The relationship of refractive error and glaucoma in a university eye clinic

Watanee Jenchitr; Matee  Jaradaroonchay

Authors

Watanee Jenchitr Faculty of Optometry, Rangsit University, Patumthani 12000, Thailand
Matee Jaradaroonchay Faculty of Optometry, Rangsit University, Patumthani 12000, Thailand

Keywords:

angle-closure glaucoma, eye clinic, myopia, hyperopia, open-angle glaucoma, refractive error

Abstract

The Faculty of Optometry at Rangsit University performed a retrospective study using records from the eye clinic at Rangsit University (RSU) Healthcare. The objective of the study was to evaluate the relationships between refractive errors and glaucoma and between systemic diseases and glaucoma. Participants were patients attending the eye clinic between 2015 and 2019, aged 40-80 years, who had complete eye examinations and regular follow-up. The total number of subjects was 3,468 (mean age 60.19 ±10.63 years). The examination included measurement of the presenting and best-corrected visual acuity, auto and manifest refraction, applanation intraocular pressure measurement, gonioscopy, cup-to-disc ratio, nerve fiber layer analysis, and perimeter and central corneal thickness measurement. Glaucoma was diagnosed via standardized criteria of the American Academy of Ophthalmology. Cases of refractive error, expressed as spherical equivalent (SE), included 1,154 cases of myopia (mild, moderate and severe), 1,381 cases of hyperopia (mild, moderate and severe) and 359 cases of astigmatism. Subjects also included 302 emmetropic individuals, 139 subjects with pseudophakia and 133 individuals who had undergone refractive surgery. A total of 555 glaucoma cases (19.56%) were identified, including 354 cases of primary open-angle glaucoma (POAG), 50 instances of primary angle-closure glaucoma (PACG), 106 cases of normotension glaucoma (NTG), and 45 cases of secondary glaucoma (SOAG). Subjects with glaucoma-related conditions included 41 post-glaucoma surgery cases, 81 ocular hypertension (OHT) cases, 186 primary open-angle glaucoma-suspect (POAGS) cases, 178 individuals with primary angle closure (PAC) and 166 subjects who had undergone laser peripheral iridotomy (LPI). The results indicated that the prevalence of some types of glaucoma and glaucoma-related conditions (PAC, NTG, OHT and SOAG) increased with advancing age (p = 0.022, 0.001, 0.001, 0.021 respectively). Relationships between refractive error and glaucoma subtypes were found. Mild, moderate and high myopia (‑0.50 to -3.00 D, -3.25 to -5.00 D, and -5.25 D or greater, respectively) were correlated with POAG and NTG (p = 0.001). Mild and moderate hyperopia (+0.50 to +2.00 D and +2.25 to +5.00 D, respectively), were correlated with POAG and NTG (p = 0.001). PACG was correlated with mild, moderate and high myopia and mild to moderate hyperopia (p = 0.001). The lack of relationship between high hyperopia with PACG may be due to fact that 5.85 % of the studied population had already undergone laser peripheral iridotomy. Among glaucoma subtypes, NTG patients were most advanced in age (68.82 ± 10.73 years) and SOAG patients were the youngest (58.36 ± 13.88.79 years). Compared to previous reports, our study revealed an increased glaucoma prevalence in individuals with myopia and hyperopia due to methodological differences and possibly due to our patients being older (60 years vs. 58 years). Diabetes was significantly correlated with SOAG (p = 0.041). Hypertension was not related to any type of glaucoma. Dyslipidemia was significantly correlated with SOAG (p = 0.046). In conclusion, this study found myopia and hyperopia to be related to an increased prevalence of all forms of open-angle glaucoma, including normal-tension glaucoma and angle-closure glaucoma, even after laser peripheral iridotomy. Diabetes and dyslipidemia were correlated with secondary open-angle glaucoma.

References

Bourne, R. R. A., Sukudom, P., Foster, P. J., Tantisevi, V., Jitapunkul, S., Lee, P. S., ... & Rojanapongpun, P. (2003). Prevalence of glaucoma in Thailand: a population based survey in Rom Klao District, Bangkok. British journal of ophthalmology, 87(9), 1069-1074. DOI: 10.1136/bjo.87.9.1069

Chen, T. C. (2008). Normal-Tension Glaucoma (Low-Tension Glaucoma) 365.12. In Roy and Fraunfelder's Current Ocular Therapy (pp. 498-500). WB Saunders.

Coleman, A. L., & Miglior, S. (2008). Risk factors for glaucoma onset and progression. Surv Ophthalmol. 2008, 53(Suppl 1), S3-1053. DOI: 10.1016/j.survophthal.2008.08.006

Czudowska, M., Solouki, A. M., Verhoeven, J. M., Van Duijn, C. M., Verkerk, A. J., Ikram, M. K., . . . Klaver, C. W. (2010). A genome-wide association study identifies a susceptibility locus for refractive errors and myopia at 15q14. Nat Genet. 2010 October, 42(10), 897-901.

Gedde, S. J., Chen, P. P., Muir, K. W., Vinod, K., Lind, J. T., Wright, M. M., ... & Mansberger, S. L. (2021). Primary Angle-Closure Disease Preferred Practice Pattern®. Ophthalmology, 128(1), 30-70. DOI: https://doi.org/10.1016/j.ophtha.2020.10.021

Gordon, M. O., Beiser, J. A., Brandt, J. D., Heuer, D. K., Higginbotham, E. J., Johnson, C. A., ... & Ocular Hypertension Treatment Study Group. (2002). The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Archives of ophthalmology, 120(6), 714-720. DOI: 10.1001/archopht.120.6.714

Grødum, K., Heijl, A., & Bengtsson, B. (2001). Refractive error and glaucoma. Acta ophthalmologica Scandinavica, 79(6), 560-566. DOI: 10.1034/j.1600-0420.2001.790603.x

Holden, B. A., Fricke, T. R., Wilson, D. A., Jong, M., Naidoo, K. S., Sankaridurg, P., ... & Resnikoff, S. (2016). Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology, 123(5), 1036-1042. DOI: 10.1016/j.ophtha.2016.01.006

Iribarren, R., Hashemi, H., Khabazkhoob, M., Morgan, I. G., Emamian, M. H., Shariati, M., & Fotouhi, A. (2015). Hyperopia and lens power in an adult population: The shahroud eye study. J Ophthalmic Vis Res. Oct-Dec, 10(4), 400-407. DOI: 10.4103/2008-322X.158895

Jackson, D. J., Razai, M. S., Falama, R., Mongwa, M., Mutapanduwa, M., Baemisi, C., ... & Ngondi, J. M. (2014). The clinical characteristics of patients with glaucoma presenting to Botswana healthcare facilities: an observational study. BMJ open, 4(12), e005965. DOI: https://doi.org/10.1136/bmjopen-2014-005965

Jenchitr, W., & Raiyawa, A. (2012). Refractive errors: the major visual impairments in Thailand. Rangsit Journal of Arts and Sciences, 2(2), 133-141. DOI: 10.14456/rjas.2012.13

Jonas, J. B., Guo, Y., Duan, J. L., Liu, L. J., Sun, Y., Tang, P., . . . Jonas, J. B. (2017). High myopia in Greater Beijing School Children in 2016. PLoS One, 12(11):e0187396. DOI: 10.1371/journal.pone.0187396

Kong, X., Chen, Y., Chen, X., & Sun, X. (2011). Influence of family history as a risk factor on primary angle closure and primary open angle glaucoma in a Chinese population. Ophthalmic Epidemiol, 18(5), 226-232. DOI: 10.3109/09286586.2011.595040

Marcus, M. W., de Vries, M. M., Montolio, F. G. J., & Jansonius, N. M. (2011). Myopia as a risk factor for open-angle glaucoma: a systematic review and meta-analysis. Ophthalmology, 118(10), 1989-1994. DOI: 10.1016/j.ophtha.2011.03.012

Mitchell, P., Smith, W., Attebo, K., & Healey, P. R. (1996). Prevalence of open-angle glaucoma in Australia. The Blue Mountains Eye Study. Ophthalmology Oct, 103(10), 1661-1669. DOI: 10.1016/s0161-6420(96)30449-1

Mitchell, P., Hourihan, F., Sandbach, J., & Wang, J. J. (1999). The relationship between glaucoma and myopia: the Blue Mountains Eye Study. Ophthalmology, 106(10), 2010-2015. DOI: 10.1016/s01616420(99)90416-5

Mohamed-Noor, J., Bochmann, F., Siddiqui, M. A. R., Atta, H. R., Leslie, T., Maharajan, P., ... & Azuara-Blanco, A. (2009). Correlation between corneal and scleral thickness in glaucoma. Journal of glaucoma, 18(1), 32-36.

Nolan, W. P. (2007). Prevention of primary angle-closure glaucoma in Asia. British Journal of Ophthalmology, 91(7), 847-848. DOI: 10.1136/bjo.2006.111435

Otabil, K. N., Tenkorang, S. B., Mac, A. L., & Otabil, E. A. (2013). Prevalence of glaucoma in an eye clinic in Ghana. Russian Open Medical Journal, 2(3), 0310.

Pekmezci, M., Vo, B., Lim, A. K., Hirabayashi, D. R., Tanaka, G. H., & Weinreb, R. N. (2009). The Characteristics of Glaucoma in Japanese Americans. Arch Ophthalmol, 127(2), 167-171. DOI: 10.1001/archophthalmol.2008.593

Perera, S. A., Wong, T. Y., Tay, W. T., Foster, P. J., Saw, S. M., & Aung, T. (2010). Refractive error, axial dimensions, and primary open-angle glaucoma: the Singapore Malay Eye Study. Archives of ophthalmology, 128(7), 900-905. DOI: 10.1001/archophthalmol.2010.125

Quigley, H. A., & Broman, A. T. (2006). The number of people with glaucoma worldwide in 2010 and 2020. British journal of ophthalmology, 90(3), 262-267. DOI: 10.1136/bjo.2005.081224.

Shen, L., Melles, R. B., Metlapally, R., Barcellos, L., Schaefer, C., Risch, N., Herrinton, L. J., Wildsoet, C., & Jorgenson, E. (2016). The Association of Refractive Error with Glaucoma in a Multiethnic Population. Ophthalmology Jan, 123(1), 92-101. DOI: 10.1016/j.ophtha.2015.07.002

Shen, S. Y., Wong, T. Y., Foster, P. J., Loo, J. L., Rosman, M., Loon, S. C., ... & Aung, T. (2008). The prevalence and types of glaucoma in Malay people: the Singapore Malay eye study. Investigative ophthalmology & visual science, 49(9), 3846-3851. DOI https://doi.org/10.1167/iovs.08-1759

Sothornwit, N., Jenchitr, W., Asawaphureekorn, S., & Rojanapongpun, P. (2019). Prevalence and characteristics of glaucoma in Thailand: a population-based study. Rangsit Jounal of Optometry, 1(1), 35-46

Springelkamp, H., Wolfs, R. C., Ramdas, W. D., Hofman, A., Vingerling, J. R., Klaver, C. C., & Jansonius, N. M. (2017). Incidence of glaucomatous visual field loss after two decades of follow-up: the Rotterdam Study. European journal of epidemiology, 32(8), 691-699. DOI: https://doi.org/10.1007/s10654-017-0270-y

Stein, J. D., Kim, D. S., Niziol, L. M., Talwar, N., Nan, B., Musch, D. C., & Richards, J. E. (2011). Differences in rates of glaucoma among Asian Americans and other racial groups, and among various Asian ethnic groups. Ophthalmology, 118(6), 1031-1037. DOI: 10.1016/j.ophtha.2010.10.024

Wong, T. Y., Klein, B. E., Klein, R., Knudtson, M., & Lee, K. E. (2003). Refractive errors, intraocular pressure, and glaucoma in a white population. Ophthalmology, 110(1), 211-217. DOI: 10.1016/s0161-6420(02)01260-5

Xu, L., Wang, Y., Wang, S., Wang, Y., & Jonas, J. B. (2007). High myopia and glaucoma susceptibility: the Beijing Eye Study. Ophthalmology, 114(2), 216-220. DOI: 10.1016/j.ophtha.2006.06.050

Xu, L., Cao, W. F., Wang, Y. X., Chen, C. X., & Jonas, J. B. (2008). Anterior chamber depth and chamber angle and their associations with ocular and general parameters: the Beijing Eye Study. American journal of ophthalmology, 145(5), 929-936. DOI: 10.1016/j.ajo.2008.01.00