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Study finds link between myopia, open-angle glaucoma risk
Ophthalmology. 2011;118(10):1989-1994
Based on homogeneous data analyses, high and low myopia were associated with an elevated risk of open-angle glaucoma, a large study found.
"This should be taken into account when it comes to individualized risk management in, for example, screening or treatment decisions," the study authors said. "A better understanding of the role of the magnitude of the refractive error is clinically important from the point of view of individualized risk management, among others."
The study involved a meta-analysis of 11 population-based cross-sectional studies published between 1994 and 2010 including 48,161 patients. The authors used a random effects model to pool study-specific odds ratios.
The primary outcome measure was odds ratios (95% confidence interval) of myopia as a risk factor for open-angle glaucoma. Based on the 11 risk estimates, the pooled odds ratio of the association between myopia and open-angle glaucoma was 1.92.
Heterogeneity among the 11 studies was statistically significant (P = .02). Data showed significant heterogeneity among studies that reported an association between any myopia and glaucoma and between low myopia and glaucoma, but not between high myopia and glaucoma.
After studies contributing markedly to heterogeneity were excluded, overall pooled odds ratios were 1.88 for any myopia and glaucoma, and 1.77 for low myopia and glaucoma.
Based on seven studies reporting risk estimates for low and high myopia, the pooled odds ratio of the association between less than 3 D myopia and glaucoma was 1.65; the pooled odds ratio of the association between 3 D or more myopia and glaucoma was 2.46, the authors said.
Marcus and colleagues have performed a thoughtful meta-analysis of 11 studies to ascertain the preponderance of evidence with regard to effect of myopia on the risk for developing glaucoma. It is an important finding that high myopia, defined as greater than 3 D of myopia, was very strongly correlated with an increased risk for developing glaucoma. The elucidation of this patient specific factor will help clinicians better stratify the risks for a glaucoma suspect in order to advise on the frequency of surveillance and prophylactic treatment decisions. Although the pathophysiologic significance of high myopia remains unknown, it implicates the structural integrity of the lamina cribrosa.
– Douglas J. Rhee, MD
OSN Glaucoma Board
Member