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Editors Selection IGR 19-3

Epidemiology: Myopia-POAG association by Ethnicity

Comment by Brigette Cole & Steve Mansberger on:

109184 Association Between Myopia and Primary Open-Angle Glaucoma by Race and Ethnicity in Older Adults in the California Medicare Population, Yao M; Kitayama K; Kitayama K; Yu F et al., JAMA ophthalmology, 2023; 141: 525-532

See also comment(s) by Xiulan Zhang & Yunhe Song •

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Myopia is associated with risk of primary open-angle glaucoma (POAG). Axial myopia is known to create biomechanical changes to the optic nerve including increased disc area, tilt, and peripapillary atrophy as well as lamina cribosa thinning, which may lead to increased stress and strain of the optic nerve with structural and functional loss from glaucoma. Understanding these relationships might provide new insights into improving diagnosis and treatment of glaucoma.

The aim of this cross-sectional study was to examine and quantify the association of myopia and POAG among different racial and ethnic groups within a database of more than two million Medicare beneficiaries in California during 2019. The study included Californians aged 65 years and older and used ICD-10 codes to categorize those with and without myopia and POAG. Researchers employed multivariable logistic regression, stratified by race and ethnicity, to assess how these factors might alter the myopia-POAG relationship.

The study found that myopia, regardless of degenerative changes, increased the likelihood of a POAG diagnosis. Further, there was a stronger association between myopia and POAG in Asian, Black, and Hispanic groups, indicating a higher POAG risk in these racial and ethnic minorities. This finding suggests the need for potentially earlier or more frequent screenings in these populations.

The study's limitations include reliance on administrative claims data, misclassification bias from coding the most severe diagnosis (rather than all diagnoses), and a lower myopia prevalence rate compared to other studies

The study's limitations include reliance on administrative claims data, misclassification bias from coding the most severe diagnosis (rather than all diagnoses), and a lower myopia prevalence rate compared to other studies. One explanation for the lower prevalence of myopia is that myopia is usually not a covered diagnosis for medical insurances such as Medicare. Therefore, an administrative database based on medical insurance may be more likely have bias from under coding of myopia when compared to the prevalence of myopia from a community-based prevalence study. Unaccounted socio-economic factors in the Medicare data could also affect the results. The authors note that previous research shows racial and ethnic minorities experience lower glaucoma testing rates, inconsistent follow-up, and less surgical treatment relative to the disease burden. Additionally, the challenge of differentiating between myopia and glaucoma during optic disc and visual field evaluations complicates early diagnosis, especially in high-risk, underserved groups. Further research is required to identify and understand the healthcare barriers, including socioeconomic factors, that racial and ethnic minorities encounter. Recognizing these barriers are crucial as they may significantly impact patient's ability to access frequent screenings and necessary healthcare. Addressing these challenges will likely require multidisciplinary teams including social workers, patient care coordinators, and others to ensure equitable healthcare access and support for these communities.

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