Objective: To describe 9-year changes in refractive errors and estimate incidence of myopia and hyperopia in adults of African-descent, along with associated risk factors.

Methods: The 9-year follow-up of the Barbados Eye Studies (1997-2003) reexamined 2793 surviving cohort members (81% participation). Refractive errors were determined by automated refraction. Myopia/hyperopia were defined as spherical equivalent < -0.5 diopters (D)/> +0.5 D, and the cutoff for moderate-high myopia/hyperopia was 3.0 D. Incidence rates of myopia/hyperopia were estimated by the product-limit approach, based on eyes without such conditions at baseline. Risk factors were evaluated by logistic regression in discrete time hazard models.

Results: Nine-year refraction changes varied by age. Persons aged 40 to 49 years experienced hyperopic shifts (median, +0.38 D), whereas persons > or =60 years had myopic shifts (median, -0.75D). Overall 9-year incidence was 12.0% for myopia and 29.5% for hyperopia; rates were 3.6% and 2.0% for moderate-high myopia and hyperopia, respectively. Myopia risk increased with age, baseline nuclear lens opacities (risk ratio [RR] = 1.7; 95% confidence interval [CI]: 1.01-2.9), glaucoma (RR = 6.0, 95% CI: 3.9-9.3), and ocular hypertension (RR = 2.0, 95% CI: 1.3-3.0), while cortical lens opacities decreased risk (RR = 0.6, 95% CI: 0.4-0.9). Incidence of moderate-high myopia was also related to baseline age, nuclear opacities, glaucoma, male gender (RR = 1.7, 95% CI: 1.0-2.8), and diabetes history (RR = 1.9, 95% CI: 1.01-3.5). Hyperopia risk decreased with older age, male gender, and glaucoma diagnosis.

Conclusions: Refractive errors continue to develop frequently in older adults. Nuclear lens opacities, glaucoma, and diabetes increase the risk of older-onset myopia, a result of public health relevance to this and similar African-origin populations.