Elsevier

Ophthalmology

Volume 123, Issue 1, January 2016, Pages 92-101
Ophthalmology

Original article
The Association of Refractive Error with Glaucoma in a Multiethnic Population

https://doi.org/10.1016/j.ophtha.2015.07.002Get rights and content

Purpose

To evaluate the association between refractive error and the prevalence of glaucoma by race or ethnicity.

Design

Cross-sectional study.

Participants

Kaiser Permanente Northern California Health Plan members with refractive error measured at 35 years of age or older between 2008 and 2014 and with no history of cataract surgery, refractive surgery, or a corneal disorder.

Methods

We identified 34 040 members with glaucoma or ocular hypertension (OHTN; cases) and 403 398 members without glaucoma (controls). Glaucoma cases were classified as primary angle-closure glaucoma (PACG); 1 of the 4 forms of open-angle glaucoma: primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), pigmentary glaucoma (PIGM), and pseudoexfoliation glaucoma (PEX); or OHTN. Refractive error, expressed as spherical equivalent (SE), was coded as a continuous trait and also as categories. Logistic regression analyses were used to estimate the association between refractive error and the prevalence of glaucoma overall and in specific racial or ethnic groups.

Main Outcome Measures

The association between refractive error and glaucoma subtypes evaluated as odds ratios (ORs) with 95% confidence intervals (CIs).

Results

In controls, the mean SE was −0.59 diopters (D) (standard deviation, 2.62 D). Each 1-D reduction in SE was associated with a 22% decrease in the odds of PACG (OR, 0.78; 95% CI, 0.77–0.80) and with increases in the odds of open-angle glaucoma ranging from 1.23 (95% CI, 1.20–1.26) for PIGM, to 1.07 (95% CI, 1.03–1.11) for PEX, and to 1.05 (95% CI, 1.04–1.06) for OHTN. In addition, we observed a stronger association between myopia and POAG among non-Hispanic whites (OR, 1.12; 95% CI, 1.11–1.13) and NTG among Asians (OR, 1.17; 95% CI, 1.15–1.20) and non-Hispanic whites (OR, 1.19; 95% CI, 1.15–1.22).

Conclusions

Myopia was associated with an increased prevalence of all forms of open-angle glaucoma and OHTN, whereas hyperopia was associated with a substantially increased prevalence of PACG. Although high myopia is a strong risk factor for glaucoma subtypes, low and moderate myopia also have a significant effect on glaucoma risk. Additionally, there were moderate racial differences in the association of myopia with the risk of POAG and NTG.

Section snippets

Setting

Study participants were identified from the KPNC, a large nonprofit integrated healthcare delivery system with 3.5 million active members comprising approximately 30% of the population of Northern California. The KPNC membership has been shown to be representative of the general population with respect to demographic characteristics, including racial or ethnic diversity, with some underrepresentation at the extremes of income.19 Since 1995, KPNC has recorded diagnoses, prescriptions, and

Results

A total of 1 679 185 KPNC members were eligible for the study. Of those, 52% of the glaucoma cases (n = 69 939) and 36% of the controls (n = 536 761) had refractive errors measured at 35 years of age or older (Table 1). A history of cataract surgery was the most common reason for exclusion, and the proportion of cases that were excluded for this reason varied by glaucoma subtype, ranging from 32% for OHTN to 76% for PEX. After these exclusions, a total of 34 040 glaucoma cases (49%) and 403 398

Discussion

In this large, community-based cross-sectional study, we assessed the associations between refractive error and the prevalence of several subtypes of glaucoma. Although hyperopia was associated with PACG, myopia was associated with an increased prevalence of all forms of open-angle glaucoma. The magnitudes of the associations were strongest for those with the greatest refractive error. In general, associations were stronger in younger persons, whereas some associations were strongest in racial

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    See editorial on page 7.

    Supplemental material is available at www.aaojournal.org.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by a research grant from the Kaiser Permanente Medical Care Plan, Northern California Region, Community Benefit program, Oakland, California.

    Author Contributions:

    Conception and design: Shen, Jorgenson

    Analysis and interpretation: Shen, Melles, Metlapally, Barcellos, Schaefer, Risch, Herrinton, Wildsoet, Jorgenson

    Data collection: Shen, Melles, Jorgenson

    Obtained funding: Schaefer, Jorgenson

    Overall responsibility: Shen, Melles, Metlapally, Barcellos, Schaefer, Risch, Herrinton, Wildsoet, Jorgenson

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