0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Epidemiology |

Refractive Error, Axial Dimensions, and Primary Open-Angle Glaucoma:  The Singapore Malay Eye Study FREE

Shamira A. Perera, FRCOphth; Tien Y. Wong, MD, PhD; Wan-Ting Tay, BSc(Hons); Paul J. Foster, MD, PhD; Seang-Mei Saw, PhD; Tin Aung, MBBS, PhD, FRCS(Edin)
[+] Author Affiliations

Author Affiliations: Singapore Eye Research Institute and Singapore National Eye Centre, Singapore (Drs Perera, Wong, Saw, and Aung and Ms Tay); Departments of Ophthalmology (Drs Wong, Saw, and Aung) and Community, Occupational and Family Medicine (Dr Saw), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (Dr Wong); and Institute of Ophthalmology, University College, London, England (Dr Foster).


Arch Ophthalmol. 2010;128(7):900-905. doi:10.1001/archophthalmol.2010.125.
Text Size: A A A
Published online

Objective  To explore the relationship of refractive error and ocular biometry with primary open-angle glaucoma (POAG) in the Malay population.

Methods  The Singapore Malay Eye Study is a population-based cross-sectional survey that examined 3280 persons (78.7% response) aged 40 to 80 years. Participants underwent a standardized clinical examination including slitlamp biomicroscopy, Goldmann applanation tonometry, refraction, dilated optic disc assessment, and measurement of axial length (AL) and central corneal thickness (CCT). Glaucoma was defined according to International Society for Geographical and Epidemiological Ophthalmology criteria.

Results  After adjusting for possible confounders, persons with moderate or high myopia (less than −4.0 diopters, right eyes) were more likely to have POAG (odds ratio [OR], 2.87; 95% confidence interval, 1.09-7.53); this association remained significant after controlling for CCT (2.80; 1.07-7.37). Longer AL was associated with POAG (ORs, 2.49, 3.61, and 2.88, comparing quartiles 2, 3, and 4, respectively, with quartile 1 of AL; P = .03 for trend). If CCT was controlled for, persons with AL in quartile 4 were 3 times more likely to have POAG (OR, 3.00; 95% confidence interval, 1.09-8.24) than those in quartile 1.

Conclusion  This population-based study in Singapore shows an association of moderate myopia and increasing AL with POAG independent of other factors, including CCT.

The relationship between refractive error and glaucoma has been investigated in several clinical trials and population-based studies.14 Most studies have suggested that moderate to high myopia is associated with increased risk of primary open-angle glaucoma (POAG),5,6 low-tension glaucoma,7,8 and ocular hypertension.912 In the Blue Mountains Eye Study in Australia, after adjusting for age, sex, and other risk factors, eyes with moderate myopia were 2 times more likely to have POAG.13 In the Barbados Eye Study, a myopic refraction was one of several risk factors for POAG in adult black people.14,15 The Beaver Dam Eye Study showed that, after taking into account the effects of age, sex, and other risk factors, persons with myopia were 60% more likely to have glaucoma than those with emmetropia.16 In Asian populations, the relationship of myopia and POAG was reported in the Beijing Eye Study in China (significant relationship with high myopia of less than −6 diopters [D])17 and the Meiktila Eye Study in Myanmar.18 However, not all studies have found significant relationships; for example, no association between myopia and POAG was found in the Ocular Hypertension Treatment Study.3

The association between myopia and POAG has been thought to be due to a variety of mechanisms, including increased susceptibility of the optic nerve head to damage by raised intraocular pressure (IOP) and the increased effect of shearing forces in optic nerve head damage. Jonas et al19 showed that, for a given IOP in eyes with POAG, optic nerve damage appears to be more pronounced in highly myopic eyes with large optic discs than in non–highly myopic eyes. This may suggest a higher susceptibility for glaucomatous optic nerve fiber loss in highly myopic eyes compared with non–highly myopic eyes.18,20 However, a major gap in the current literature is a lack of studies on the relationship between axial dimensions and POAG. Thus, it is unclear whether the relationship between myopia and POAG is mediated by axial length (AL) or other factors (corneal curvature or lenticular changes with age). In addition, previous studies have not controlled for the effects of central corneal thickness (CCT), which is now known to strongly influence the measurement of IOP and is a risk factor for POAG.3

In this study, we investigated the association of refractive error and ocular biometry with POAG while controlling for the effects of CCT in a population-based study of Asian Malay adults in Singapore.

STUDY POPULATION

The Singapore Malay Eye Study is a population-based cross-sectional study of Malay subjects aged 40 to 80 years in Singapore. The study methods have been described previously.21,22 The sampling frame consisted of all Malays aged 40 to 80 years living in 15 residential districts across southwestern Singapore, selected using an age-stratified random sampling procedure from a list of Malay names provided by the Ministry of Home Affairs. Of the 4168 participants eligible to participate, 3280 (78.7%) were examined in the clinic and the remaining 888 (21.3%) were classified as nonparticipants. Nonparticipants tended to be older (aged 70-80 years) compared with participants, but there was no difference in sex, sampling location, and telephone ownership between the 2 groups.

Approval for the study protocol was granted by the hospital's institutional review board, and the study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all subjects before enrollment.

STUDY MEASUREMENTS

All participants underwent a standardized interview, examination, and ocular imaging at a centralized study clinic.23,24 Visual acuity was measured using a logMAR vision chart (Lighthouse International, New York, New York) read at a distance of 4 m. The refraction and corneal curvature of both of the participant's eyes were measured with an autorefractor (RK-5 Autorefractor Keratometer; Canon Inc Ltd, Tokyo, Japan). Final refraction was determined using subjective refraction by trained and certified study optometrists. Axial length and central anterior chamber depth (ACD) were measured by noncontact partial coherence laser interferometry (IOLMaster; Carl Zeiss, Jena, Germany). Central corneal thickness was measured in each eye with an ultrasound pachymeter (Advent; Mentor O & O Inc, Norwell, Massachusetts), and the median value of 5 readings was recorded.

A structured slitlamp examination (model BQ-900; Haag-Streit, Berne, Switzerland) was performed by study ophthalmologists before and after pupil dilation. A Goldmann applanation tonometer (Haag-Streit) was used to obtain 1 reading of IOP from each eye before dilation. After pupil dilation, the eyes were examined at the slitlamp again for an optic disc and retinal examination. Vertical cup-disc ratio (VCDR) and neuroretinal rim appearance were carefully recorded.

DEFINITIONS AND DIAGNOSIS

Refractive error was estimated using standardized subjective refraction techniques; if unavailable, autorefraction measurements were used instead. Myopia was defined as a spherical equivalence (SE) of less than −0.50 D; hyperopia, an SE of greater than +0.5 D; and emmetropia, an SE of −0.5 to +0.5 D. Moderate or high myopia was defined as an SE of less than −4.0 D; this cutoff was chosen because there were few eyes with high myopia (SE of less than −6.0 D) for an analysis with POAG.

The diagnosis and classification of glaucoma cases have been reported previously25,26 and will be described briefly. Glaucoma cases were defined according to the International Society for Geographical and Epidemiological Ophthalmology criteria based on 3 categories.25 Category 1 cases were defined as optic disc abnormality (VCDR or VCDR asymmetry ≥97.5th percentile or neuroretinal rim width from the 11- to 1-o’clock position or the 5- to 7-o’clock position <0.1 VCDR) and glaucomatous visual field defect. Category 2 cases were defined as a severely damaged optic disc (VCDR or VCDR asymmetry ≥99.5th percentile) in the absence of an adequate visual field test. When diagnosing category 1 or 2 glaucoma, it was required that there be no other explanation for the VCDR finding (ie, dysplastic disc or marked anisometropia) or visual field defect (ie, retinal vascular disease, macular degeneration, or cerebrovascular diseases). Category 3 cases were defined as blindness in individuals who had no visual field or optic disc data (corrected visual acuity, <3/60) and who had undergone previous glaucoma surgery or had an IOP greater than the 99.5th percentile. Ocular hypertension was defined as the presence of IOP greater than 21 mm Hg in individuals who did not meet the criteria for glaucoma. Primary open-angle glaucoma was defined as an eye with evidence of glaucoma (as defined in this paragraph) with an angle appearance in which the posterior trabecular meshwork was seen for 180° or more of the angle circumference during dynamic gonioscopy.26

STATISTICAL ANALYSIS

Statistical analysis was performed using commercially available software (SPSS, version 15; SPSS Inc, Chicago, Illinois). Any POAG was analyzed as a binary outcome variable, and all potential risk factors were categorized as defined in the previous section (eg, refractive error) or in quartiles (eg, AL). We used logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for POAG for each risk factor, adjusting for age and sex. In multivariate analysis, we further adjusted for education, height, hypertension, and hemoglobin A1c level, and subsequently IOP and CCT. We also adjusted for AL in models of refractive error and POAG to determine the relative contribution of AL to the relationship. The likelihood ratio test was used to assess the contribution of AL in the regression model. Finally, we estimated population-attributable risk for POAG associated with myopia and moderate or high myopia.

Because the correlation between the 2 eyes was high (correlation coefficient between the right and left eyes for AL, 0.93 [P < .001]) and the results of analyses using data from left eyes were similar, only the data from right eyes are shown in further analyses.

A total of 3280 subjects were recruited, giving a response rate of 78.7% for the study. From 3280, we excluded 154 with previous cataract surgery in both eyes, and 17 without lens status, leaving 3109 in this study. There were 104 cases of POAG. Table 1 shows the characteristics of participants with and without POAG. In general, persons with POAG tended to be older, but there were no significant differences for sex, education, previous hypertension, diabetes mellitus or smoking status, total cholesterol and triglyceride levels, or body mass index.

Table Graphic Jump LocationTable 1. Characteristics of Participants With and Without POAG in the Singapore Malay Eye Study (Right and Left Eyes)a

Table 2 shows the crude and adjusted mean of SE, AL, corneal curvature, ACD, and CCT based on right eye data. Eyes with POAG were not significantly different from normal eyes in any of these parameters.

Table Graphic Jump LocationTable 2. Mean Spherical Equivalent, Axial Length, Corneal Curvature, Anterior Chamber Depth, and Central Corneal Thickness in Normal Right Eyes and in Right Eyes With POAG (Primary Open-Angle Glaucoma)

Table 3 shows the relationship of refractive error, AL, corneal curvature, ACD, and CCT with POAG. Persons with moderate or high myopia were more likely to have POAG (OR, 2.87, after adjusting for age, sex, education, height, hypertension and hemoglobin A1c level; OR, 2.80 with further adjustment for CCT). Longer AL was associated with POAG (ORs, 2.49, 3.61,and 2.88, respectively, comparing quartiles 2, 3, and 4 of AL with quartile 1; P = .03 for trend). After further controlling for CCT, persons with AL in quartile 4 were 3 times more likely to have POAG (OR, 3.00) than persons with AL in quartile 1. Deeper ACD was significantly associated with lower risk of POAG (quartile 4 vs 1: OR, 0.31; 95% CI, 0.10-0.98). Corneal curvature and CCT were not associated with POAG.

Table Graphic Jump LocationTable 3. Association of Refractive Error, Axial Dimension, Corneal Curvature, and POAG in the Right Eye

In models of refractive error and POAG adjusted additionally for AL, the association between moderate or high myopia and POAG was no longer significant (OR, 2.77; 95% CI, 0.77-9.97), and AL contributed significantly to this association based on the likelihood ratio statistic (P < .001) (data not shown).

Finally, the population-attributable risk of POAG associated with myopia was 14.6% and for moderate or high myopia was 5.5% (data not shown).

This population study in Singapore Malays shows an association between moderate or high myopia (worse than −4 D) and POAG. Persons with moderate or high myopia had an almost 3 times higher risk of POAG compared with those with emmetropia. This finding confirmed previous reports of the association between myopia and POAG in other studies, principally the Blue Mountains Eye Study and the Beaver Dam Eye Study, the statistical data of which are given in Table 4 for comparison. Our study is unique, however, in that we were also able to demonstrate an association between increasing AL (measured using noncontact partial coherence laser interferometry) and POAG. We also demonstrated that the association of moderate or high myopia and POAG was no longer significant after controlling for AL, suggesting that axial myopia rather than other factors (eg, corneal curvature or lenticular changes) may be the main biometric constituent that underlies risk for POAG.

Table Graphic Jump LocationTable 4. Prevalence and Odds Ratio of POAG, by Refractive Status in Different Studies, Right Eye Only

We found that a longer AL was associated with POAG, but also that a shorter ACD was also associated with POAG. This is an interesting observation, and we believe this could be due to ACD being shallower in older persons because of increased lens thickness2730 and increased prevalence of POAG with age.3133 Several theories have been put forward to explain a link between myopia and POAG. Myopia has been found to influence IOP, with myopia associated with a higher IOP than emmetropia and hyperopia.13 The optic nerve head in myopic eyes may be more susceptible than nonmyopic eyes to glaucomatous damage from elevated or normal IOP.8,34,35 Shearing forces exerted by scleral tension across the lamina cribrosa may be crucial to the mechanism of glaucomatous damage.36 Investigators37 have calculated that myopic eyes have higher scleral tension across the lamina than eyes with a shorter AL, even when IOP is the same. This difference becomes even more marked in eyes with thinner sclera. Similar connective tissue changes may also occur in glaucoma and myopia.38 Our finding that AL was significantly associated with POAG largely explains the association between myopia and POAG and may support a theory involving connective tissue changes being associated with longer axial dimensions as a potential mechanism for POAG.

The strengths of our study include that this was a population-based study with a high participation rate (78.7%) and with diagnosis of glaucoma based on optic nerve changes and perimetric findings according to International Society for Geographical and Epidemiological Ophthalmology criteria, unlike the Beaver Dam Eye Study16 in which IOP was used to define glaucoma. The standardized assessment of refraction, IOP measurement, and glaucoma definitions strengthen the validity of any conclusions. Our population-based design also minimizes selection bias, unlike some previous clinic-based studies2,4,7 in which the fact that more myopic patients would attend a clinic would increase the likelihood of detecting POAG. Furthermore, previous studies4,13,14,1618 have not examined the influence of CCT. Recent studies have shown the correlation of CCT with optic disc measurements,39,40 and thinner CCT has been identified as a risk factor for the development of POAG in eyes with ocular hypertension.3,41 In our study, CCT was not associated with POAG.

Longer AL however, does not correlate with CCT in myopic patients,42 in healthy populations, or in patients with glaucoma.43 We found similarly that AL was not associated with CCT (Pearson correlation coefficient, 0.081). Furthermore, we did not find that controlling for CCT influenced our results. The measurement of AL by noncontact partial coherence laser interferometry instead of ultrasonographic methods and the use of subjective refractions by trained optometrists instead of autorefraction further increase the robustness of our study.

A limitation of our study was its cross-sectional nature. The conclusions we can draw about the potential influence of myopia on POAG are not based on longitudinal data. A cohort study will help determine whether myopia is associated with subsequent risk of POAG. Another limitation is that these data were based on single measurements (of refraction, IOP, optic disc, and visual fields) during the course of the study. As shown in Table 3, the number of participants with higher degrees of myopia were small. Therefore, although the study had a large number of participants, once they were subdivided into myopia categories, more robust associations were hard to find because the study was underpowered to elicit this information. This could explain why the 95% CIs are quite wide in Table 3. Finally, the clinical diagnosis of glaucoma in myopia may be difficult. The optic discs of myopic patients are also notoriously difficult to assess. The discs frequently appear glaucomatous, with larger diameters, greater cup-disc ratios, and larger and shallower optic cups.20,44,45 Myopic discs are often obliquely inserted, which can result in an abnormal shape with horizontal ovalness or cyclotorsion. Visual field abnormalities have also been reported in highly myopic eyes and in eyes with tilted discs.46 It is possible that cases of high myopia were misclassified as POAG in previous population-based and clinical studies, leading to a spurious association between myopia and POAG. However, of a total of 59 cases of right eyes with POAG in our study, only 1 had high myopia of more than −6 D, so misclassification is not expected to be substantial.

Population-attributable risk estimates are best used to prioritize medical and public health interventions based on the magnitude of the potential effect of a risk factor on the disease outcome in the community. In determining the impact of myopia on POAG, we have found a population-attributable risk of 14.6% for myopia and 5.5% for moderate or high myopia. This finding suggests that myopia may account for 1 in 7 cases of POAG, at least in Malays. It is worth noting that the prevalence of myopia is higher in Chinese Singaporeans than in Malays. Furthermore, with increasing prevalence of myopia in younger Singaporeans, the contribution of myopia to POAG rates over time may be substantial.

In conclusion, in this population-based study in Singapore Malays, we found an association between moderate or high myopia and longer AL and POAG. Our findings suggest that axial myopia is a potential risk factor for POAG.

Correspondence: Tin Aung, MBBS, PhD, FRCS(Edin), Glaucoma Service, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore 168751 (tin11@pacific.net.sg).

Submitted for Publication: January 31, 2009; final revision received July 10, 2009; accepted August 16, 2009.

Financial Disclosure: None reported.

Funding/Support: This study was supported by grant 0796/2003 from the National Medical Research Council and grant 501/1/25-5 from the Biomedical Research Council of Singapore; by the Singapore Tissue Network; and by the Ministry of Health.

AGIS Investigators, The Advanced Glaucoma Intervention Study (AGIS),12: baseline risk factors for sustained loss of visual field and visual acuity in patients with advanced glaucoma. Am J Ophthalmol 2002;134 (4) 499- 512
PubMed
Fong  DSEpstein  DLAllingham  RR Glaucoma and myopia: are they related? Int Ophthalmol Clin 1990;30 (3) 215- 218
PubMed
Gordon  MOBeiser  JABrandt  JD  et al.  The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol 2002;120 (6) 714- 720
PubMed
Grødum  KHeijl  ABengtsson  B Refractive error and glaucoma. Acta Ophthalmol Scand 2001;79 (6) 560- 566
PubMed
Knapp  A Glaucoma in myopic eyes. Trans Am Ophthalmol Soc 1925;2361- 70
PubMed
Podos  SMBecker  BMorton  WR High myopia and primary open-angle glaucoma. Am J Ophthalmol 1966;62 (6) 1038- 1043
PubMed
Abdalla  MIHamdi  M Applanation ocular tension in myopia and emmetropia. Br J Ophthalmol 1970;54 (2) 122- 125
PubMed
Perkins  ESPhelps  CD Open angle glaucoma, ocular hypertension, low-tension glaucoma, and refraction. Arch Ophthalmol 1982;100 (9) 1464- 1467
PubMed
Daubs  JGCrick  RP Effect of refractive error on the risk of ocular hypertension and open angle glaucoma. Trans Ophthalmol Soc U K 1981;101 (1) 121- 126
PubMed
David  RZangwill  LMTessler  ZYassur  Y The correlation between intraocular pressure and refractive status. Arch Ophthalmol 1985;103 (12) 1812- 1815
PubMed
Seddon  JMSchwartz  BFlowerdew  G Case-control study of ocular hypertension. Arch Ophthalmol 1983;101 (6) 891- 894
PubMed
Tomlinson  APhillips  CI Applanation tension and axial length of the eyeball. Br J Ophthalmol 1970;54 (8) 548- 553
PubMed
Mitchell  PHourihan  FSandbach  JWang  JJ The relationship between glaucoma and myopia: the Blue Mountains Eye Study. Ophthalmology 1999;106 (10) 2010- 2015
PubMed
Wu  SYNemesure  BLeske  MC Refractive errors in a black adult population: the Barbados Eye Study. Invest Ophthalmol Vis Sci 1999;40 (10) 2179- 2184
PubMed
Wu  SYNemesure  BLeske  MC Glaucoma and myopia. Ophthalmology 2000;107 (6) 1026- 1027
PubMed
Wong  TYKlein  BEKlein  RKnudtson  MLee  KE Refractive errors, intraocular pressure, and glaucoma in a white population. Ophthalmology 2003;110 (1) 211- 217
PubMed
Xu  LWang  YWang  SWang  YJonas  JB High myopia and glaucoma susceptibility the Beijing Eye Study. Ophthalmology 2007;114 (2) 216- 220
PubMed
Casson  RJGupta  ANewland  HS  et al.  Risk factors for primary open-angle glaucoma in a Burmese population: the Meiktila Eye Study. Clin Experiment Ophthalmol 2007;35 (8) 739- 744
PubMed
Jonas  JBMartus  PBudde  WM Anisometropia and degree of optic nerve damage in chronic open-angle glaucoma. Am J Ophthalmol 2002;134 (4) 547- 551
PubMed
Jonas  JBDichtl  A Optic disc morphology in myopic primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 1997;235 (10) 627- 633
PubMed
Foong  AWSaw  SMLoo  JL  et al.  Rationale and methodology for a population-based study of eye diseases in Malay people: the Singapore Malay Eye Study (SiMES). Ophthalmic Epidemiol 2007;14 (1) 25- 35
PubMed
Wong  TYChong  EWWong  WL  et al. Singapore Malay Eye Study Team, Prevalence and causes of low vision and blindness in an urban Malay population: the Singapore Malay Eye Study. Arch Ophthalmol 2008;126 (8) 1091- 1099
PubMed
Amerasinghe  NWong  TYWong  WL  et al. SiMES Study Group, Determinants of the optic cup to disc ratio in an Asian population: the Singapore Malay Eye Study (SiMES). Arch Ophthalmol 2008;126 (8) 1101- 1108
PubMed
Su  DHWong  TYWong  WL  et al. Singapore Malay Eye Study Group, Diabetes, hyperglycemia, and central corneal thickness: the Singapore Malay Eye Study. Ophthalmology 2008;115 (6) 964- 968.e1
PubMed10.1016/j.ophtha.2007.08.021
Foster  PJBuhrmann  RQuigley  HAJohnson  GJ The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol 2002;86 (2) 238- 242
PubMed
Foster  PJDevereux  JGAlsbirk  PH  et al.  Detection of gonioscopically occludable angles and primary angle closure glaucoma by estimation of limbal chamber depth in Asians: modified grading scheme. Br J Ophthalmol 2000;84 (2) 186- 192
PubMed
Wong  TYFoster  PJNg  TPTielsch  JMJohnson  GJSeah  SK Variations in ocular biometry in an adult Chinese population in Singapore: the Tanjong Pagar Survey. Invest Ophthalmol Vis Sci 2001;42 (1) 73- 80
PubMed
Xu  LCao  WFWang  YXChen  CXJonas  JB Anterior chamber depth and chamber angle and their associations with ocular and general parameters: the Beijing Eye Study. Am J Ophthalmol 2008;145 (5) 929- 936
PubMed
Hashemi  HKhabazkhoob  MMehravaran  SYazdani  KMohammad  KFotouhi  A The distribution of anterior chamber depth in a Tehran population: the Tehran Eye Study. Ophthalmic Physiol Opt 2009;29 (4) 436- 442
He  MHuang  WZheng  YAlsbirk  PHFoster  PJ Anterior chamber depth in elderly Chinese: the Liwan Eye Study. Ophthalmology 2008;115 (8) 1286- 1290, 1290.e1-1290.e2
PubMed10.1016/j.ophtha.2007.12.003
Mitchell  PSmith  WAttebo  KHealey  PR Prevalence of open-angle glaucoma in Australia: the Blue Mountains Eye Study. Ophthalmology 1996;103 (10) 1661- 1669
PubMed
Leske  MCConnell  AMSchachat  APHyman  L The Barbados Eye Study: prevalence of open angle glaucoma. Arch Ophthalmol 1994;112 (6) 821- 829
PubMed
Quigley  HAWest  SKRodriguez  JMunoz  BKlein  RSnyder  R The prevalence of glaucoma in a population-based study of Hispanic subjects: Proyecto VER. Arch Ophthalmol 2001;119 (12) 1819- 1826
PubMed
Chihara  ELiu  XDong  J  et al.  Severe myopia as a risk factor for progressive visual field loss in primary open-angle glaucoma. Ophthalmologica 1997;211 (2) 66- 71
PubMed
Lotufo  DRitch  RSzmyd  L  JrBurris  JE Juvenile glaucoma, race, and refraction. JAMA 1989;261 (2) 249- 252
PubMed
Quigley  HA Reappraisal of the mechanisms of glaucomatous optic nerve damage. Eye (Lond) 1987;1 (Pt 2) 318- 322
PubMed
Cahane  MBartov  E Axial length and scleral thickness effect on susceptibility to glaucomatous damage: a theoretical model implementing Laplace's law. Ophthalmic Res 1992;24 (5) 280- 284
PubMed
Curtin  BJIwamoto  TRenaldo  DP Normal and staphylomatous sclera of high myopia: an electron microscopic study. Arch Ophthalmol 1979;97 (5) 912- 915
PubMed
Jonas  JBStroux  AVelten  IJuenemann  AMartus  PBudde  WM Central corneal thickness correlated with glaucoma damage and rate of progression. Invest Ophthalmol Vis Sci 2005;46 (4) 1269- 1274
PubMed
Henderson  PAMedeiros  FAZangwill  LMWeinreb  RN Relationship between central corneal thickness and retinal nerve fiber layer thickness in ocular hypertensive patients. Ophthalmology 2005;112 (2) 251- 256
PubMed
Miglior  SPfeiffer  NTorri  VZeyen  TCunha-Vaz  JAdamsons  IEuropean Glaucoma Prevention Study (EGPS) Group, Predictive factors for open-angle glaucoma among patients with ocular hypertension in the European Glaucoma Prevention Study. Ophthalmology 2007;114 (1) 3- 9
PubMed
Al-Mezaine  HSAl-Obeidan  SKangave  DSadaawy  AWehaib  TAAl-Amro  SA The relationship between central corneal thickness and degree of myopia among Saudi adults. Int Ophthalmol 2009;29 (5) 373- 378
PubMed
Ventura  ACBohnke  MMojon  DS Central corneal thickness measurements in patients with normal tension glaucoma, primary open angle glaucoma, pseudoexfoliation glaucoma, or ocular hypertension. Br J Ophthalmol 2001;85 (7) 792- 795
PubMed
Dichtl  AJonas  JBNaumann  GO Histomorphometry of the optic disc in highly myopic eyes with absolute secondary angle closure glaucoma. Br J Ophthalmol 1998;82 (3) 286- 289
PubMed
Jonas  JBGusek  GCNaumann  GO Optic disk morphometry in high myopia. Graefes Arch Clin Exp Ophthalmol 1988;226 (6) 587- 590
PubMed
Brazitikos  PDSafran  ABSimona  FZulauf  M Threshold perimetry in tilted disc syndrome. Arch Ophthalmol 1990;108 (12) 1698- 1700
PubMed

Figures

Tables

Table Graphic Jump LocationTable 1. Characteristics of Participants With and Without POAG in the Singapore Malay Eye Study (Right and Left Eyes)a
Table Graphic Jump LocationTable 2. Mean Spherical Equivalent, Axial Length, Corneal Curvature, Anterior Chamber Depth, and Central Corneal Thickness in Normal Right Eyes and in Right Eyes With POAG (Primary Open-Angle Glaucoma)
Table Graphic Jump LocationTable 3. Association of Refractive Error, Axial Dimension, Corneal Curvature, and POAG in the Right Eye
Table Graphic Jump LocationTable 4. Prevalence and Odds Ratio of POAG, by Refractive Status in Different Studies, Right Eye Only

References

AGIS Investigators, The Advanced Glaucoma Intervention Study (AGIS),12: baseline risk factors for sustained loss of visual field and visual acuity in patients with advanced glaucoma. Am J Ophthalmol 2002;134 (4) 499- 512
PubMed
Fong  DSEpstein  DLAllingham  RR Glaucoma and myopia: are they related? Int Ophthalmol Clin 1990;30 (3) 215- 218
PubMed
Gordon  MOBeiser  JABrandt  JD  et al.  The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol 2002;120 (6) 714- 720
PubMed
Grødum  KHeijl  ABengtsson  B Refractive error and glaucoma. Acta Ophthalmol Scand 2001;79 (6) 560- 566
PubMed
Knapp  A Glaucoma in myopic eyes. Trans Am Ophthalmol Soc 1925;2361- 70
PubMed
Podos  SMBecker  BMorton  WR High myopia and primary open-angle glaucoma. Am J Ophthalmol 1966;62 (6) 1038- 1043
PubMed
Abdalla  MIHamdi  M Applanation ocular tension in myopia and emmetropia. Br J Ophthalmol 1970;54 (2) 122- 125
PubMed
Perkins  ESPhelps  CD Open angle glaucoma, ocular hypertension, low-tension glaucoma, and refraction. Arch Ophthalmol 1982;100 (9) 1464- 1467
PubMed
Daubs  JGCrick  RP Effect of refractive error on the risk of ocular hypertension and open angle glaucoma. Trans Ophthalmol Soc U K 1981;101 (1) 121- 126
PubMed
David  RZangwill  LMTessler  ZYassur  Y The correlation between intraocular pressure and refractive status. Arch Ophthalmol 1985;103 (12) 1812- 1815
PubMed
Seddon  JMSchwartz  BFlowerdew  G Case-control study of ocular hypertension. Arch Ophthalmol 1983;101 (6) 891- 894
PubMed
Tomlinson  APhillips  CI Applanation tension and axial length of the eyeball. Br J Ophthalmol 1970;54 (8) 548- 553
PubMed
Mitchell  PHourihan  FSandbach  JWang  JJ The relationship between glaucoma and myopia: the Blue Mountains Eye Study. Ophthalmology 1999;106 (10) 2010- 2015
PubMed
Wu  SYNemesure  BLeske  MC Refractive errors in a black adult population: the Barbados Eye Study. Invest Ophthalmol Vis Sci 1999;40 (10) 2179- 2184
PubMed
Wu  SYNemesure  BLeske  MC Glaucoma and myopia. Ophthalmology 2000;107 (6) 1026- 1027
PubMed
Wong  TYKlein  BEKlein  RKnudtson  MLee  KE Refractive errors, intraocular pressure, and glaucoma in a white population. Ophthalmology 2003;110 (1) 211- 217
PubMed
Xu  LWang  YWang  SWang  YJonas  JB High myopia and glaucoma susceptibility the Beijing Eye Study. Ophthalmology 2007;114 (2) 216- 220
PubMed
Casson  RJGupta  ANewland  HS  et al.  Risk factors for primary open-angle glaucoma in a Burmese population: the Meiktila Eye Study. Clin Experiment Ophthalmol 2007;35 (8) 739- 744
PubMed
Jonas  JBMartus  PBudde  WM Anisometropia and degree of optic nerve damage in chronic open-angle glaucoma. Am J Ophthalmol 2002;134 (4) 547- 551
PubMed
Jonas  JBDichtl  A Optic disc morphology in myopic primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 1997;235 (10) 627- 633
PubMed
Foong  AWSaw  SMLoo  JL  et al.  Rationale and methodology for a population-based study of eye diseases in Malay people: the Singapore Malay Eye Study (SiMES). Ophthalmic Epidemiol 2007;14 (1) 25- 35
PubMed
Wong  TYChong  EWWong  WL  et al. Singapore Malay Eye Study Team, Prevalence and causes of low vision and blindness in an urban Malay population: the Singapore Malay Eye Study. Arch Ophthalmol 2008;126 (8) 1091- 1099
PubMed
Amerasinghe  NWong  TYWong  WL  et al. SiMES Study Group, Determinants of the optic cup to disc ratio in an Asian population: the Singapore Malay Eye Study (SiMES). Arch Ophthalmol 2008;126 (8) 1101- 1108
PubMed
Su  DHWong  TYWong  WL  et al. Singapore Malay Eye Study Group, Diabetes, hyperglycemia, and central corneal thickness: the Singapore Malay Eye Study. Ophthalmology 2008;115 (6) 964- 968.e1
PubMed10.1016/j.ophtha.2007.08.021
Foster  PJBuhrmann  RQuigley  HAJohnson  GJ The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol 2002;86 (2) 238- 242
PubMed
Foster  PJDevereux  JGAlsbirk  PH  et al.  Detection of gonioscopically occludable angles and primary angle closure glaucoma by estimation of limbal chamber depth in Asians: modified grading scheme. Br J Ophthalmol 2000;84 (2) 186- 192
PubMed
Wong  TYFoster  PJNg  TPTielsch  JMJohnson  GJSeah  SK Variations in ocular biometry in an adult Chinese population in Singapore: the Tanjong Pagar Survey. Invest Ophthalmol Vis Sci 2001;42 (1) 73- 80
PubMed
Xu  LCao  WFWang  YXChen  CXJonas  JB Anterior chamber depth and chamber angle and their associations with ocular and general parameters: the Beijing Eye Study. Am J Ophthalmol 2008;145 (5) 929- 936
PubMed
Hashemi  HKhabazkhoob  MMehravaran  SYazdani  KMohammad  KFotouhi  A The distribution of anterior chamber depth in a Tehran population: the Tehran Eye Study. Ophthalmic Physiol Opt 2009;29 (4) 436- 442
He  MHuang  WZheng  YAlsbirk  PHFoster  PJ Anterior chamber depth in elderly Chinese: the Liwan Eye Study. Ophthalmology 2008;115 (8) 1286- 1290, 1290.e1-1290.e2
PubMed10.1016/j.ophtha.2007.12.003
Mitchell  PSmith  WAttebo  KHealey  PR Prevalence of open-angle glaucoma in Australia: the Blue Mountains Eye Study. Ophthalmology 1996;103 (10) 1661- 1669
PubMed
Leske  MCConnell  AMSchachat  APHyman  L The Barbados Eye Study: prevalence of open angle glaucoma. Arch Ophthalmol 1994;112 (6) 821- 829
PubMed
Quigley  HAWest  SKRodriguez  JMunoz  BKlein  RSnyder  R The prevalence of glaucoma in a population-based study of Hispanic subjects: Proyecto VER. Arch Ophthalmol 2001;119 (12) 1819- 1826
PubMed
Chihara  ELiu  XDong  J  et al.  Severe myopia as a risk factor for progressive visual field loss in primary open-angle glaucoma. Ophthalmologica 1997;211 (2) 66- 71
PubMed
Lotufo  DRitch  RSzmyd  L  JrBurris  JE Juvenile glaucoma, race, and refraction. JAMA 1989;261 (2) 249- 252
PubMed
Quigley  HA Reappraisal of the mechanisms of glaucomatous optic nerve damage. Eye (Lond) 1987;1 (Pt 2) 318- 322
PubMed
Cahane  MBartov  E Axial length and scleral thickness effect on susceptibility to glaucomatous damage: a theoretical model implementing Laplace's law. Ophthalmic Res 1992;24 (5) 280- 284
PubMed
Curtin  BJIwamoto  TRenaldo  DP Normal and staphylomatous sclera of high myopia: an electron microscopic study. Arch Ophthalmol 1979;97 (5) 912- 915
PubMed
Jonas  JBStroux  AVelten  IJuenemann  AMartus  PBudde  WM Central corneal thickness correlated with glaucoma damage and rate of progression. Invest Ophthalmol Vis Sci 2005;46 (4) 1269- 1274
PubMed
Henderson  PAMedeiros  FAZangwill  LMWeinreb  RN Relationship between central corneal thickness and retinal nerve fiber layer thickness in ocular hypertensive patients. Ophthalmology 2005;112 (2) 251- 256
PubMed
Miglior  SPfeiffer  NTorri  VZeyen  TCunha-Vaz  JAdamsons  IEuropean Glaucoma Prevention Study (EGPS) Group, Predictive factors for open-angle glaucoma among patients with ocular hypertension in the European Glaucoma Prevention Study. Ophthalmology 2007;114 (1) 3- 9
PubMed
Al-Mezaine  HSAl-Obeidan  SKangave  DSadaawy  AWehaib  TAAl-Amro  SA The relationship between central corneal thickness and degree of myopia among Saudi adults. Int Ophthalmol 2009;29 (5) 373- 378
PubMed
Ventura  ACBohnke  MMojon  DS Central corneal thickness measurements in patients with normal tension glaucoma, primary open angle glaucoma, pseudoexfoliation glaucoma, or ocular hypertension. Br J Ophthalmol 2001;85 (7) 792- 795
PubMed
Dichtl  AJonas  JBNaumann  GO Histomorphometry of the optic disc in highly myopic eyes with absolute secondary angle closure glaucoma. Br J Ophthalmol 1998;82 (3) 286- 289
PubMed
Jonas  JBGusek  GCNaumann  GO Optic disk morphometry in high myopia. Graefes Arch Clin Exp Ophthalmol 1988;226 (6) 587- 590
PubMed
Brazitikos  PDSafran  ABSimona  FZulauf  M Threshold perimetry in tilted disc syndrome. Arch Ophthalmol 1990;108 (12) 1698- 1700
PubMed

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 27

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles