Modelling changes in the prevalence of childhood myopia

Purpose: To re-examine the changes with time in the underlying patterns of individual refraction at different ages, which have led to an increased prevalence of myopia in a population of Asian children.Methods: Using published cross-sectional longitudinal data, the frequency distributions of spherical equivalent refractive error (SE) in yearly cohorts of 6- and 12-year-old Japanese children during the period 1984-1996 were modelled in terms of ex- and bi-Gaussian distributions.Results: Both models suggested that over the period of the study, little change occurred in the SE frequency distributions for 6-year-olds, with most children having SEs near emmetropia. In contrast, in each annual cohort of 12-year-olds, although the SE of some children remained near-emmetropic, a sub-set failed to maintain emmetropia. Most of this group became more myopic between 6 and 12 years of age. The proportion of children showing myopic progression increased over the period of study.Conclusions: The observed increase in mean levels of myopia in older Japanese children in the late 20th century is due to a greater proportion of children failing to maintain emmetropisation between the ages of 6 and 12, rather than to myopic shifts in all children. Some children, with small SE changes between 6 and 12 years of age, would not have benefitted from any treatment intended to slow myopia progression.