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Divakar Gupta, Daniel Moore, Karine Bojikian, Mark Slabaugh; Relationship between eye shape and the risk for glaucoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3524.
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Myopia has long been identified as a risk factor for open-angle glaucoma (OAG). We aimed to determine if the primary risk factor for OAG is due primarily to increased axial length or if other correlated factors leading to myopia may be involved.
We collected our data using two methods: retrospective chart review of patients who had undergone biometry (IOL Master) prior to elective cataract surgery at University of Washington or Harborview Medical Center from 2009-2011, and prospective collection of data from patients in the University of Washington Eye Institute Glaucoma Clinic who agreed to have ocular biometry. We excluded patients with secondary causes of glaucoma and subjects classified as glaucoma suspects. Predicted refraction was calculated using the biometry data and individual variation from a best fit regression line was determined for all subjects. This was compared between those with and without OAG.
Our dataset included 901 eyes of 901 subjects, 281 with glaucoma and 620 without glaucoma. The average age was 67.16 ± 12.38., the corneal curvature was 43.87 ±1.67 D and the axial length was 24.38 ± 1.76 mm. Subjects with glaucoma had longer axial lengths, (24.88 ± 1.91 mm vs. 24.16 ± 1.65, p<0.001) and flatter corneas (43.62 ± 1.73 D vs. 43.98 ± 1.64 D, p=0.002) than those without glaucoma. In a multivariate analysis, age and axial length were significant independent risk factors for glaucoma in this population. Using deviation from a best fit regression line for all biometric data derived refractions, it was found that for any given refractive error, subjects with glaucoma had longer axial lengths compared to controls (0.218 ± 0.882 mm vs. -0.099 ± 0.82mm, p < 0.001).
Axial length and age were independent risk factors for glaucoma in this population. Analysis of the biometric data showed that for any refractive error, subjects with glaucoma tended to have longer axial lengths than those without glaucoma. This data suggests that an increased axial length rather than strictly refractive error might be the pathophysiologic mechanism underlying the association between myopia and OAG.
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