Abstract
Refractive errors (REs) affect over half of the global population, with consequences ranging from blurred vision to blindness. Here we conducted ancestry-stratified and cross-ancestry meta-analyses of genome-wide association studies for RE in people of European (n = 1,495,159), East Asian (n = 121,172) and African (n = 144,737) ancestries. The cross-ancestry meta-analysis identified 932 RE-associated variants, including 241 previously unknown associations, four East Asian-specific associations and one African-specific association. Statistical fine-mapping pinpointed 16 high-confidence putative causal variants, and gene prioritization analyses highlighted 23 genes involved in eye development. We constructed an enhanced polygenic predictor incorporating functional annotations that explained 21.4% of RE variation, effectively stratified the onset, progression and severity of myopia, and achieved an area under the receiver operating characteristic curve of 0.806 for predicting high myopia. Our multi-ancestry genome-wide association study expands substantially the catalog of genetic variants for RE and demonstrates the potential clinical utility of polygenic prediction in identifying high-risk people across diverse populations.