Myopia is becoming an important cause of visual impairment. Determining risk profiles will help to develop targeted prevention strategies. This study aims to explore the difference in myopia development between genders in two cohorts representing different generations, and to assess whether hypothetical interventions targeting education or lifestyle factors would reduce a gender gap. This study included two Dutch population-based cohorts; 11,109 adults aged ≥ 45 years from the Rotterdam Study I-III born between 1887 and 1960, and 7229 children from the birth cohort Generation R study born between 2002 and 2006 at age 9–13 years. Sequential G-estimation was used to estimate changes in gender-specific myopia prevalence, incidence and spherical equivalent if hypothetical interventions such as education and lifestyle changes would have been implemented. Myopia prevalence was 32.3% in men and 29.3% in women in the generation born between 1887 and 1960 (0.23 dioptre difference in spherical equivalent; p < 0.001); while this prevalence was 20.2% in boys and 24.7% in girls born between 2002 and 2006 at age 13 (0.15 dioptre difference in spherical equivalent; p = 0.02). In the older generation, hypothetically intervening to lower education reduced the difference between genders by -52.4% (-108.0%; -13.2%) for spherical equivalent and − 53.0% (-112.0%; -11.6%) for myopia. In children, hypothetically intervening on reducing reading time (-50.0%, 95%CI=-267.5%; 33.8% for spherical equivalent) and number of books read/week (-76.8%, 95% CI=-349.9%; 20.2% for spherical equivalent) was most prominent, but not statistically significant. The results show that men had a higher prevalence of myopia in our study of older generations; while girls had a higher prevalence in the young generation. Our hypothetical interventions suggest that these generation-specific gender preponderances were largely due to education and, possibly, lifestyle factors in youth.

近视正在成为视力障碍的重要原因。确定风险状况将有助于制定有针对性的预防策略。本研究旨在探讨代表不同世代的两个队列中性别之间近视发展的差异，并评估针对教育或生活方式因素的假设干预措施是否会减少性别差距。这项研究包括两个基于荷兰人群的队列;11,109 名来自鹿特丹研究 I-III 的 45 ≥成年人出生于 1887 年至 1960 年之间，以及 7229 名来自出生队列 R 世代研究的儿童出生于 2002 年至 2006 年之间，年龄在 9-13 岁之间。如果实施假设的干预措施，例如教育和生活方式的改变，则使用顺序 G 估计来估计性别特异性近视患病率、发病率和等效球形的变化。在 1887 年至 1960 年出生的一代人中，男性近视患病率为 32.3%，女性为 29.3%（球形当量差异为 0.23 屈光度;p < 0.001）;而 2002 年至 2006 年出生的 13 岁出生的男孩和 24.7% 的女孩的患病率分别为 2006% 和 2006%（球形当量差异为 0.15 屈光度;p = 0.02）。在老一代人中，假设对较低教育程度的干预使球形等效体的性别差异减少了 -52.4%（-108.0%;-13.2%），近视减少了 -53.0%（-112.0%;-11.6%）。在儿童中，假设减少阅读时间 （-50.0%， 95%CI=-267.5%;球形等效物为 33.8%） 和每周阅读书籍数量 （-76.8%， 95% CI=-349.9%;球形等效物为 20.2%）是最突出的，但无统计学意义。 结果表明，在我们对老一代人的研究中，男性的近视患病率更高;而女孩在年轻一代中的患病率更高。我们的假设干预表明，这些特定于世代的性别优势主要是由于教育，也可能是由于青年的生活方式因素。