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Highland environment and genetic background are associated with myopia risk in Tibetans and Hans

Eye (2026)Cite this article

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Abstract

Background

This study aimed to investigate the relationship of high-altitude environmental features and ethnic Tibetan background with myopia.

Methods

This cross-sectional study was conducted at highland and lowland sites. The highland sites were located on the Chinese Tibetan Plateau, approximately 4000 m above sea level. A total of 3634 Tibetans and 377 Hans were included in the highland group. The lowland group was from the Yaoxi community, in Wenzhou City, located 10–20 m above sea level, where 176 Han individuals were included. Non-cycloplegic spherical equivalent refraction (SER) and biochemical function tests were measured.

Results

Age-specific myopia prevalence was highest in highland Hans, followed by lowland Hans and highland Tibetans. Among participants in the highland group, including Tibetans and Hans, increased risk of moderate and high myopia was associated with gender [OR (95% CI): 0.47 (0.23, 0.97) for females], education level [OR (95% CI): 3.62 (1.76, 7.45) for middle school education and above], and elevated mean haemoglobin per red blood cell (MCH) [OR (95% CI): 8.04 (1.04, 62.34)]. Among Han participants in both groups, only elevated mean corpuscular volume (MCV) [OR (95% CI): 5.91 (1.00, 34.92)] was associated with increased risk of moderate and high myopia.

Conclusions

The higher prevalence of myopia in Hans compared to Tibetans, and in highland Hans compared to lowland Hans, suggests that both ethnicity and high-altitude environment influence myopia development, potentially through gene–environment interactions. Elevated MCV and MCH levels, particularly in highland Hans, may serve as biomarkers for risk, warranting further investigation.

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Fig. 1: Study flowchart.
Fig. 2: Myopia characteristics among Tibetans and Hans across communities.
Fig. 3: Risk factors associated with moderate and high myopia in different communities.

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Data availability

All relevant data are provided within the manuscript and supplementary materials.

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Acknowledgements

We acknowledge Dr. Meiqin Zheng and the students for helping conduct the study and Prof. Dong-Hua Yang for her advice on manuscript writing.

Funding

The National Key R&D Program of China, Grant Number: 2023YFC3604001; Zhejiang Province Medical and Health Science &Technology Project, Grant Number: 2025ky1016; Wenzhou Science & Technology Bureau Basic Research Funding, Grant Number: Y2020358.

Author information

Author notes

  1. These authors contributed equally: Jie Chen, Fan Lu.

Authors and Affiliations

  1. Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, PR China

    Xiaoman Li, Jiahua Chen, Xiaoyue Hu, Yuanyuan Liu, Na Lin, Guangyun Mao, Yuanbo Liang, Zi-Bing Jin, Lizhong Wang, Jia Qu, Jie Chen & Fan Lu

  2. National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, PR China

    Xiaoman Li, Jiahua Chen, Xiaoyue Hu, Yuanyuan Liu, Na Lin, Guangyun Mao, Yuanbo Liang, Zi-Bing Jin, Lizhong Wang, Jia Qu, Jie Chen & Fan Lu

  3. School of public health & management, Wenzhou medical university, Wenzhou, Zhejiang, PR China

    Guangyun Mao

  4. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Science Key Laboratory, Beijing, PR China

    Zi-Bing Jin

  5. Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong, PR China

    Chi Pui Pang

  6. Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, PR China

    Fan Lu

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Contributions

XL: Conceptualization, Data curation, Investigation, Writing-original draft, Writing-review & editing, Formal analysis, Methodology. JHC: Writing–original draft, Writing–review & editing, Data curation, Formal analysis, Validation, Visualization. XH: Data curation, Formal analysis, Writing-original draft, Writing-review & editing, Validation. YL: Data curation, Visualization, Writing-review & editing. NL: Data curation, Writing – review & editing. GM: Data curation, Writing-review & editing. YL: Data curation, Writing – review & editing. ZJ: Data curation, Writing-review & editing. CP: Writing-original draft, Writing-review & editing. LW: Visualization, Writing-review & editing. JQ: Writing-review & editing. JC: Funding acquisition, Investigation, Writing-original draft preparation, Writing-reviewing and editing, Methodology and Data curation. FL: Investigation, Writing-original draft preparation, Writing-reviewing and editing, Conceptualization, Methodology and Data curation. XL: Study design, Data curation, Interpretation of results, Writing-original draft. jhc, XH, YL, NL: Data collection, Investigation, Formal analysis. GM, ZJ: Study design, Formal analysis, Writing-review & editing. CP, LW: Writing-review & editing. JQ, JC, FL: Study design, Writing-review & editing, Funding acquisition.

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Correspondence to Jie Chen or Fan Lu.

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Li, X., Chen, J., Hu, X. et al. Highland environment and genetic background are associated with myopia risk in Tibetans and Hans. Eye (2026). https://doi.org/10.1038/s41433-026-04370-y

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