Myopia severity associated with increased risk of open-angle glaucoma
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Individuals with myopia, particularly high myopia, were found to be at greater risk of developing open-angle glaucoma, according to data published in the American Journal of Ophthalmology.
“Myopia is a public health issue of increasing concern, particularly in East Asia, where it is already at a pandemic level. Estimates are that by 2050, the worldwide prevalence of myopia and high myopia will have increased substantially to nearly 5 billion and 1 billion people, respectively,” Ahnul Ha, MD, of the department of ophthalmology at Seoul National University College of Medicine in South Korea, and colleagues wrote. “Uncorrected refractive errors not only impose a socioeconomic burden but also can present the following severe, myopia-associated and sight-threatening complications that may negatively affect quality of life: [age-related] macular degeneration, retinal detachment, cataract and open-angle glaucoma (OAG).
“Clearer understanding of the myopia/OAG-risk association calls for wider and deeper investigation, particularly given its significant public health urgency.”
Ha and colleagues conducted a two-stage, dose-response meta-analysis to determine the OAG risk per unit dose of myopia (defined as spherical equivalent [SE] decrease of 1 D), using data from 24 population-based studies on both myopia and OAG, which included 514,265 participants across 11 countries.
“We found that for each unit increase in myopia, the risk of glaucoma increases by approximately 20%,” the researchers wrote. “The risk more steeply increases in high-degree myopia, representing a significant non-linear relationship.”
The risk of OAG was found to increase steeply at around –6 D, with a further steep increase from –8 D, showing a nonlinear concave upward slope (P = .03). Researchers determined that odds ratio differences based on ethnicity (Asians vs. Westerners) or geographic areas were not statistically significant.
“There should be increased awareness of glaucoma among individuals with myopia, regardless of its degree,” Ha and colleagues concluded. “Importantly, more vigilant monitoring is needed in myopia worse than –6 D, given the steeply increasing risk incurred in high-degree myopia.”
Perspective
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For those practitioners who did not already consider myopia to be a risk factor for glaucoma, this recent study warrants your attention to update your glaucoma risk assessment. This meta-analysis is larger and more robust than any previous study on myopia and OAG, and it is the first to show a large increase in risk of glaucoma as myopia increases.
These findings are widely applicable, as studies conducted all over the world among diverse populations were included in the analysis. Unfortunately, this study does not tell us anything about how IOP or patient ethnicity factor into glaucoma risk among myopes.
After reading this meta-analysis, I will be even more careful when evaluating my myopic patients for glaucoma, especially the high myopes. Because myopic nerves can be large, malinserted and have extensive peripapillary atrophy, they can be challenging to evaluate clinically. OCT scans may be low quality or have a lot of variability from scan to scan. Practitioners should not forget that serial stereo photography of the optic nerve can be a useful tool to monitor for changes over time.
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