Parental smoking and childhood refractive error: the STARS study

Abstract

Purpose To assess the relationship between parental smoking and childhood refractive errors in Singapore Chinese children aged 6-72 months recruited through the STrabismus, Amblyopia, and Refractive errors in Singaporean children study. Methods A total of 4164 children were recruited, with a positive response rate of 72.3% (n ¼ 3009). Cycloplegic refraction measurements were obtained from all children by trained eye professionals. Parents underwent an interviewer-administered questionnaire with information on demographics, lifestyle, and parental smoking history being obtained. Results Spherical equivalent readings were obtained for 87.7% of the children. In all, 52.1% were male (n ¼ 1375). The overall prevalence of myopia (at least À 0.5 D) was 11.0%. Overall, 37.1% of the fathers interviewed gave a history of smoking. Among the mothers interviewed, 9.2% gave a history of smoking, 6.6% had smoked during the child's life, and 2.2% had smoked during the pregnancy. Maternal history of ever smoking, smoking during child's life, and smoking during pregnancy were associated with decreased odds ratio (OR) of childhood myopia (OR 0.50 (P ¼ 0.01), OR 0.39 (P ¼ 0.01), and OR 0.3 (P ¼ 0.14), respectively). Paternal history of smoking was associated with decreased OR of childhood myopia (OR of 0.72 (P ¼ 0.02)). Conclusion In light of this finding of an inverse association between parental smoking and childhood myopia, further studies are suggested to better understand the role of nicotinic acetylcholine receptor pharmacology in ocular development. This may pave the way for the development of targeted treatment strategies for prevention of myopia.

Is there a link between passive smoke exposure and early‐onset myopia in preschool Asian children?

“…Because nicotine activates nAChRs and is a constituent of tobacco smoke, the anti‐myopia effect of nicotinic AChR antagonists has stimulated the investigation of whether tobacco smoke exposure might affect refractive development in children . Several cross‐sectional clinical reports have found that passive tobacco smoke exposure associates with a shift in refractive distribution towards hyperopia, i.e., lower myopia prevalence, in exposed children . In contrast, a long‐term prospective study performed in British adults by Rahi et al, found that myopia was positively associated with maternal smoking in the first trimester; this is the only population‐based study whose direction of effect conforms with the anti‐myopia action in chicks of antagonists to nAChRs .…”

“…Because of its prominent biological actions, nicotine is presumed to be responsible for this finding, even though tobacco smoke contains many additional active chemicals. Besides variability between studies, the effect estimates may have been confounded by socioeconomic status . Socioeconomic status such as educational level is a risk factor for refractive error .…”

Myopia in young patients with type 1 diabetes mellitus

“…(11,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) No attempt was made to adjust the results for important variables, such as gender or ethnicity, or to weigh the results according to differences in methods. Statistical analysis was performed using the IBM SPSS Statistics version 19.0 (IBM Corp, Armonk, NY, USA).…”

“…The prevalence rates were taken directly from cohort-, army-and population-based studies in Singapore published from 2001 onwards. (11,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) To calculate the average rate of prevalence, results were weighted according to the number of subjects participating in the study. The weighted average (x) was calculated using the following formula:…”

“…a spherical equivalent [SE] of -0.50 D or worse) is present in the following proportions in children and adolescents: 10.9%, 34.2%, 59.2% and 78.5% of those aged < 7.0, 7.0-9.9, 10.0-11.9 and ≥ 12.0 years, respectively. (11,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) Over the last decade, it has been suggested that a carbohydrate-rich Western diet with a high glycaemic load may predispose one to juvenile-onset myopia. (23) It has also been hypothesised that chronic hyperglycaemia and hyperinsulinaemia may result in higher levels of free insulin-like growth factor (IGF)-1 and lower levels of IGF-binding protein 3, which in turn may result in unregulated scleral growth and myopia.…”