Is the Change in Prevalence of High Myopia Compared to That of Myopia Really Disproportionate?

Purpose: It has been noted that, at higher prevalences, the rate of change in the prevalence of high myopia seems to be disproportionately greater compared with the rate of change in the prevalence of myopia. A simple, evidence-based explanation for this relationship is offered.

Methods: Using a convenience sample of 41 datasets with prevalence estimates for at least two refractive error thresholds (e.g., -0.50 and -6.00 D) the common slope of the logit vs. refractive threshold was applied to model expected rates of high myopia across the myopia prevalence range and the corresponding ratio of change in high myopia to myopia prevalence.

Results: The logit of high myopia is related linearly to the logit of myopia. The ratio of increase in high myopia prevalence to that for myopia prevalence increases with underlying prevalence. For example, an increase in myopia prevalence from 19% to 20% is modelled to be accompanied by a 0.1% increase in the prevalence of high myopia from 1.55% to 1.65%-a ratio of 0.1. Conversely, an increase in myopia prevalence from 79% to 80% is predicted to result in a 1% increase in the prevalence of high myopia from 20.6% to 21.6%-a ratio of 1.0.

Conclusions: The increase in the prevalence of high myopia compared with that of myopia as the latter increases is merely a function of the underlying nature of refractive error probability distributions and requires no further investigation as to its origin.

Translational relevance: This study shows how the prevalence of myopia and high myopia are inter-related. A widespread effort to slow myopia progression will affect the prevalence of high myopia but not myopia in general. In contrast, efforts to delay myopia onset will affect both.