Thirty-five-year trend in the prevalence of refractive error in Austrian conscripts based on 1.5 million participants

To quantify the current burden of myopia and hyperopia in Austrian young men and the time trend of myopia in the past 35 years by individual and social correlates.

We included data on all Austrian military conscripts from 1983 to 2017 (n=1 507 063) from six medical investigation stations. Young men provided data on education, weight and height for calculating body mass index, blood pressure and resting heart rate. Non-cycloplegic refractions were measured by an autorefractometer. Spherical equivalent was calculated by standard formula (sphere+cylinder/2, unit dioptres (D)). Myopic refractive error was defined as <-0.5 D). Hyperopic refractive error was defined as >0.5 D.

The largest burden of refractive error in Austria is myopia, which rose from 13.8% to 24.4% over 35 years, with less than 5% hyperopic population. Over time, the prevalence of myopia was constantly lower yet increased more rapidly among those with low education levels (11.4%-21.7%) compared with those with higher education (24.5%-29.6%) in all medical investigation stations. We found consistent associations of some unfavourable health indicators (underweight: ORs 1.1-1.4, higher resting heart rate: all p trend <0.001) with higher myopia prevalence, which point towards lifestyle factors playing an important role in the development of myopia.

Primary preventive measures are needed to curb the observed trend in myopia among Austrian young men. Future research should investigate the impact of modifiable factors on myopia development and progression, particularly lifestyle factors that are dramatically shifting.