Generational difference of refractive error and risk factors in the Handan offspring myopia study

Zhong Lin, Tie Ying Gao, Balamurali Vasudevan, Vishal Jhanji, Kenneth J. Ciuffreda, Peng Zhang, Lei Li, Guang Yun Mao, Ning Li Wang, Yuan Bo Liang*

*Corresponding author for this work

Research output: Contribution to journalArticle

16 Citations (Scopus)
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Purpose.: To report the refractive error difference (RED) between parents and their children, and its risk factors, in a rural area of China.

Methods.: Children (6–17 years) and their parents (36.2 ± 4.1 years) from the Handan Offspring Myopia Study (HOMS) were enrolled. Cycloplegic autorefraction (cyclopentolate 1%, Topcon KR8800) of the children and noncycloplegic autorefraction of their parents were assessed. A detailed vision-based questionnaire was also completed. Refractive error difference was defined as the difference between the parental spherical equivalent (SE) and their children's SE. Generational myopic shift was defined as the estimated RED when a child would be 18 years old according to a prediction model.

Results.: Three hundred fifty-six pairs of parents and 585 children were enrolled. The RED (median, quartiles) increased from −1.33 (−1.99, −0.98) diopters (D) in children aged 6 to 7 years to 0.81 (−0.16, 2.28) D in children aged 16 to 17 years. The children's SE was predicted to approach the parental SE at 14 years of age. Moreover, the children's estimated myopic shift would be 1.03 D. Multiple linear regression revealed that older children (β = 0.23 D/y, P < 0.0001) and girls (β = 0.24, P = 0.01) tended to have a higher RED.

Conclusions.: In this rural Chinese population, the children's refraction was estimated to be similar to the parental refraction at 14 years of age. Moreover, the generational myopic shift was estimated to be approximately 1 D at 18 years of age. These data suggest that the generational difference reflects the increasing prevalence of myopia in the younger generation, which is likely due to changes in environmental exposure.

Original languageEnglish
Pages (from-to)5711-5717
Number of pages7
JournalInvestigative Ophthalmology and Visual Science
Issue number9
Publication statusPublished - Sep 2014


  • Myopia
  • Refractive error
  • Risk factors

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience
  • Medicine(all)

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    Lin, Z., Gao, T. Y., Vasudevan, B., Jhanji, V., Ciuffreda, K. J., Zhang, P., Li, L., Mao, G. Y., Wang, N. L., & Liang, Y. B. (2014). Generational difference of refractive error and risk factors in the Handan offspring myopia study. Investigative Ophthalmology and Visual Science, 55(9), 5711-5717.