Interaction Between Lifestyle and Genetic Susceptibility in Myopia: the Generation R Study

  • Myopia is a refractive error of the eye caused by a complex interplay between nature and nurture.

  • The aim of this study was to investigate whether environmental risk factors can influence the genetic effect in children developing myopia. A total of 3422 children participating in the birth-cohort study Generation R underwent an extensive eye examination at 9 years with measurements of refractive error and axial length corneal radius ratio (AL/CR).

  • Environmental risk factors were evaluated using a questionnaire, and environmental risk scores (ERS) were calculated using backward regression analyses.

  • Genetic risk scores (GRS) were calculated based on all currently known risk variants for myopia.

  • Gene-environment interaction (G×E) was investigated using linear and logistic regression analyses. The predictive value of G×E and parental myopia was estimated using receiver operating characteristic curves.

  • Myopia prevalence was 12%. Both GRS (P < 0.01) and ERS (P < 0.01) were significantly associated with myopia and AL/CR, as was G×E interaction (P < 0.01 for myopia; P = 0.07 for AL/CR). The predictive value of parental myopia was 0.67 (95% CI 0.65-0.70), similar to the values of GRS (0.67; 95% CI 0.64-0.70; P = 0.98) and ERS (0.69; 95% CI 0.66-0.72; P = 0.98). Adding G×E interaction significantly improved the predictive value to 0.73 (95% CI 0.70-0.75; P < 0.01).

  • This study provides evidence that nature and nurture are equally important for myopia and AL/CR; however, the combination has the strongest influence.

  • Since myopia genes are common in the population, adjustment of lifestyle should be a major focus in the prevention of myopia.

Publication date

October 1, 2021


European Journal of Epidemiology


Enthoven CA, Tideman JWL, Polling JR, Tedja MS, Raat H, Iglesias AI, Verhoeven VJM, Klaver CCW
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