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GlobalPrevalenceofMyopiaandHigh
MyopiaandTemporalTrendsfrom2000
through2050
BrienA.Holden,PhD,DSc, 1,2 TimothyR.Fricke,MSc,DavidA.Wilson,PhD,
1 1,2,3 MonicaJong,PhD, 1
1,2,3 PadmajaSankaridurg,PhD, 1,2 4 1
KovinS.Naidoo,PhD, TienY.Wong,MD,ThomasJ.Naduvilath,PhD,
SergeResnikoff,MD 1,2

Tujuan: Myopiaisacommoncauseofvisionloss,withuncorrectedmyopiatheleadingcauseofdistance
visionimpairmentglobally.Individualstudiesshowvariationsintheprevalenceofmyopiaandhighmyopiabe-
tweenregionsandethnicgroups,andtherecontinuestobeuncertaintyregardingincreasingprevalenceof
miopia.
Desain: Systematicreviewandmeta-analisis.
Metode: Myopiaandestimatedtemporaltrendsfrom2000to2050usingdatapublishedsince1995
Weperformedasystematicreviewandmeta-analysisoftheprevalenceofmyopiaandhigh.Theprimarydata
weregatheredinto5-yearagegroupsfrom0to100,inurbanorruralpopulationsineachcountry,

standar
todenitionsofmyopiaof 0,50  diopter (D) orlessandofhighmyopiaof 
5.00Dorless, projectedtotheyear
KESAN

2010,daerahthenmeta-analyzedwithinGlobalBurdenofDisease(GBD).Anyurbanorruralagegroupthat
lackeddatainaGBDregiontookdatafromthemostsimilarregion.Theprevalencedatawerecombinedwith
toestimatetheurbanizationdataandpopulationdatafromUnitedNationsPopulationDepartment(UNPD)
prevalenceofmyopiaandhighmyopiaineachcountryoftheworld.Theseestimateswerecombinedwithmyopia
changeestimatesovertimederivedfromregressionanalysisofpublishedevidencetoprojecttoeachdecade
from2000through2050.
Hasil: Weincludeddatafrom145studiescovering2.1millionparticipants.Weestimated1406million
peoplewithmyopia(22.9%oftheworldpopulation;95%condenceinterval[CI],9321932million[15,2% e e
KESAN

31.5%])and163millionpeoplewithhighmyopia(2.7%oftheworldpopulation;95%CI,86387million[1,4% e e
6.3%])in2000.Wepredictby2050therewillbe4758millionpeoplewithmyopia(49.8%oftheworldpopulation;
e e
36206056million[95%CI,43.4%55.7%])and938millionpeoplewithhighmyopia (9.8%oftheworldpop-
e e
ulation;4792104million[95%CI,5.7%19.4%]). KESAN

Kesimpulan: Myopiaandhighmyopiaestimatesfrom2000to2050suggestsignicantincreasesin
prevalencesglobally,withimplicationsforplanningservices,includingmanagingandpreventingmyopia-
komplikasi okular terkait dan kehilangan penglihatan antara hampir 1 miliar orang dengan tinggi Budi-pia.
ª
Ophthalmology2016;123:1036-10422016bytheAmericanAcademyofOphthalmology.Thisisanopen
accessarticleundertheCCBY-NC-NDlicense(http://creativecommons.org/licenses/by-nc-nd/4.0/).

Supplementalmaterialisavailableatwww.aaojournal.org.

In2010, itwasestimatedthatuncorrectedrefractiveerror highprevalenceofmyopia,myopicmaculardegeneration

wasthemostcommoncauseofdistancevisionimpairment,
affecting108millionpersons, causeofblindnessglobally hasbeenfoundtobethemostfrequentcauseof
5
irreversibleblindness.Myopicmaculardegenerationhas
andthesecondmostcommon 1. Theeconomicburdenof
beenfoundtocause12.2%ofvisionimpairmentinJapan
uncorrecteddistancerefractiveerror,largelycausedby (approximately200000people). 6
miopia,wasestimatedtobeUS$202billionperannum. 2 Myopiabetweendifferentregionsandethnicgroups
Thereremain2majorgapsintheliterature.First,indi-vidualstudiessuggestwidevari
Thereisasubstantiveeconomicargumentforeliminating ationintheprevalenceof.Untuk
3 7
uncorrectedmyopiaandotherrefractiveerrors.
Namun,myopiabringsfurthervisionchallenges contoh, theprevalenceofmyopiaismorethan2times
becausehighmyopiaincreasestheriskofpathologicocular higheramongEastAsiansthansimilarlyagedwhite orang.
changessuchascataract,glaukoma,retinaldetachment,
andmyopicmaculardegeneration,allofwhichcancause Kedua,theprevalenceofmyopiaindifferent
8
irreversiblevisionloss.Insomecommunitieswitha countriesseemstobeincreasing,andmostdramatically
4 8
amongyoungerpeopleinEastAsia. Thecombination

1036  2016bytheAmericanAcademyofOphthalmologyThisisanopenaccessarticleundertheCCBY-NC-NDlicense http://DX.Doi.org/10.1016/j.ophtha.2016.01.006

(http://creativecommons.org/licenses/by-nc-nd/4.0/).PublishedbyElsevierInc. ISSN0161-6420/16

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Holdenetal
GlobalMyopiaTrends20002050
Figure1. Flowdiagramsummarizingthesystematicsearchandreviewprocessforidentifyingmyopiaprevalenceevidenceglobally.MeSH
judul.
ofvisionimpairmentfromuncorrectedmyopiaand
irreversiblevisionlossfrommyopia-relatedcomplications
makeaccurateglobalestimatesoftheprevalenceandtem-
poraltrendscriticalforplanningcareandservices.Bagaimana-
sebelumnya,therearenopreciseestimatesoftheglobalprevalence
ofmyopiaorforprojectedtemporalchangesoverthenext
fewdecades.
Metode
Studi,database,andDataOrganization
Weperformedasystematicsearchandreviewoftheprevalenceof
myopiaandhighmyopiausingdatapublishedsince1995,sum-
marizedinFigure1.WesearchedPubMed(NationalLibraryof
OnJanuary10 #Pages [2] tahun2015,forpublicationsusingthe
obat-obatan),
istilahfollowingMeSH(MedicalSubjectHeading): miopia
DAN prevalensi dan refractiveerror DAN prevalensi .The
searchwasrestrictedtoarticlespublishedafterJanuary1,1995,
andwasperformedonallavailablearticlesregardlessofthe
originallanguageofpublication.Thesearchyielded1656and
2632articlesrelatingtomyopiaandrefractiveerror,masing-masing.
Theabstractofeachpublicationwasreviewedandarticlesthat
Multilizer PDF Translator Free version - translation is limited to ~ 3 pages per translation.
e
¼medicalsubject
werepopulation-basedsurveyswereincluded.Surveyswere
excludediftheydidnotspecifythenumberofeligibleparticipants
orparticipationrate,orifdatawerefromaspecicpopulationthat
KESAN
couldnotbegeneralizedtothepopulationasawhole.Werejected
8articlesthatdidnotspecifyadenitionofmyopia.
KESAN Tocover
regionswithoutdata,someadditionalarticlesweresourcedthrough
keyinformantadviceandfromreferencelistsofarticlesfound
throughPubMed.Afulllistofthe145studiesisincludedin
Appendix1(availableatwww.aaojournal.org).
Negara-specicpopulationdataforeachdecadefrom2000
KESAN
through2050, in5-yearagegroupsfrom0to
100, weredra
9
mostlyfromtheUnitedNationsWorldPopulationProspects.
PopulationdatafromtheUnitedStatesCensusBureauwereused
forasmallnumberoflow-populationstatesomittedfromthe
availableUnitedNationsdata. 10
Studieshavesuggestedthatmyopiaratesdifferinurban
11,12
comparedwithruralcommunitiesthatareotherwisesimilar.
Wethereforeobtainedseparateurbanandruralmyopiapreva-
lenceswherepossibleanddisaggregatedcountry-levelpopulations
intourbanandruralnumberssourcedfromtheUnitedNations
WorldUrbanizationProspects. 13
Countriesweregroupedintothe21GlobalBurdenofDisease
1
Daerah(GBD).Pengembangannegara-specicurbanandruralpopulation
KESAN
datawerecombinedwiththecorrespondingprevalencedatain
each5-yearagegrouptocalculatethenumberofpeoplewith
1037
Multilizer PDF Translator Free versionVolume123,
- translation is limited to ~ 3 pages per translation.
Number5,May2016
Optalmologi

miopia.Thenumbersofpeoplewithmyopiaineachagegroupin (R2 ¼ 0.86),rateofurbanization) R2 ¼ 0,07),andchangeinHDI

ruralandurbanareasofeachcountrythenwereaggregatedto (R2 ¼ 0,69).Therelationshipbetweenchangeinmyopiaovertime
obtainregionaltotals. andprevalenceofmyopiawasthestrongest,followingtheformula:
KESAN
Percentageannualprevalencechange
Denitions «
¼ 12456
:  E ð prevalensi
:  004 Þ 022813: ;
Thedenitionsofmyopiaandhighmyopiavaryacrosstheselected
KESAN
prevalencestudies.Ofthe145articlesincludedinthisstudy, mana E ¼ Eulersnumber.Therewere2exceptionstousing
mostcommondenitionofmyopiawassphericalequivalent KESAN thispercentageannualchangeformula.Pertama,becausetherewere
dari diopter 0,50 (D) nodataforprevalencelessthan28.3%,wetooktheconservative
orless(58.7%), with29.0% usingless
daripada  0.50D,5.0%using 1.00Dorlessorlessthan 1.00  D approachofusingaconstant3.8%Change/yearforallprevalences
16
(allstudiesofadults),2.9%using  0.75Dorlessorless lessthan28.3%. Kedua, Vitaleetal provideaclearindication
daripada  0.75D,and3.6%using 0.25Dorlessorlessthan 0,25  thattheeffectdecreasesatagesyoungerthan20years. Fittinga
D.Only59studiesdenedandmeasuredhighmyopia,with30.5% KESAN 2-partlinearfunctiontotheirdatasuggestedadjustingthecalcu-
deningitas
KESAN 6.00Dorless,30.5%deningitaslessthan KESAN 
6,00 latedannualchangeinmyopiagurebyafactorof0.5inthe10-untuk
KESAN
D,35.6%deningitas KESAN 
5.00Dorlessorlessthan 
5.00D,1.7% 19-Year-oldagegroups,0.25inthe5-to9-Year-oldagegroup,and
deningitas
KESAN  8.00Dorless,and1.7%deningitas KESAN 
3.00Dor 0inthe0-to4-tahun-oldagegroup.Theprevalenceofmyopiain
kurang. eachdecadewascalculatedbyadjustingtheprevalencegurebya KESAN
Westandardizedtoasphericalequivalentof 0.50Dorlessfor « cumulativechangeequaltoPrevalence 
(1 þ
(Percentageannual
myopiabecauseitwasthemostcommonlyuseddenitionin KESAN Change)(numberofyears)).
publishedprevalencestudies,isbeyondrefractionmeasurement Threestudiesshowedasimilarincreaseinprevalenceofhigh
kesalahan,andcaptureschildrenatthestartoftheirprogression.Kami myopiaovertime.Giventhesparsedata,weusedasimpleaverage
annualprevalencechangefromthesestudies(3.26%per
standardizedtoasphericalequivalentof  5.00Dorlessfor e
1618
highmyopiabecauseitisusedcommonly,identiespeopleat KESAN tahun). Selainitu,becausetheevidencetrendedtoless
higherriskofpathologicmyopia,andifuncorrected,menyebabkan annualchangeasprevalenceincreasedbetween15%and30%dan
therewasnoannualchangedataforhighmyopiaprevalenceof30%
visionimpairmentatleastequivalenttotheWorldHealth ormore,wegeneratedalogarithmicdecayfunctionthat
14
Organizationdenedblindness. e KESAN reducedto0whentheprevalencereached100%.Thisformulawas
Therelationshipbetweenprevalenceanddenitionwas KESAN usedwhentheprevalenceofhighmyopiawasmorethan30%:
analyzedusingallarticlesprovidingprevalenceat2ormorecut- Annualchange
offsformyopiaorhighmyopia.Allprevalencedatawerestan- ¼ 2237:  LN ðprevalensi Þ þ 10283: ;
dardizedtomyopiaandhighmyopiadenitionsof KESAN 0.50Dorless 16
dan  5.00Dorless, masing-masing, usinglinearregressionsspecic
KESAN mana LN ¼ naturallog. DatafromVitaleetal againsuggested
toregionalanddioptriclevel(seeSupplementalMaterial,part1, thattheannualchangeinhighmyopiaprevalencewouldbelessin
availableatwww.aaojournal.org). agegroupsyoungerthan20years. Usingasimilarprocessasinthe
myopiacase, theannualchangeinhighmyopiaprevalencewas
adjustedbyafactorof0.4inthe15-to19-tahun-oldagegroup,
Meta-analysisandExtrapolation 0.3inthe10-to14-year-oldagegroup,0.2inthe5-to9-year-old
agegroup, and0.1inthe0-to4-tahun-oldagegroup.Thechanging
Meta-analysisoftheprevalenceofmyopiaandhighmyopiawithin proportionofpeoplelivinginurbanversusruralsituationsineach
eachagegroupofeachGBDregion,usingthestandardized decadewassourcedfromtheUnitedNations.
13
myopiadenitionsandastandardizedtimepointof2010,
KESAN adalah
performedusingComprehensiveMeta-Analysissoftwareversion3
(Biostat,Englewood,NJ).Alogitrandomeffectsmodelwasused
KESAN

CondenceIntervals
tocombinestudieswithineachagegroupandregion.Thelogit
prevalencewasdenedaslog KESAN (/(1 p e p)), dimana p istheprevalence Inadditiontothe95%condencelimitscalculatedinthemeta-
KESAN
withineachagegroup.Wasnot(Thestudy-untuk-studyvariance) s2 analysisofprevalencedata,uncertaintyinfuturepopulationpro-
assumedtobethesameforallagegroupswithintheregion, jectionswasrepresentedbythehigh-andlow-fertilitypopulation
indicatingthatthisvaluewascomputedwithinagegroupsandwas projectionsfromtheUnitedNations. 13
notpooledacrossagegroups.Theinverseofthevariancewasused
tocomputerelativeweights.Thelogitprevalenceanditsstandard ControlFactors
errorwereusedtocomputethe95%condencelimits, KESAN yang
thenwastransformedtotheestimatedprevalenceanditscorre- « «
Publishedevidenceindicatesthatmyopiaiscommonandincreasing
spondinglimitsusingtheformula E (logitprevalence) E / lembur, withapparenteffectsofrace,lokasi,andgeneration.
((logit
prevalensi) þ 1), dimana E ¼ Eulersnumber. Racialeffectswerecontrolledbyusingstudiesasbroadlyrepre-
Umur-specicregionalmeta-analysisresultswereextrapolatedto
KESAN sentativeofacountryspopulationaspossibleandextrapolating
GBDregionslackingdatainanyspecicageorurbanization KESAN withinGBDregions.Locationeffectswerecontrolledbydis-
Group,withextrapolationsbasedonregionalsimilaritiesinur- aggregatingurbanandruralpopulationsandprevalenceand
banization,HumanDevelopmentIndex(IPM),racialproles, KESAN extrapolatingbasedonHDIandGBDregion.Generational
15 shiftswereaccommodatedthroughourchangeovertimemethod-
budaya,educationsystems,healthsystems,andothersimilarities.
Datagapswithinregionsalsowere KESAN lledvianearestneighbor ologyandwerefacilitatedbymaintaining5-yearagegroupsthrough
linearinterpolationbetweenagegroupsuptoamaximumof20

100.
yearsbetweengroups.

ProjectionsacrossDecades Hasil
Longitudinalandrepeatedcross-sectionalstudieshaveshown Asummaryoftheoriginaldatafromall145studiesisgivenin
e
1621
increasingprevalenceofmyopia. Weanalyzedchange Appendix2(availableatwww.aaojournal.org).Figure2showsour
inmyopiaprevalenceovertimeagainstprevalenceofmyopia estimatesofthetotalnumberofpeoplewithmyopiaglobally.Dalam

1038

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 Holdenetal 
e
GlobalMyopiaTrends20002050

Figure2. Graphshowingthenumberofpeopleestimatedtohavemyopiaandhighmyopiaforeachdecadefrom2000through2050.Errorbarsrepresent
fi
the95%condenceintervals.

2000,thiswas1406million(22.9%oftheglobalpopulation; numbersofpeoplewithmyopiawerebetween10and39years
uncertainty interval, 9321932e million [15.2%31.5%]),e ofage.However,ourprojectionssuggestthatthroughboth
increasingto1950millionin2010(28.3%oftheglobal cohortandageeffectsthisdistributionwillspreadby2050,with
e million [20.6%36.9%]).
population; 14222543 e This is largenumbersofpeoplewithmyopiafrom10yearsofageall
projectedtoincreaseto2620millionin2020(34.0%ofthe thewaythroughto79yearsofage.
e
globalpopulation;uncertaintyinterval,19763366million
e
[26.2%42.6%]),to3361millionby2030(39.9%oftheglobal Table1.PrevalenceofMyopiaEstimatedforEachGlobalBurden
e
population;uncertaintyinterval,25784217million[32.3% e ofDiseaseRegionbetween2000and2050
47.5%]),to4089millionby2040(45.2%oftheglobal
e
population;uncertaintyinterval,31455128million[38.1% e Prevalence(%)inEachDecade
52.1%]),andto4758millionby2050(49.8%oftheglobal
e
population;uncertaintyinterval,36206056million[43.4% e Region 200020102020203020402050
55.7%]). AndeanLatinAmerica 15.2 20.5 28.1 36.2 44.0 50.7
Regionaldifferencesareevidentthroughouttheprojection fi
Asia-Pacic,highincome 46.1 48.8 53.4 58.0 62.5 66.4
period,asshowninTable1.Thehigh-incomecountriesofAsia- Australasia 19.7 27.3 36.0 43.8 50.2 55.1
Pacicbeginwithasignicantlyhigherprevalenceofmyopia
fi fi Caribbean 15.7 21.0 29.0 37.4 45.0 51.7
thananyotherregion.EastAsia,SoutheastAsia,andthehigh- CentralAfrica 5.1 7.0 9.8 14.1 20.4 27.9
incomecountriesofNorthAmericaclosethegaptosomeextent CentralAsia 11.2 17.0 24.3 32.9 41.1 47.4
by2050becauseofacombinationofceilingeffectsinsomeage CentralEurope 20.5 27.1 34.6 41.8 48.9 54.1
groups,prevalencedistributionacrossagegroups,andchanging CentralLatinAmerica 22.1 27.3 34.2 41.6 48.9 54.9
agedemographics. EastAfrica 3.2 4.9 8.4 12.3 17.1 22.7
Figure2showsourestimatesofthetotalnumberofpeoplewith EastAsia 38.8 47.0 51.6 56.9 61.4 65.3
highmyopiaglobally.Thiswas163millionin2000(2.7%ofthe EasternEurope 18.025.032.238.945.950.4
globalpopulation;uncertaintyinterval,86387million[1.4% NorthAfricaandMiddleEast14.623.330.538.846.352.2
e e NorthAmerica,highincome28.334.542.148.554.058.45.0
6.3%]),increasingto277millionin2010(4.0%oftheglobal
Oceania 6.7 9.1 12.5 17.4 23.8
e
population;uncertaintyinterval,153589million[2.2%8.6%]).e
SouthAsia 14.4 20.2 28.6 38.0 46.2 53.0
Thisisprojectedtoincreaseto399millionin2020(5.2%ofthe
SoutheastAsia 33.8 39.3 46.1 52.4 57.6 62.0
e
globalpopulation;uncertaintyinterval,233815million[3.1% e SouthernAfrica 5.1 8.0 12.1 17.5 23.4 30.2
10.3%]),to517millionby2030(6.1%oftheglobalpopulation; SouthernLatinAmerica 15.6 22.9 32.4 40.7 47.7 53.4
e e
uncertaintyinterval,2981082million[3.7%12.2%]),to696 TropicalLatinAmerica 14.5 20.1 27.7 35.9 43.9 50.7
millionby2040(7.7%oftheglobalpopulation;uncertainty WestAfrica 5.2 7.0 9.6 13.6 19.7 26.8
e e
interval,3811518million[4.6%15.4%]),andto938million WesternEurope 21.9 28.5 36.7 44.5 51.0 56.2
by2050(9.8%oftheglobalpopulation;uncertaintyinterval, Global 22.9 28.3 33.9 39.9 45.2 49.8
e e
4792105[5.7%19.4%]).Regionaldifferencesareevident
throughouttheprojectionperiod,asshowninTable1.
Figure3showsthedistributionofpeoplewithmyopiaand NumbersanduncertaintyareprovidedintheSupplementalMaterial
(availableatwww.aaojournal.org).
prevalenceofmyopiaacrossagegroups.In2000,thegreatest

1039
 Ophthalmology
Figure3. Graphshowingthedistributionofpeopleestimatedtohavemyopiaacrossagegroupsin2000and2050.
Discussion
Ourstudyestimatesthatmyopiaandhighmyopiawillshow
asignicantincreaseinprevalenceglobally,affectingnearly
fi changesforchildrenandyoungpeopleoverthepast10to
5billionpeopleand1billionpeople,respectively,by2050.
Thesehaveimportantimplicationsforplanningcompre-
hensiveeyecareservices,includingrefractiveservicessuch
asspectaclesandmanagingandpreventingmyopic-related
ocularcomplicationsandvisionlossamongpeoplewith
highmyopia.
Theincreasingprevalenceofhighmyopiahasalready
16
beennotedinsomeregions.Vitaleetal foundan8-fold

increaseinhighmyopia(7.90D)over30years,from
0.2%to1.6%. 16 ThelevelofhighmyopiainAsiancountries
isconsiderablyhigher.Inthestudyofcollegefreshmanin
TaiwanbyWangetal, 19 highmyopiaincreasedfrom26%
ofallmyopiain1988to40%ofmyopiain2005.Lin
etal 17 foundthat21%of18-year-oldTaiwanesestudents
in2000hadhighmyopia( <6.00D)comparedwith10.9%
in1983.
Theprojectedincreasesinmyopiaandhighmyopiaare
widelyconsideredtobedrivenbyenvironmentalfactors
(nurture),principallylifestylechangesresultingfrom
acombinationofdecreasedtimeoutdoorsandincreased
nearworkactivities,amongotherfactors. 22
Genetic
predispositionalsoseemstoplayarole,butcannot
explainthetemporal trendsobserved over ashort
period.23 Amongenvironmentalfactors,so-calledhigh-
pressureeducationalsystems,especiallyatveryyoungages
incountriessuchasSingapore,Korea,Taiwan,andChina,
maybeacausativelifestylechange,asmaytheexcessive
useofnearelectronicdevices.Otherproposedcauses
22
includelightlevels, 24whichmaybedirectlyrelatedto
timeoutdoors,withperipheralhyperopiainthemyopic eye
(correctedanduncorrected)encouragingaxial
1040
Volume123,Number5,May2016
growth,25 anddiet.26 Theglobalmyopiaintheyear2000
valuesinFigure3,withthebulkofmyopiainagegroups
youngerthan40years,reectsthesignicantlifestyle
fl fi
25years,especiallyinthelargepopulationcentersofAsia.
Ourprojections,basedonexistingdata,assumethatthese
lifestylechangeswillcontinuetospreadwithincreasing
urbanizationanddevelopment.Acceleratedchanges,or
reversalofrecenttrends,wouldbeexpectedtoincreaseor
decreasefutureprevalencefromourpredictions,respec-
tively.Ourprojectionsindicatethatby2050,50%and10%
oftheworldwillhavemyopiaandhighmyopia,respec-
tively,a2-foldincreaseinmyopiaprevalence(from22%in
2000)anda5-foldincreaseinhighmyopiaprevalence(from
2%in2000).Higheramountsofmyopiahavethepotential
tocausevisionimpairmentbymyopicmaculardegeneration
oritscomorbidities,cataract,retinaldetachment,andglau-
coma,theriskofwhichincreasewithanyincreasein
27
myopia.Basedonourprojectionsandassumingthe
proportionofthosewithhighmyopiawhogoonto
experiencevisionlossresultingfrompathologicmyopia
remainsthesame,thenumberofpeoplewithvisionloss
resultingfromhighmyopiawouldincrease7-foldfrom
2000to2050,andmyopiawouldbecomealeadingcauseof
permanentblindnessworldwide.Thisisaconservativees-
timate;Figure3showsnotonlythatwilltherebemore
peoplewithmyopiaby2050,butalsothattheywillalso
beolderandmoresusceptibletothepathologiceffectsof
myopiathanin2000.
Ourstudydesignhassomepotentiallimitations.Therst fi
isthepaucityofprevalencedatainmanycountriesandage
groups,acrossrepresentativegeographicareas,racial
groupings,andHDIs.Thisproblemwasgreaterforhigh
myopiathanmyopia.Thefurthertheprimarydataare
extrapolated,thegreatertheuncertaintyoftheestimates
 Holdenetal 
e
GlobalMyopiaTrends20002050

becomes.Second,manycountriesandagegroupsacross myopiaandhighmyopia.Theuptakeofmyopiacontrol,
representativegeographicareas,racialgroupings,and however,requiresastrongevidencebaseandaconcertedeffort
HDIslackeddataonthechangeinmyopia,especially bygovernment,education,andhealthsystems.
highmyopia,overtime.Localeffectsonchangesinmyopia Inconclusion,oursystematicreview,meta-analysis,and
overtimearepotentiallylostwhenannualchangesare projectionsprovidemyopiaandhighmyopiapredictions
extrapolatedacrossregions.However,Vitaleetal 16
noted through2050andtheirdistributionbetweenGBDregions.
thatthemyopiaandhighmyopiachangesseeninAfrican Ourestimatesandprojectionsassimilatelocal,individual
studiesintoanimprovedglobalunderstandingofmyopia
AmericanswereverysimilartothoseinEuropean epidemiologicfactors.Ourmethodologyprovidesabasis
Americans,suggestingthatalthoughenvironmental forvalidationofprojectionsagainstnewevidenceasit
changesareimportant,racialdifferencesprobablyarenot. ispublished.Ifcorrect,ourprojectionshavesignicant
Third,projectingonthebasisofcurrentinformationhas fi
thepotentialtomissvaryingchangesovertime.Fourth, implcatonsfrg
variationsinthedenitionofmyopiaandhighmyopiain omprehnsivyca
fi ces
thevidncbasm globay,whicudnet
necsarytodjuh ocaterls1bin
prevalncwusdtoi,h fi peolwithgmyab20 fi
50,7.timesorhan2Tbfulcdyp
increasesuncertainty.Thereareconictingdataonthe fl tobufferthisscenariowouldbesubstantial.
ef c tofgendrmypia
revalnc.Foxmp,Wu
etal foundthagirlsbCwecy 28 fi References
morelikelytohavemyopiathanboys,whereasHashemi
etal 29 foundtheoppositetobetrue.Withthesesortsof
conicts,itseemsunlikelythatthereisasimplegender fl 1.BourneRR,StevensGA,WhiteRA,etal.Causesofvision
effectonmyopiadevelopment.Theremaybeamore lossworldwide,19902010:asystematicanalysis.TheLancet e
complexgendereffect,wheredifferentialaccessto, GlobalHealth2013;1:e33949. –
encouragementtoparticipatein,orchoiceswithrespectto 2.SmithT,FrickK,HoldenB,etal.Potentiallostproductivity
resultingfromtheglobalburdenofuncorrectedrefractive
education,outdooractivities,lightexposure,ora
combinationthereofbetweenboysandgirlsinuencesthe error.BullWorldHealthOrg2009;87:4317. –
fl 3.FrickeT,HoldenB,WilsonD,etal.Globalcostofcorrecting
devlopmntfyia.Wb
lievdthasknof visionimpairmentfromuncorrectedrefractiveerror.Bull
gendrfctwasbyoh WorldHealthOrg2012;90:72838.–
scopefthiudy,w
dinotsagreb 4.WongTY,FerreiraA,HughesR,etal.Epidemiologyand
ngedr.Also,wua diseaseburdenofpathologicmyopiaandmyopicchoroidal
logarithmcdey neovascularization:anevidence-basedsystematicreview.Am
functioesmah
futre JOphthalmol2014;157:925.e12. –
prevalncofmyi,dth 5.IwaseA,AraieM,TomidokoroA,etal.Prevalenceandcauses
usitpoblehafr
prevalncmyhbo oflowvisionandblindnessinaJapaneseadultpopulation:the
restimad,pclyfo Tajimistudy.Ophthalmology2006;113:13541362.e1. –
regionswhtcup 6.YamadaM,HiratsukaY,RobertsCB,etal.Prevalenceof
evalncsrmodt
low.Hevr,gintha visualimpairmentintheadultJapanesepopulationbycause
therisanlmof andseverityandfutureprojections.OphthalEpidemiol
uncertaiysodw
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FootnotesandFinancialDisclosures
Originallyreceived:June3,2015. AuthorContributions:
Finalrevision:December15,2015. Conceptionanddesign:Holden,Fricke,Wilson
Accepted:January5,2016. Analysisandinterpretation:Holden,Jong,Naidoo,Sankaridurg,Wong,
Availableonline:February11,2016. Manuscriptno.2015-906. Naduvilath,Resnikoff
1
BrienHoldenVisionInstitute,Sydney,Australia. Datacollection:Fricke,Wilson
2
SchoolofOptometryandVisionScience,UniversityofNewSouth Obtainedfunding:none
Wales,Sydney,Australia.
Overallresponsibility:Holden,Fricke,Wilson,Naduvilath
3
AfricanVisionResearchInstitute,UniversityofKwaZulu-Natal,Durban,
AbbreviationsandAcronyms:
SouthAfrica.
D ¼ diopter; GBD ¼ GlobalBurdenofDisease; HDI ¼ HumanDevel-
4
SingaporeEyeResearchInstitute,SingaporeNationalEyeCenter,Duke- opmentIndex.
NUSMedicalSchool,Singapore,RepublicofSingapore.
Correspondence:
FinancialDisclosure(s):
KovinS.Naidoo,PhD,BrienHoldenVisionInstitute,UniversityofNew
Theauthor(s)havenoproprietaryorcommercialinterestinanymaterials
SouthWales,Gate14BarkerStreet,RupertMyersBuilding,4thFloor,
discussedinthisarticle.
Kensington,NewSouthWales2052,Australia.E-mail:k.naidoo@
SupportedbytheBrienHoldenVisionInstitute,Sydney,Australia. brienholdenvision.org.

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