of Washington, Seattle
    • 4Department of Ophthalmology, Seattle Children’s Hospital, Seattle, Washington
    • 5Southern California College of Optometry, Marshall B. Ketchum University, Fullerton
    • 6Singapore Eye Research Institute, Singapore
    • 7Centre for Vision Research, Westmead Institute, Sydney, Australia
    • 8Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
    • 9Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    • 10Saw Swee Hock School of Public Health, National University of Singapore, Singapore
    • 11Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles
    JAMA Ophthalmol. 2020;138(5):501-509. doi:10.1001/jamaophthalmol.2020.0412
    Key Points

    Question  How is parental myopia associated with early-onset myopia in preschool children of different race/ethnicity?

    Findings  In this cohort study of cycloplegic refraction data from 9793 children aged 6 to 72 months, maternal and paternal myopia were associated with a higher risk of myopia in children before school age. Even among children without myopia, parental myopia was associated with a greater ratio of axial length to corneal curvature radius and more myopic refractive error.

    Meaning  Parental myopia, especially childhood-onset myopia, was associated with a greater risk of early-onset myopia in children regardless of race/ethnicity and as early as 1 year of age.


    Importance  Parental myopia is an important risk factor for preschool myopia in Asian children. Further investigation of the association between parental myopia and early-onset myopia risk in other racial/ethnic groups, such as African American and Hispanic white children, could improve understanding of the etiology and treatment of this condition.

    Objective  To investigate the association of parental myopia with refractive error and ocular biometry in multiethnic children aged 6 to 72 months.

    Design, Setting, and Participants  This cohort study pooled data from children in 3 population-based studies with comparable design from the US, Singapore, and Australia. Parental myopia was defined as the use of glasses or contact lenses for distance viewing by the child’s biological parent(s). Multivariable regressions were conducted to assess the association of parental myopia. Data were collected from 2003 to 2011 and analyzed from 2017 to 2019.

    Main Outcomes and Measures  Cycloplegic refraction and prevalence of myopia (spherical equivalent refractive error of≤−0.5 diopters [D]) in the more myopic eye.

    Results  The analysis cohort included 9793 children, including 4003 Asian, 2201 African American, 1998 Hispanic white, and 1591 non-Hispanic white participants (5106 boys [52.1%]; mean [SD] age, 40.0 [18.9] months). Compared with children without parental myopia, the odds ratios for early-onset myopia were 1.42 (95% CI, 1.20-1.68) for children with 1 parent with myopia, 2.70 (95% CI, 2.19-3.33) for children with 2 parents with myopia, and 3.39 (95% CI, 1.99-5.78) for children with 2 parents with childhood-onset myopia. Even among children without myopia, parental myopia was associated with a greater ratio of axial length to corneal curvature radius (regression coefficient for myopia in both parents, 0.023; P < .001) and more myopic refractive error (regression coefficient for myopia in both parents, −0.20 D; P < .001). Effects of parental myopia were observed in all 4 racial/ethnic groups and across age groups except those younger than 1 year. However, parental myopia was not associated with the age-related trends of refractive error (regression coefficient for children without parental myopeia, 0.08; for children with 2 parents with myopia, 0.04; P = .31 for interaction) and ratio of axial length to corneal curvature radius (regression coefficient for children without parental myopeia, 0.031; for children with 2 parents with myopia, 0.032; P = .89 for interaction) beyond infancy.

    Conclusions and Relevance  Parental myopia, especially childhood-onset parental myopia, was associated with a greater risk of early-onset myopia in Asian, Hispanic, non-Hispanic white, and African American children. The observed associations of parental myopia in children as early as 1 year of age and in children without myopia suggests that genetic susceptibility may play a more important role in early-onset myopia and that parental myopia may contribute to myopia in children by setting up a more myopic baseline before school age.