High Myopes in Singapore: 19-Year Progression from Childhood to Adulthood

The prevalence of myopia is increasing rapidly worldwide and is estimated to reach 1 billion high myopes by 2050 (defined as having a refractive error of spherical equivalent [SE] of ≤–5.00 diopters [D]). 1 Holden B.A. Fricke T.R. Wilson D.A. et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016; 123: 1036-1042 Abstract Full Text Full Text PDF PubMed Scopus (1058) Google Scholar The burden of myopia falls heavily on East Asian countries, and high myopia is increasing disproportionately in prevalence in East Asian young adults. 2 Lin L.L. Shih Y.F. Hsiao C.K. Chen C.J. Prevalence of myopia in Taiwanese schoolchildren: 1983 to 2000. Ann Acad Med Singapore. 2004; 33: 27-33 PubMed Google Scholar ,3 Chen M. Wu A. Zhang L. et al. The increasing prevalence of myopia and high myopia among high school students in Fenghua City, eastern China: a 15-year population-based survey. BMC Ophthalmol. 2018; 18: 159 Crossref PubMed Scopus (54) Google Scholar High myopia portends an increased risk of ocular pathology, being associated with cataract, glaucoma, retinal detachment, and myopic macular degeneration (MMD). 1 Holden B.A. Fricke T.R. Wilson D.A. et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016; 123: 1036-1042 Abstract Full Text Full Text PDF PubMed Scopus (1058) Google Scholar The international Meta-analysis of Pathologic Myopia (META-PM) classification describes increasing severity of MMD based on the natural history of progression of myopic eyes, with tessellated fundus (grade 1 MMD) associated with risk of developing more advanced stages of MMD that are associated with vision loss. 4 Ohno-Matsui K. Kawasaki R. Jonas J.B. et al. International photographic classification and grading system for myopic maculopathy. Am J Ophthalmol. 2015; 159: 877-883 Abstract Full Text Full Text PDF PubMed Scopus (271) Google Scholar Studies also have shown an association between decreased choroidal thickness (CT) and progressively more severe MMD. 5 Fang Y. Du R. Nagaoka N. et al. OCT-based diagnostic criteria for different stages of myopic maculopathy. Ophthalmology. 2019; 126: 1018-1032 Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar Thus far, few, if any, prospective studies have been conducted with long follow-up describing the progression of myopia in East Asian children through young adulthood. In the 19-year Singapore Cohort Study of the Risk Factors for Myopia cohort, we sought to examine the progression of myopia in highly myopic Singaporean children from childhood to young adulthood, as well as to evaluate longitudinal risk factors for myopia pathology, namely MMD and CT, in young adulthood.