Associations of high myopia in childhood


Purpose High myopia in early childhood is a recognised association of ocular and systemic disease. The aim of this study was to describe the types, pattern and frequency of these associations.

Methods All children presenting to two ophthalmology units over 3 years who were found to have high myopia were recruited. High myopia was defined as one or both eyes demonstrating 6 dioptres spherical equivalent or more of myopic refractive error on retinoscopy. We limited the age to less than 10 years old. A retrospective case review was undertaken of the 112 consecutive children who fulfilled the criteria above. The demographic data, source and indication for referral were recorded along with the ocular and systemic findings and diagnosis.

Results Only 9 (8%) of the children had 'simple high myopia' with no associated ocular or systemic associations. In 54% there was an underlying systemic association with or without further ocular problems (e.g. developmental delay, prematurity, Marfan, Stickler, Noonan, Down syndrome) and in the remaining 38% there were further ocular problems associated with the high myopia (e.g. lens subluxation, coloboma, retinal dystrophy, anisometropic amblyopia). A family history of high myopia did not preclude associated abnormality: in 4 cases the diagnosis of a systemic condition in the child led to the identification of the disease in at least one myopic relative. Asian (p < 0.001) and male (p < 0.05) patients were over-represented in the series.

Conclusion High myopia is strongly associated with systemic and ocular problems; it may be the reason for the child's initial medical referral and an important clue to an underlying systemic or ocular condition. Referrals infrequently originated from community optometrists despite prior attendance. We suggest that all children under 10 years of age with high myopia are referred to a paediatric ophthalmology clinic for review and we propose a structured clinical evaluation in the hospital eye clinic.


  1. 1

    Curtin BJ . Myopia: a review of its aetiology, pathogenesis and treatment. Surv Ophthalmol 1970;15:1–17.

    Google Scholar 

  2. 2

    Whitmore WG . The aetiology of myopia. Curr Opin Ophthalmol 1991;2:72–7.

    Article  Google Scholar 

  3. 3

    Mohindra I, Held R . Refraction in humans from birth to five years. Doc Ophthalmol Proc Ser 1981;28:17–29.

    Google Scholar 

  4. 4

    Cook RC, Glassock RE . Refractive and ocular findings in the newborn. Am J Ophthalmol 1951;34:1407–13.

    CAS  Article  Google Scholar 

  5. 5

    Laatikainan L, Erkkilä H . Proportion of myopia in visual screening of school children. Doc Ophthalmol Proc Ser 1981;28:1–4.

    Article  Google Scholar 

  6. 6

    Sperduto RD, et al. Prevalence of myopia in the United States. Arch Ophthalmol 1983;101:405–7.

    CAS  Article  Google Scholar 

  7. 7

    Bedrossian RH . The effect of atropine on myopia. Ophthalmology 1979;86:713–7.

    CAS  Article  Google Scholar 

  8. 8

    Oakley KH, Young FA . Bifocal control of myopia. Am J Optom Physiol Opt 1975;52:758–64.

    CAS  Article  Google Scholar 

  9. 9

    Whitmore WG . Congenital and development myopia. Eye 1992;6:361–5.

    Article  Google Scholar 

  10. 10

    Drack AV . Inheritance of refractive errors. In: Traboulsi EI, editor. Genetic diseases of the eye. New York: Oxford University Press, 1998.

  11. 11

    HM Registrar General. Data from the 1991 Census. Office of Population Censuses and Surveys. London: HMSO, 1995.

  12. 12

    Joint Working Party of the Royal College of Ophthalmologists and British Paediatric Association. Ophthalmic services for children. London: Royal College of Ophthalmologists, 1994.

  13. 13

    Cruysberg JRM, Deutman AF . Delay in diagnosis of homocystinuria: retrospective study of consecutive patients. BMJ 1996;313:1037–40.

    CAS  Article  Google Scholar 

  14. 14

    Kaiser-Kupfer MI, Caruso RC, Valle D . Gyrate atrophy of the choroid and retina; long-term reduction of ornithine slows retinal degeneration. Arch Ophthalmol 1991;109:1539–48.

    CAS  Article  Google Scholar 

  15. 15

    Burke JP, O'Keefe M, Bowell R, Naughton ER . A closer look at the eye in homocystinuria: a screened population. J Inerit Metab Dis 1988;11(Suppl 2):237–9.

    Article  Google Scholar 

  16. 16

    Scott JD . Congenital myopia and retinal detachment. Trans Ophthalmol Soc UK 1980;100:69–71.

    CAS  Google Scholar 

  17. 17

    Tyni T, Kivela T, Lappi M, et al. Ophthalmologic findings in long chain 3-hydroxyacyl-CoA dehydrogenase deficiency caused by the G1528C mutation. Ophthalmology 1998;105:810–24.

    CAS  Article  Google Scholar 

  18. 18

    Taylor RH, Burke J, O'Keefe M, Beighl B, Naughton E . Ophthalmic abnormalities in homocystinuria: the value of screening. Eye 1998;12:427–30.

    Article  Google Scholar 

  19. 19

    Shores J, Berger KR, Murphy EA, Pyeritz RE . Progression of aortic dilatation and the benefit of long-term beta-adrenergic blockade in Marfan's sydnrome. N Engl J Med 1994;330:1335–41.

    CAS  Article  Google Scholar 

  20. 20

    Ainsworth JR, Marr JE . Myopia in young children. Ophthalmic Physiol Opt 2000;20:S1.

    Google Scholar 

  21. 21

    Warburg M, Risse R . Ophthalmological services to mentally retarded persons: a review and recommendations. Ugeskrift for Laeger 1994;156:6366–9.

    CAS  PubMed  Google Scholar 

  22. 22

    Simons K . Preschool vision screening: rationale, methodology and outcome. Surv Ophthalmol 1996;41:3–30.

    CAS  Article  Google Scholar 

  23. 23

    Watts P, Walker K, Beck L . Photoscreening for refractive errors in children and young adults with severe learning disabilities using the MTI photoscreener. Eye 1999;13:363–8.

    Article  Google Scholar 

  24. 24

    Sato T . The causes and prevention of acquired myopia. Tokyo: Kanehara Shuppan, 1957.

  25. 25

    Young TL, Ronan SM, Drahozal LA, Wildenberg SC, Alvear AB, Oetting WS, et al. Evidence that a locus for familial high myopia maps to chromosome 18p. Am J Hum Genet 1998;63:109–19.

    CAS  Article  Google Scholar 

  26. 26

    Young TL, Ronan SM, Alvear AB, Wildenberg SC, Oetting WS, Atwood LD, et al. A second locus for familial high myopia maps to chromosome 12q. Am J Hum Genet 1998;63:1419–24.

    CAS  Article  Google Scholar 

  27. 27

    Bundey S, Alam H . A five-year prospective study on the health of children in different ethnic groups, with particular reference to the effect of inbreeding. Eur J Hum Genet 1993;1:206–19.

    CAS  Article  Google Scholar 

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Correspondence to J R Ainsworth.

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Presented as a poster at the Oxford Ophthalmological Congress, 1998

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Marr, J., Halliwell-Ewen, J., Fisher, B. et al. Associations of high myopia in childhood. Eye 15, 70–74 (2001).

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  • Child
  • Myopia
  • Ocular associations
  • Refractive error
  • Systemic associations

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