Refractive error may be the main cause of visual impairment worldwide, yet surprisingly little is known about its course in adults. Looking to bridge this gap, researchers recently documented a characteristic pattern in refractive error change with a myopic shift between the ages of 35 and 44 followed by a hyperopic shift between ages 45 and 64, which decreased with age.

As far as risk factors go, the team found that smoking is associated with a hyperopic shift, whereas female sex and myopic baseline spherical equivalent (SE) are associated with a myopic shift. Educational level and occupation were not linked to a change in refractive error at ages 35 through 74.

This population-based cohort study included 15,010 participants from Germany aged 35 through 74 years at baseline. A five-year change in SE was computed as the difference between follow-up and baseline objective refraction. Linear and logistic regression analysis were conducted to assess potential risk factors.

The investigators identified an age-related shift in refractive error, namely -0.12D for patients aged 35 through 44, 0.25D for ages 45 through 54, 0.25D for ages 55 through 64and 0.12D for ages 65 through 74 during the five-year follow-up.

Smokers had a hyperopic shift (odds ratio; OR=1.31), while baseline SE (OR=0.89 per diopter) and female sex (OR=1.49) were linked to a myopic shift. Education, occupation and other cardiovascular parameters were not associated with change in refractive error.

Stingl JV, Ban SA, Nagler M, et al. Five-year change in refractive error and its risk factors: results from the Gutenberg Health Study. Br J Ophthalmol. August 6, 2021. [Epub ahead of print].