Heritability and familial aggregation of refractive error in the Old Order Amish

PURPOSE. To determine the heritability of refractive error and familial aggregation of myopia and hyperopia in an elderly Old Order Amish (OOA) population. METHODS. Nine hundred sixty-seven siblings (mean age, 64.2 years) in 269 families were recruited for the Amish Eye Study in the Lancaster County area of Pennsylvania. Refractive error was determined by noncycloplegic manifest refraction. Heritability of refractive error was estimated with multivariate linear regression as twice the residual sibling-sibling correlation after adjustment for age and gender. Logistic regression models were used to estimate the sibling recurrence odds ratio (OR_s). Myopia and hyperopia were defined with five different thresholds. RESULTS. The age- and gender-adjusted heritability of refractive error was 70% (95% CI: 48%-92%) in the OOA. Age and gender-adjusted OR_s and sibling recurrence risk (λ _s), with different thresholds defining myopia ranged from 3.03 (95% CI: 1.58-5.80) to 7.02 (95% CI: 3-41-14.46) and from 2.36 (95% CI: 1.65-3.19) to 5.61 (95% CI: 3-06-9.34). Age and gender-adjusted OR_s and λ_s for different thresholds of hyperopia ranged from 2.31 (95% CI: 1.56-3-42) to 2.94 (95% CI: 2.04-4.22) and from 1.33 (95% CI: 1.22-1.43) to 1.85 (95% CI: 1.18-2.78), respectively. Women were significantly more likely than men to have hyperopia. There was no significant gender difference in the risk of myopia. CONCLUSIONS. In the OOA, refractive error is highly heritable. Hyperopia and myopia aggregate strongly in OOA families.