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Editors Selection IGR 22-4
Epidemiology: Myopia-POAG association by Ethnicity
Comment by Xiulan Zhang & Yunhe Song 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 Brigette Cole & Steve Mansberger •Myopia has already raised a common public health issue of concern worldwide. It has become a consensus that myopia can significantly increase the risk of developing primary open-angle glaucoma (POAG), particularly in high myopia.1,2 However, it remained with uncertainty that whether the race or ethnicity could influence the risks.
The study by Yao et al., recently published in JAMA Ophthalmology, ventures into the field of ophthalmic epidemiology, particularly the intersection of myopia and POAG among diverse racial and ethnic groups. This study draws from a substantial dataset of 2,717,346 beneficiaries from the 2019 California Medicare population to examine potential dispari-ties in glaucoma risk. The study's chief revelation that myopia is associated with a higher adjusted odds of POAG, especially among Hispanic (adjusted OR = 3.28), Asian (OR = 2.74), and Black (OR = 2.60) beneficiaries when compared to non-Hispanic White (OR = 2.14) beneficiaries, is both striking and consistent with the work of Varma et al.3 and Holden et al.4 These findings raise excellent guide about the adequacy of current screening guidelines across different ethnicities.
The study is inherently limited by its cross-sectional design, which precludes establishing causality. While the use of ICD-10-CM codes for diagnosis is a practical approach for large-scale studies, it might introduce misclassification biasHowever, the study is inherently limited by its cross-sectional design, which precludes establishing causality. While the use of ICD-10-CM codes for diagnosis is a practical approach for large-scale studies, it might introduce misclassification bias. For example, there existed a high false positive rate of diagnosing glaucoma in myopia, particularly in high myopia.5 The results in this study might overestimate the risk for developing POAG in myopic patients, since the accurate recorded diagnoses may have been misclassified into glaucoma falsely. Moreover, the study population is limited to California Medicare beneficiaries aged 65 years or older, the findings may not be generalizable to younger populations, people living in other regions, or those with different insurance coverage. Additionally, as pointed by the authors, only myopia and degenerative myopia were included. The lack of stratification by myopia severity may mask the true strength of the association, especially as high myopia may present a different risk profile for POAG.2
Despite these limitations, the work by Yao and colleagues work is an essential contribution to not only advancing our understanding of the intersection between myopia and POAG but also prompting healthcare policymakers to consider race and ethnicity when designing preventive ophthalmic care strategies. The study serves as a call to action for further longitudinal and interventional research to validate these findings and to develop targeted interventions that could mitigate the higher risk of POAG in racially and ethnically diverse populations.
References
- Marcus MW, de Vries MM, Junoy Montolio FG, Jansonius NM. Myopia as a risk factor for open-angle glaucoma: a systematic review and meta-analysis. Ophthalmology. 2011;118(10):1989-1994.e2.
- Wang YX, Yang H, Wei CC, Xu L, Wei WB, Jonas JB. High myopia as risk factor for the 10-year incidence of open-angle glaucoma in the Beijing Eye Study. Br J Ophthalmol. 2023;107(7):935-940.
- Varma R, Ying-Lai M, Francis BA, et al.; Los Angeles Latino Eye Study Group. Prevalence of open-angle glaucoma and ocular hypertension in Latinos: the Los Angeles Latino Eye Study. Ophthalmology. 2004;111(8):1439-48.
- Holden BA, Fricke TR, Wilson DA, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-1042.
- Song Y, Li F, Chong RS, et al.; Glaucoma Suspects with High Myopia Study Group. High Myopia Normative Database of Peripapillary Retinal Nerve Fiber Layer Thickness to Detect Myopic Glaucoma in a Chinese Population. Ophthalmology. 2023;130(12):1279-1289.
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