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      The Association of Refractive Error with Glaucoma in a Multiethnic Population

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          Abstract

          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.

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          Author and article information

          Journal
          7802443
          6266
          Ophthalmology
          Ophthalmology
          Ophthalmology
          0161-6420
          1549-4713
          16 December 2015
          08 August 2015
          January 2016
          01 January 2017
          : 123
          : 1
          : 92-101
          Affiliations
          [1 ]Division of Research, Kaiser Permanente Northern California, Oakland, California.
          [2 ]Division of Epidemiology, School of Public Health, University of California - Berkeley, Berkeley, California.
          [3 ]Department of Ophthalmology, Redwood City Medical Center, Kaiser Permanente Northern California, Redwood City, California.
          [4 ]School of Optometry/Vision Science Program, University of California - Berkeley, Berkeley, California.
          [5 ]Institute for Human Genetics, University of California San Francisco - San Francisco, California.
          [6 ]Department of Epidemiology and Biostatistics, University of California - San Francisco, San Francisco, California.
          Author notes
          Correspondence: Eric Jorgenson, PhD, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612. eric.jorgenson@ 123456kp.org .
          Article
          PMC4695304 PMC4695304 4695304 nihpa744943
          10.1016/j.ophtha.2015.07.002
          4695304
          26260281
          Categories
          Article

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