Korean J Ophthalmol.  2016 Jun;30(3):214-224. 10.3341/kjo.2016.30.3.214.

Refractive Errors in Koreans: The Korea National Health and Nutrition Examination Survey 2008-2012

• Rim TH
• Kim SH
• Lim KH
• Choi M
• Kim HY
• Baek SH
• Epidemiologic Survey Committee of the Korean Ophthalmological Society

• KMID: 2373977
• DOI: http://doi.org/10.3341/kjo.2016.30.3.214

Abstract

PURPOSE
Our study provides epidemiologic data on the prevalence of refractive errors in all age group ≥5 years in Korea.
METHODS
In 2008 to 2012, a total of 33,355 participants aged ≥5 years underwent ophthalmologic examinations. Using the right eye, myopia was defined as a spherical equivalent (SE) less than -0.5 or -1.0 diopters (D) in subjects aged 19 years and older or as an SE less than -0.75 or -1.25 D in subjects aged 5 to 18 years according to non-cycloplegic refraction. Other refractive errors were defined as follows: high myopia as an SE less than -6.0 D; hyperopia as an SE larger than +0.5 D; and astigmatism as a cylindrical error less than -1.0 D. The prevalence and risk factors of myopia were evaluated.
RESULTS
Prevalence rates with a 95% confidence interval were determined for myopia (SE <-0.5 D, 51.9% [51.2 to 52.7]; SE <-1.0 D, 39.6% [38.8 to 40.3]), high myopia (5.0% [4.7 to 5.3]), hyperopia (13.4% [12.9 to 13.9]), and astigmatism (31.2% [30.5 to 32.0]). The prevalence of myopia demonstrated a nonlinear distribution with the highest peak between the ages of 19 and 29 years. The prevalence of hyperopia decreased with age in subjects aged 39 years or younger and then increased with age in subjects aged 40 years or older. The prevalence of astigmatism gradually increased with age. Education was associated with all refractive errors; myopia was more prevalent and hyperopia and astigmatism were less prevalent in the highly educated groups.
CONCLUSIONS
In young generations, the prevalence of myopia in Korea was much higher compared to the white or black populations in Western countries and is consistent with the high prevalence found in most other Asian countries. The overall prevalence of hyperopia was much lower compared to that of the white Western population. Age and education level were significant predictive factors associated with all kinds of refractive errors.

Keyword

Astigmatism; Hyperopia; Myopia; Refractive errors

MeSH Terms

Adolescent
Adult
Age Distribution
Aged
Child
Child, Preschool
Cross-Sectional Studies
Female
Follow-Up Studies
Humans
Male
Middle Aged
*Nutrition Surveys
Prevalence
Refractive Errors/*epidemiology/physiopathology
Republic of Korea/epidemiology
Retrospective Studies
Risk Factors
Visual Acuity/*physiology
Young Adult

Figure

• 

  Fig. 1 Age-specific proportions of refractive errors in the right eye by (A) spherical equivalent (SE), (B) cylindrical error (Cyl), and (C) axis distribution of astigmatism (n = 33,355).

Reference

1. Resnikoff S, Pascolini D, Mariotti SP, Pokharel GP. Global magnitude of visual impairment caused by uncorrected refractive errors in 2004. Bull World Health Organ. 2008; 86:63–70.

2. Wang Q, Klein BE, Klein R, Moss SE. Refractive status in the Beaver Dam Eye Study. Invest Ophthalmol Vis Sci. 1994; 35:4344–4347.

3. Attebo K, Ivers RQ, Mitchell P. Refractive errors in an older population: the Blue Mountains Eye Study. Ophthalmology. 1999; 106:1066–1072.

4. Wu SY, Nemesure B, Leske MC. Refractive errors in a black adult population: the Barbados Eye Study. Invest Ophthalmol Vis Sci. 1999; 40:2179–2184.

5. Wong TY, Foster PJ, Hee J, et al. Prevalence and risk factors for refractive errors in adult Chinese in Singapore. Invest Ophthalmol Vis Sci. 2000; 41:2486–2494.

6. Zhao J, Pan X, Sui R, et al. Refractive Error Study in Children: results from Shunyi District, China. Am J Ophthalmol. 2000; 129:427–435.

7. Maul E, Barroso S, Munoz SR, et al. Refractive Error Study in Children: results from La Florida, Chile. Am J Ophthalmol. 2000; 129:445–454.

8. Pokharel GP, Negrel AD, Munoz SR, Ellwein LB. Refractive Error Study in Children: results from Mechi Zone, Nepal. Am J Ophthalmol. 2000; 129:436–444.

9. Lin LL, Shih YF, Hsiao CK, et al. Epidemiologic study of the prevalence and severity of myopia among schoolchildren in Taiwan in 2000. J Formos Med Assoc. 2001; 100:684–691.

10. He M, Zeng J, Liu Y, et al. Refractive error and visual impairment in urban children in southern China. Invest Ophthalmol Vis Sci. 2004; 45:793–799.

11. Xu L, Li J, Cui T, et al. Refractive error in urban and rural adult Chinese in Beijing. Ophthalmology. 2005; 112:1676–1683.

12. Saw SM, Chan YH, Wong WL, et al. Prevalence and risk factors for refractive errors in the Singapore Malay Eye Survey. Ophthalmology. 2008; 115:1713–1719.

13. Vitale S, Ellwein L, Cotch MF, et al. Prevalence of refractive error in the United States, 1999-2004. Arch Ophthalmol. 2008; 126:1111–1119.

14. Jobke S, Kasten E, Vorwerk C. The prevalence rates of refractive errors among children, adolescents, and adults in Germany. Clin Ophthalmol. 2008; 2:601–607.

15. Krishnaiah S, Srinivas M, Khanna RC, Rao GN. Prevalence and risk factors for refractive errors in the South Indian adult population: the Andhra Pradesh Eye disease study. Clin Ophthalmol. 2009; 3:17–27.

16. Pan CW, Wong TY, Lavanya R, et al. Prevalence and risk factors for refractive errors in Indians: the Singapore Indian Eye Study (SINDI). Invest Ophthalmol Vis Sci. 2011; 52:3166–3173.

17. Wu JF, Bi HS, Wang SM, et al. Refractive error, visual acuity and causes of vision loss in children in Shandong, China: the Shandong Children Eye Study. PLoS One. 2013; 8:e82763.

18. Yoon KC, Mun GH, Kim SD, et al. Prevalence of eye diseases in South Korea: data from the Korea National Health and Nutrition Examination Survey 2008-2009. Korean J Ophthalmol. 2011; 25:421–433.

19. Kim EC, Morgan IG, Kakizaki H, et al. Prevalence and risk factors for refractive errors: Korean National Health and Nutrition Examination Survey 2008-2011. PLoS One. 2013; 8:e80361.

20. Saw SM, Katz J, Schein OD, et al. Epidemiology of myopia. Epidemiol Rev. 1996; 18:175–187.

21. French AN, Morgan IG, Mitchell P, Rose KA. Risk factors for incident myopia in Australian schoolchildren: the Sydney adolescent vascular and eye study. Ophthalmology. 2013; 120:2100–2108.

22. Rasmussen OD. Incidence of myopia in China: data and theses from periodical investigations covering thirty years residence, and association with refracting and hospital centres, in a score of the larger cities. Br J Ophthalmol. 1936; 20:350–360.

23. Wu HM, Seet B, Yap EP, et al. Does education explain ethnic differences in myopia prevalence? A population-based study of young adult males in Singapore. Optom Vis Sci. 2001; 78:234–239.

24. Sawada A, Tomidokoro A, Araie M, et al. Refractive errors in an elderly Japanese population: the Tajimi study. Ophthalmology. 2008; 115:363–370.e3.

25. Dandona R, Dandona L, Naduvilath TJ, et al. Refractive errors in an urban population in Southern India: the Andhra Pradesh Eye Disease Study. Invest Ophthalmol Vis Sci. 1999; 40:2810–2818.

26. Tarczy-Hornoch K, Ying-Lai M, Varma R. Myopic refractive error in adult Latinos: the Los Angeles Latino Eye Study. Invest Ophthalmol Vis Sci. 2006; 47:1845–1852.

27. Vitale S, Sperduto RD, Ferris FL 3rd. Increased prevalence of myopia in the United States between 1971-1972 and 1999-2004. Arch Ophthalmol. 2009; 127:1632–1639.

28. Saw SM, Gazzard G, Koh D, et al. Prevalence rates of refractive errors in Sumatra, Indonesia. Invest Ophthalmol Vis Sci. 2002; 43:3174–3180.

29. Katz J, Tielsch JM, Sommer A. Prevalence and risk factors for refractive errors in an adult inner city population. Invest Ophthalmol Vis Sci. 1997; 38:334–340.

30. Wensor M, McCarty CA, Taylor HR. Prevalence and risk factors of myopia in Victoria, Australia. Arch Ophthalmol. 1999; 117:658–663.

31. Rim TH, Woo YJ, Park HJ, Kim SS. Current status and future expectations of cataract surgery in Korea: KNHANES IV. J Korean Ophthalmol Soc. 2014; 55:1772–1778.

32. Wen G, Tarczy-Hornoch K, McKean-Cowdin R, et al. Prevalence of myopia, hyperopia, and astigmatism in non-Hispanic white and Asian children: multi-ethnic pediatric eye disease study. Ophthalmology. 2013; 120:2109–2116.

33. Gupta A, Casson RJ, Newland HS, et al. Prevalence of refractive error in rural Myanmar: the Meiktila Eye Study. Ophthalmology. 2008; 115:26–32.

34. Fotouhi A, Morgan IG, Iribarren R, et al. Validity of non-cycloplegic refraction in the assessment of refractive errors: the Tehran Eye Study. Acta Ophthalmol. 2012; 90:380–386.

35. You QS, Wu LJ, Duan JL, et al. Factors associated with myopia in school children in China: the Beijing Childhood Eye Study. PLoS One. 2012; 7:e52668.