Abstract
Myopia is a refractive error of the eye caused by a complex interplay between nature and nurture. The aim of this study was to investigate whether environmental risk factors can influence the genetic effect in children developing myopia. A total of 3422 children participating in the birth-cohort study Generation R underwent an extensive eye examination at 9 years with measurements of refractive error and axial length corneal radius ratio (AL/CR). Environmental risk factors were evaluated using a questionnaire, and environmental risk scores (ERS) were calculated using backward regression analyses. Genetic risk scores (GRS) were calculated based on all currently known risk variants for myopia. Gene-environment interaction (G×E) was investigated using linear and logistic regression analyses. The predictive value of G×E and parental myopia was estimated using receiver operating characteristic curves. Myopia prevalence was 12%. Both GRS (P < 0.01) and ERS (P < 0.01) were significantly associated with myopia and AL/CR, as was G×E interaction (P < 0.01 for myopia; P = 0.07 for AL/CR). The predictive value of parental myopia was 0.67 (95% CI 0.65–0.70), similar to the values of GRS (0.67; 95% CI 0.64–0.70; P = 0.98) and ERS (0.69; 95% CI 0.66–0.72; P = 0.98). Adding G×E interaction significantly improved the predictive value to 0.73 (95% CI 0.70–0.75; P < 0.01). This study provides evidence that nature and nurture are equally important for myopia and AL/CR; however, the combination has the strongest influence. Since myopia genes are common in the population, adjustment of lifestyle should be a major focus in the prevention of myopia.
Highlights
Myopia is the most common eye disorder in developed countries
A backward regression model showed that outdoor exposure (P = 0.03), reading distance (P < 0.01) and number of books read per week (P < 0.01) were significantly associated with axial length corneal radius ratio (AL/CR) (Table 2)
Gene-environment interaction (G×E) interaction was borderline significant for axial length (AL)/CR (P = 0.07) and significant for myopia (P < 0.01), indicating that the effect of Genetic risk scores (GRS) on AL/CR and myopia increased within higher levels of environmental risk scores (ERS) (Table 3)
Summary
Myopia is the most common eye disorder in developed countries. Around 50% of young adults in Europe and up to 83% of the Chinese university students have myopia [1, 2]. The global myopia prevalence is rising and expected to increase from one in three persons in 2000 to half of the worldwide population in 2050 [3]. Myopia is caused by an axial elongation of the eye accompanied by structural changes of. Myopia can be optically corrected, it is associated with an increased risk of visual impairment and blindness later in life due to retinal complications such as myopic macular degeneration, cataract and glaucoma [4]. A higher degree of myopia results in an earlier onset of retinal complications [5]
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