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Caroline Klaver, Virginie Verhoeven, Gabriëlle Buitendijk, Johannes Vingerling, ; Influence of education on penetrance of myopia genes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5960.
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The dissection of the genetic etiology of myopia is well underway, and many risk variants have been identified. Education is an established environmental risk factor for myopia. We studied gene-environment interaction between risk variants and education.
We included 840 myopic cases (spherical equivalent (SE) ≤ - 3 D) and 7,772 non myopic controls (SE ≥ -1.5 D, all 45+ years) from the population-based Rotterdam Study in the analysis. A genetic risk score was calculated on the basis of the 26 susceptibility SNPs for SE derived from the CREAM consortium, and categorized into tertiles. Educational level was categorized in primary education; lower vocational education; and higher vocational education or university. The synergy index was calculated according to methods developed by Rothman. Risk of myopia was calculated with logistic regression analysis for combined strata of educational level and genetic risk score. A prediction model including both factors was evaluated with area under the curve (AUC) in a receiver operating curve (ROC).
The risk of myopia augmented with increasing genetic risk score; the risk also augmented with higher educational levels. The synergy index between genetic risk score and education was statistically significant (SI 1.8; 95% CI 1.06-2.98).The genetic risk of myopia was lowest in those with primary education (OR 2.5; 95% 95% CI 0.73, 8.75), and highest in subjects with university/higher vocational training (OR 21.8; 95% CI 6.80-70.20). The predictive value for myopia versus non-myopia was highest when both factors were included in the model (AUC 0.67; 95% CI 0.65-0.69).
The influence of education on the penetrance of myopia genes is strong. How near work at a young age influences myopia development particularly in subjects with high genetic susceptibility should be a focus of further research.
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