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Editors Selection IGR 16-4

Myopia

Comment by Shan Lin on:

16925 High myopia and glaucoma susceptibility the Beijing Eye Study, Xu L; Wang S et al., Ophthalmology, 2007; 114: 216-220

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Xu et al. (183) report an association of glaucoma prevalence with high (> 8 D) and marked (6-8 D) myopia as compared to lower grades of myopia, emmetropia, and hyperopia, in the Beijing Eye Study. In this population-based, cross-sectional study of communities in and around Beijing, 4439 individuals (83% response rate) aged 40 years or older were screened. There were two separate definitions of glaucoma based on 1) optic nerve appearance; and 2) glaucomatous visual field loss (on FDT), respectively. Within the criteria of these definitions, the authors have convincingly demonstrated a strong correlation of optic nerve head and perimetric glaucoma with myopia > 6 D.

A strong correlation of optic nerve head and perimetric glaucoma with myopia > 6 D was demonstrated

Unfortunately, definitions of glaucoma vary among studies and necessarily include criteria related to optic nerve evaluation - a feature which is often abnormal in patients with myopia. Does a high or marked myope have glaucoma or non-progressive optic nerve damage (with or without visual field defect)? For example, in a recent study, Doshi et al. report a cases series of young and middle-aged Chinese men - 44% of whom were high myopes (> 6 D) - who had a constellation of findings consistent with glaucoma, but did not progress over a mean follow-up of 7 years. Such cases may be included disproportionately among those with high myopia.
As pointed out by the authors, there are prior studies that have supported a link between myopia and glaucoma prevalence. The strong correlation found in the present paper suggests that a disorder of the optic nerve other than glaucoma may be at play in Chinese with high myopia. Since glaucoma is defined as a progressive condition, the investigators have an opportunity to follow up with those who were originally diagnosed with glaucoma at a later time point. In addition, biometry may be considered as well as standard automated perimetry.

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