Link between myopia, glaucoma in Medicare beneficiaries shows racial, ethnic disparities
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Key takeaways:
- Individuals who identified as Asian, Black or Hispanic had higher odds of having both myopia and primary open-angle glaucoma than non-Hispanic white individuals.
- Improved glaucoma screening may be needed.
There was a stronger association between myopia and incidence of primary open-angle glaucoma among Asian, Black and Hispanic Medicare beneficiaries in California vs. non-Hispanic white beneficiaries, according to a study.
“While these results do not imply a causative mechanism, they may serve as a foundation to consider more frequent or earlier glaucoma screening for racial and ethnic minority individuals with myopia and also merit further investigation of potential racial and ethnic disparities in the diagnosis of glaucoma among patients with myopia,” Melissa Yao, BA, of the department of ophthalmology at University of California, Los Angeles, and colleagues wrote in JAMA Ophthalmology.
In their cross-sectional study, the researchers used 2019 California Medicare beneficiaries claims data to evaluate the association between myopia and primary open-angle glaucoma (POAG) and determine whether race and ethnicity differences exist.
Of 2,717,346 beneficiaries (53% aged 65-74 years; 56.8% women), 2.2% reported having myopia and 6.3% reported having POAG. Also, 62.8% identified as white, 12.8% as Asian, 4.3% as Black and 4.2% as another race/ethnicity. There were 15.8% who identified as Hispanic.
The researchers found beneficiaries with myopia had increased odds of POAG (adjusted OR = 2.41; 95% CI, 2.35-2.47). When stratified by race and ethnicity, multivariable models also showed this association to be stronger in beneficiaries who identified as Asian (aOR = 2.74; 95% CI, 2.57-2.92), Black (aOR = 2.6; 95% CI, 2.31-2.94) or Hispanic (aOR = 3.28; 95% CI, 3.08-3.48) compared with non-Hispanic white beneficiaries (aOR = 2.14; 95% CI, 2.08-2.21).
“These findings suggest possible disparities in glaucoma risk by race and ethnicity in individuals with myopia and may indicate greater need for glaucoma screening in individuals with myopia from racial and ethnic minority backgrounds,” the researchers wrote.
Perspective
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Myopia and race are two (amongst many) potential risk factors for glaucoma. While the correlation of myopia and glaucoma has yet to be clearly delineated, we do know that the prevalence of both myopia and glaucoma varies greatly by ethnicity and race, with both conditions being more common in Black, Asian and Hispanic populations.
Taking these points into consideration, Yao and colleagues performed this cross-sectional study, finding that a myopia diagnosis increased the odds of a POAG diagnosis, with a greater association in Asians, Blacks and Hispanics. Also, the association between myopia and glaucoma was strongest for severe POAG, possibly suggesting that myopia may be more significant of a risk factor than currently believed.
Research on racial, ethnic and socioeconomic disparities in glaucoma have routinely suggested a potential underdiagnosis of glaucoma in populations of higher risk. While we are yet to understand the exact relationship between myopia and glaucoma, we do know the statistics for each. It is certainly a reminder that patients with greater risk deserve our thoughtful attention and/or more frequent screening for an earlier diagnosis and an improved visual prognosis.
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