The Association Between the Retinal Sequelae of Myopia and Glaucoma in a Global Cohort

Leo Itzel Arnal,1 Yeabsira Mesfin,2 Gabriel Ferreira,3 Anish Salvi,1 Karen M Wai,1 Eubee Koo,1 Andrea L Kossler,1 Euna Koo,1 Ehsan Rahimy,1,4 Prithvi Mruthyunjaya,1 Chase A Ludwig1 1Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA; 2Department of Ophthalmology, University of California San Francisco School of Medicine, San Francisco, CA, USA; 3Department of Medicine, Várzea Grande University Center (UNIVAG), Várzea Grande, Brazil; 4Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA, USACorrespondence: Chase A Ludwig, Department of Ophthalmology, Byers Eye Institute, 2370 Watson Court, Office 100D, Palo Alto, CA, 94303, USA, Tel +1 650 724 2722, Fax +1 650 853 6086, Email [email protected]: Discerning glaucoma in myopic eyes with tilted optic nerve discs is challenging given the atypical appearance and segmentation on optical coherence tomography. This study aims to determine the association between retinal sequelae of myopia and primary open-angle glaucoma (POAG). We hypothesize that retinal sequelae of myopia may aid in identifying high-risk glaucoma patients.Methods: An aggregated electronic health records research network was used to retrospectively identify 929,142 myopic patients. We evaluated the association of POAG with retinal sequelae of myopia, including choroidal neovascularization (CNV), myopic macular degeneration (MMD), foveoschisis, macular hole (MH), rhegmatogenous retinal detachment (RRD), and foveal retinal detachment (FRD). Logistic regressions estimated odds ratios (adjusted for age, sex, race, and ethnicity). Cox models estimated hazard ratios (additionally adjusted for pseudophakia).Results: FRD exhibited the strongest association with POAG (AOR: 5.82; 95% CI: 3.44– 9.85), followed by foveoschisis (AOR: 3.10; 95% CI: 1.84– 5.21) and MMD (AOR: 2.87; 95% CI: 2.19– 3.75). Severe subtypes of POAG were also more highly associated with each retinal sequela than moderate and milder severity subtypes. Additionally, patients with each retinal sequela experienced a significantly faster progression from glaucoma suspect to POAG than those without these sequelae. Kaplan-Meier curves and adjusted Cox regression models suggested a faster progression from glaucoma suspect to POAG in those with foveoschisis (HR: 5.33; 95% CI: 2.21– 12.85; p< 0.005), CNV (HR: 1.73; 95% CI: 1.12– 2.67; p=0.01), MMD (HR: 2.74; 95% CI: 1.47– 5.10; p< 0.005), MH (HR: 1.73; 95% CI: 1.29– 2.31; p< 0.005), and RRD (HR: 1.54; 95% CI: 1.28– 1.86; p< 0.005), whereas FRD was not significantly associated with glaucoma progression (HR: 1.28; 95% CI: 0.18– 9.10; p=0.8).Conclusion: The retinal sequelae of myopia are associated with the presence and progression of primary open-angle glaucoma. The presence of the retinal sequelae of myopia should cue ophthalmologists to refer such patients for glaucoma evaluation to encourage earlier detection and more targeted management.Keywords: glaucoma, myopia, retinal sequelae, primary open-angle glaucoma