Obesity May be Tied to Higher Pediatric Astigmatism Incidence

With-the-rule astigmatism possesses different characteristics, such as a steep vertical meridian and greater commonality in children, than against-the-rule astigmatism, which is steeper in the horizontal meridian and more common in adults over 40. Photo: Marc Bloomenstein OD. Click image to enlarge. Obesity more than doubled the risk of astigmatism in school-aged children and adolescents in a recent study published in The Open Ophthalmology Journal.Researchers from Jiangsu province in China 9,458 students between the ages of seven and 20 using data from the Nantong School-aged Children Eye Study, assessing patients’ refractive status, nutritional status and ocular measurements to determine whether obesity or other weight categories were associated with astigmatism. They excluded participants with ocular disease, prior ocular surgery, orthokeratology use, contact lens wear and obesity caused by underlying diseases. In addition, they defined astigmatism as cylinder error of at least 1.00D.A total of 53.2% of patients were male, and the cohort had a mean total age of 13.3 years. The researchers noted in their study that “the prevalence of astigmatism among Chinese school-aged children and adolescents was 28.5%, and the overall prevalence of obesity was 11.8%.”The prevalence of astigmatism rose steadily across nutritional groups. Patients with malnutrition had a 21.1% prevalence, compared with 25.7% in normal-weight participants, 35.3% in overweight participants and 40.7% in obese participants. After adjusting for age, refractive state and other factors, “overweight participants were 1.48 times more likely to suffer from astigmatism,” while obese participants were 2.01 times more likely” to have the condition.Most astigmatism cases presented as “with-the-rule” forms, the most common type of astigmatism. This type comprised 96.3% of eyes in the astigmatism group. The authors speculated that astigmatism was caused by obesity-related “periorbital fat increasing eyelid pressure on the cornea.” They explained that “obese children and adolescents have shallow orbits and prominent periorbital fat in the eyelids, which may lead to greater pressure on the cornea from the eyelids.”The study did not find a significant association between nutritional status and myopia after multivariate adjustment. Researchers also discussed that the study had several limitations, including the cross-sectional design, lack of corneal topography measurements and the use of non-cycloplegic refraction, which may have overestimated myopia prevalence.Click here for the journal source. Wang M, Zhou Y, Chen X, et al. Obesity increases the prevalence of astigmatism in children and adolescents. Open Ophthalmol J. June 20, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.