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Less myopia associated with work outdoors, less education, higher Vitamin D, higher lutein – Dec 2016

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

JAMA Ophthalmol. Publishedonline December 1, 2016. doi:10.1001/jamaophthalmol.2016.4752
Katie M. Williams, FRCOphth1,2; Graham C. G. Bentham, MA3; Ian S. Young, MD4; et al Ann McGinty, PhD4; Gareth J. McKay, PhD4; Ruth Hogg, PhD5; Christopher J. Hammond, MD1; Usha Chakravarthy, PhD5; Mati Rahu, PhD6; Johan Seland, PhD7; Gisele Soubrane, MD8; Laura Tomazzoli, MD9; Fotis Topouzis, MD10; Astrid E. Fletcher, PhD11


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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.

Attached files

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7420 Myopia.jpg admin 01 Dec, 2016 21:48 59.40 Kb 876
7419 UV Myopia.jpg admin 01 Dec, 2016 21:48 18.63 Kb 899
7418 eoi160096.pdf PDF 2016 admin 01 Dec, 2016 21:47 293.50 Kb 5952