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Myopia and the Urban Environment: Findings in a Sample of 12-Year-Old Australian School Children

¹From the Centre for Vision Research, Department of Ophthalmology and the Westmead Millennium Institute, University of Sydney, Sydney, Australia; the ²School of Applied Vision Sciences, Faculty of Health Sciences, University of Sydney, Sydney, Australia; and the ³ARC Centre of Excellence in Vision Science and Research School of Biological Sciences, Australian National University, Canberra, Australia.

PURPOSE. To examine associations between myopia and measures of urbanization in a population-based sample of 12-year-old Australian children.

METHODS. Questionnaire data on sociodemographic and environmental factors including ethnicity, parental education, and time spent in near work and outdoor activities were collected from 2367 children (75.0% response) and their parents. Population density data for the Sydney area were used to construct five urban regions. Myopia was defined as spherical equivalent refraction –0.50 D.

RESULTS. Myopia prevalence was lowest in the outer suburban region (6.9%) and highest in the inner city region (17.8%), with mean refraction tending toward greater myopia by region (outer suburban to inner city), after adjustment for age, sex, ethnicity, near work, outdoor activity, and parental myopia. Multivariate-adjusted analyses confirmed greater odds for myopia in regions of higher population density (P_trend = 0.0001). Myopia was significantly more prevalent among children living in apartment residences than other housing types (² < 0.0001), after adjustment for ethnicity, near work, and outdoor activity. Housing density (measured as the number of houses visible from a front door) was not significantly associated with myopia (² = 0.1). For both European Caucasian and East Asian children, myopia was most prevalent in the inner city region (8.1% and 55.1%, for European Caucasian and East Asian, respectively).

CONCLUSIONS. The higher myopia prevalence in inner city-urban areas compared with outer suburban areas for this large childhood sample suggest that even moderate environmental differences within a predominantly urban setting may be associated with increased odds of myopia. These findings are consistent with previous reports of rural-urban differences in childhood myopia.