Large Study Shows Racial, Ethnic Differences in Myopia Progression

Mother and daughter on a medical appointment with ophthalmologist
Research shows stark differences in myopia progression between children of Asian descent and others.

Researchers examining the differences in myopic progression in children by race/ethnicity and age found that progression differed significantly between East/Southeast Asian and White patients, depending on the patients’ age. Their findings were published in Investigative Ophthalmology & Visual Science.

While only a third of American and European adults have myopia, the prevalence in many East Asian countries can reach up to 90%, the study shows. The risk factors that contribute to myopia in children are of particular importance, according to researchers, since the incidence of childhood onset of myopia has increased. And, because research shows myopia that begins earlier in childhood progresses at a faster rate than adult-onset myopia, understanding which patients are most at-risk and at what age can help physicians develop appropriate interventions.

To research this, investigators conducted a retrospective cohort study that included more than 36,000 refractions from more than 11,000 children with myopia. Subjects enrolled in Kaiser Permanente Southern California between 2011 and 2016 and between the ages of 4 and 11 years old with a documented refraction between −6.00 D and −1.00 D were included. Those with a history of amblyopia, strabismus, retinopathy of prematurity, or prior ocular surgery were excluded from the analyses. In total, 11,595 subjects met the inclusion criteria. The cohort was 53% female, 55% Latinx, 15% White, 9% Black, 9% East/Southeast Asian, and 2% South Asian. The mean age at the time of initial refraction was 8.9 years. Subjects had an average of 3.4 refractions, including the baseline measurement, during the study period. 

The research team applied a 3-way interaction model to assess the effects of age at baseline, time since baseline, and race/ethnicity. They found that children of East/Southeast Asian descent showed significantly faster myopia progression across time (P <.001) compared with other racial/ethnic groups. More specifically, East/Southeast Asian children who presented with myopia between 6 years of age and before age 8 progressed similarly to White patients in the same age group and significantly faster compared with White patients in other age groups. 

“Our findings suggested that prevention efforts and clinical trials should consider race,” says the study’s author. “Attention on East and Southeast Asian children should be considered, as they demonstrate higher progression of myopia than any other race.”

The investigators note several limitations to their study. First, while the study sample size is larger than other similar studies, the results may not be fully generalizable to other White or East/Southeast Asian populations. Secondly, the study did not include children older than 11 years of age. Third, cycloplegic refractions were not routinely performed in these subjects. Lastly, the research team assumed that the progression of the condition was linear.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Luong TQ, Shu Y-H, Modjtahedi BS, et al. Racial and ethnic differences in myopia progression in a large, diverse cohort of pediatric patients. Invest Ophthalmol Vis Sci. 2020;61(13):20. doi: 10.1167/iovs.61.13.20.