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Meta-Analysis
. 2020 Apr 9;61(4):49.
doi: 10.1167/iovs.61.4.49.

The Complications of Myopia: A Review and Meta-Analysis

Annechien E G Haarman  1   1 , Clair A Enthoven  1   1 , J Willem L Tideman  1   1 , Milly S Tedja  1   1 , Virginie J M Verhoeven  1   1   1 , Caroline C W Klaver  1   1   1   1
Affiliations
Meta-Analysis

The Complications of Myopia: A Review and Meta-Analysis

Annechien E G Haarman et al. Invest Ophthalmol Vis Sci. .

Abstract

Purpose: To determine the risk between degree of myopia and myopic macular degeneration (MMD), retinal detachment (RD), cataract, open angle glaucoma (OAG), and blindness.

Methods: A systematic review and meta-analyses of studies published before June 2019 on myopia complications. Odds ratios (OR) per complication and spherical equivalent (SER) degree (low myopia SER < -0.5 to > -3.00 diopter [D]; moderate myopia SER ≤ -3.00 to > -6.00 D; high myopia SER ≤ -6.00 D) were calculated using fixed and random effects models.

Results: Low, moderate, and high myopia were all associated with increased risks of MMD (OR, 13.57, 95% confidence interval [CI], 6.18-29.79; OR, 72.74, 95% CI, 33.18-159.48; OR, 845.08, 95% CI, 230.05-3104.34, respectively); RD (OR, 3.15, 95% CI, 1.92-5.17; OR, 8.74, 95% CI, 7.28-10.50; OR, 12.62, 95% CI, 6.65-23.94, respectively); posterior subcapsular cataract (OR, 1.56, 95% CI, 1.32-1.84; OR, 2.55, 95% CI, 1.98-3.28; OR, 4.55, 95% CI, 2.66-7.75, respectively); nuclear cataract (OR, 1.79, 95% CI, 1.08-2.97; OR, 2.39, 95% CI, 1.03-5.55; OR, 2.87, 95% CI, 1.43-5.73, respectively); and OAG (OR, 1.59, 95% CI, 1.33-1.91; OR, 2.92, 95% CI, 1.89-4.52 for low and moderate/high myopia, respectively). The risk of visual impairment was strongly related to longer axial length, higher myopia degree, and age older than 60 years (OR, 1.71, 95% CI, 1.07-2.74; OR, 5.54, 95% CI, 3.12-9.85; and OR, 87.63, 95% CI, 34.50-222.58 for low, moderate, and high myopia in participants aged >60 years, respectively).

Conclusions: Although high myopia carries the highest risk of complications and visual impairment, low and moderate myopia also have considerable risks. These estimates should alert policy makers and health care professionals to make myopia a priority for prevention and treatment.

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Conflict of interest statement

Disclosure: A.E.G. Haarman, None; C.A. Enthoven, None; J.W.L. Tideman, None; M.S. Tedja, None; V.J.M. Verhoeven, None; C.C.W. Klaver, None

Figures

Figure 1.
Figure 1.
Prevalence of MMD among groups with any, low, moderate, and high myopia derived from eight population-based studies.
Figure 2.
Figure 2.
Forest plot of MMD in any myopia (random effects model; Q = 16.1; I2 = 56.5); low myopia (random effects model; Q = 27.6; I2 = 85.5); moderate myopia (random effects model; Q = 18.0; I2 = 72.2), and high myopia (random effects model; Q = 5.2; I2 = 4.3). Red lines with diamond represents the summary OR per myopia category. Summary OR for myopia categories are as follows: any myopia OR, 102.11 (95% CI, 52.60–198.22); low myopia OR, 13.57 (95% CI, 6.18–29.79); moderate myopia OR, 72.74 (95% CI, 33.18–159.48); and high myopia OR, 845.08 (95% CI, 230.05–3104.34).
Figure 3.
Figure 3.
BCVA in eyes with and without MMD.
Figure 4.
Figure 4.
BCVA in eyes with different stages of MMD.
Figure 5.
Figure 5.
Forest plot of RD in any myopia (random effects model; Q = 1.7; I2 = 0.0); low myopia (random effects model; Q = 3.7; I2 = 0.5); moderate myopia (fixed effects model; Q = 2.8; I2 = 0.6); and high myopia (random effects model; Q = 3.3; I2 = 0.4). Red lines with diamond represents the summary OR per myopia category. Summary OR for myopia categories are as follows: any myopia OR, 3.45 (95% CI, 1.08–11.00); low myopia OR, 3.15 (95% CI, 1.92–5.17); moderate myopia OR, 8.74 (95% CI, 7.28–10.50); and high myopia OR, 12.62 (95% CI, 6.65–23.94).
Figure 6.
Figure 6.
Forest plot of PSC in any myopia (random effects model; Q = 11.6; I2 = 13.8); low myopia (fixed effects model; Q = 7.5; I2 = 19.7); moderate myopia (fixed effects model; Q = 7.5; I2 = 19.2); and high myopia (random effects model; Q = 6.0; I2 = 0.14). Red lines with diamond represents the summary OR per myopia category, which are as follows: any myopia OR, 2.09 (95% CI, 1.60–2.74); low myopia OR, 1.56 (95% CI, 1.32–1.84); moderate myopia OR, 2.55 (95% CI, 1.99–3.28); and high myopia OR, 4.55 (95% CI, 2.67–7.75). *Represents Pan et al. 2013 Singapore Malay Eye Study. **Represents Pan et al. 2013 Singapore Indian Eye Study.
Figure 7.
Figure 7.
Forest plot of nuclear cataract in any myopia (random effects model; Q = 9.3; I2 = 0); low myopia (random effects model; Q = 5.7; I2 = 0); moderate myopia (random effects model; Q = 4.0; I2 = 0.0); and high myopia (random effects model; Q = 5.0; I2 = 0.0). Red lines with diamond represents the summary OR per myopia category, which are as follows: any myopia OR, 2.51 (95% CI, 1.53–4.13); low myopia OR, 1.79 (95% CI, 1.08–2.97); moderate myopia OR, 2.39 (95% CI, 1.03–5.55); and high myopia OR, 2.87 (95% CI, 1.43–5.73). *Represents Pan et al. 2013 Singapore Malay Eye Study. **Represents Pan et al. 2013 Singapore Indian Eye Study.
Figure 8.
Figure 8.
Forest plot of cortical cataract in any myopia (random effects model; Q = 11.5; I2 = 12.8); low myopia (fixed effects model; Q = 0.9; I2 = 0.0); moderate myopia (fixed effects model; Q = 7.15; I2 = 30.1); and high myopia (fixed effects model; Q = 6.7; I2 = 25.9). Red lines with diamond represents the summary OR per myopia category, which are as follows: any myopia OR, 1.15 (95% CI, 0.94–1.40); low myopia OR, 0.99 (95% CI, 0.85–1.15); moderate myopia OR, 1.06 (95% CI, 0.83–1.35); and high myopia OR, 1.07 (95% CI, 0.81–1.40). *Represents Pan et al. 2013 Singapore Malay Eye Study. **Represents Pan et al. 2013 Singapore Indian Eye Study.
Figure 9.
Figure 9.
Prevalence of RD after CE in myopic patients. Horizontal axis represent different studies investigating RD rate. Two studies are case–control studies (Ripandelli et al. 2003 and Jeon et al. 2011), the other five studies are retrospective case series. The vertical axis represent the prevalence of RD.
Figure 10.
Figure 10.
Forest plot of OAG in any myopia (fixed effects model; Q = 8.3; I2 = 0.0); low myopia (fixed effects model; Q = 0.3; I2 = 0.0); and moderate/high myopia (random effects model; Q = 2.6; I2 = 0.0). Red lines with diamond represents the summary OR per myopia category, which are as follows: any myopia OR, 1.95 (95% CI, 1.74–2.19); low myopia OR, 1.59 (95% CI, 1.33–1.91); moderate/high myopia OR, 2.92 (95% CI, 1.89–4.52).
Figure 11.
Figure 11.
Overview of visual field progression (%) between nonmyopic and myopic patients. Different refractive error categories were indicated by orange patterns. Patients were categorized as myopic if refractive error category was unavailable. Doshi et al. found 0% progression in the group SER ≤ –6 D.
Figure 12.
Figure 12.
Kaplan–Meier curve of the cumulative risk of visual impairment with increasing age per category of AL (left) and SER (right). Reproduced with permission from Tideman JL, Snabel MC, Tedja MS, et al. Association of axial length with risk of uncorrectable visual impairment for Europeans with myopia. JAMA Ophthalmol. 2016;134:1355–1363. © 2016 American Medical Association.
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