Myopia glaukooman vaaratekijänä

Anja Tuulonen

Näytön aste: C

Likitaitteisuus saattaa lisätä riskiä sairastua glaukoomaan.

Systemaattinen katsaus 1

The systematic review «Burr JM, Mowatt G, Hernández R ym. The clinical ef...»1 aimed to identify the magnitude of risk of OAG attributable to age, ethnicity, family history, myopia and diabetes. Population-based cohort and cross-sectional studies, investigating the risk of developing OAG were included, as well as meta-analyses and systematic reviews of observational population-based studies. Studies reporting populations in UK, Europe, North America, Canada or Australia were included. Hospital or clinic-based setting were excluded. The review was restricted to English language publications. The methodological quality of the included studies was assessed.

4 383 reports were identified from the search for studies on epidemiology, risk and disease progression, of which 285 were selected for full assessment for this review. 92 reports describing 27 studies met the inclusion criteria for the review.

The overall quality of each study was summarised as (A) no major flaws or (B) possible important flaws. Studies were included when they rated ‘A’ in all fields. Exceptions were made to include ‘B’ studies when no better evidence was available. In most studies (81 %), participants were sampled adequately and selected from a relevant population. Suboptimal approaches to diagnose OAG (e.g. high IOP, absence of a visual test, baring of the blind spot, case records, unstandardised criteria) were used in five studies (19 %). Myopia status was obtained from a secure record (examination or examination records) in most studies. Participants with myopia were defined as having ≥ 1 measurements with refractive errors greater than 0.5 D, ascertained by either measurement of present spectacles or a refraction examination.

Crude and adjusted relative risks (or odds ratios depending on study design) of OAG for the risk factors under investigation were abstracted. Where two or more studies contributed data, a random effects meta-analysis was undertaken. If both an unadjusted and adjusted ratio were reported in a study, an age- and gender-adjusted odds ratio was used in the meta-analysis. A relative risk was generated when an adjusted odds ratio was not reported and raw data were available.

The proportion of people with OAG appeared to be higher in participants with myopia than in those without myopia. The prevalence of OAG among people with myopia ranged from 1.4 to 4.3 %, with a pooled estimate of 2.7 % (95 % CI 1.5 to 3.9). The pooled relative risk of OAG among participants with myopia (any definition) compared with non-myopes was estimated to be 1.88 (95 % CI 1.53 to 2.31). This result should be treated with caution as there was no standardisation on the definition of myopia across the studies and therefore the risk for low (<–6 D) and moderate (>–6 D) could not be determined.

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: hyvä

Systemaattinen katsaus 2

Structured Medline (January 1950 – January 2013) search and a hand search of references and citations of retrieved articles yielding 57 articles from 41 studies were included in the systematic review «Hollands H, Johnson D, Hollands S ym. Do findings ...»2.

The summary prevalence of glaucoma in the highest-quality studies was 2.6 % (95 % CI, 2.1 %-3.1 %). Among risk factors evaluated high myopia increased the risk of glaucoma (≥ 6 diopters; odds ratio [OR], 5.7; 95 % CI, 3.1-11).

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: hyvä

Systemaattinen katsaus 3

The objective of the analysis of this systematic review «Health Quality Ontario. Routine eye examinations f...»3 was to determine the strength of association between age, gender, ethnicity, family history of disease and refractive error and the risk of developing glaucoma. The medical advisory secretariat conducted a computerized search of literature in English-language articles, published from January 2000 to March 2006. In addition, a search was conducted for published guidelines, health technology assessments, and policy decisions. Bibliographies of references of relevant papers were searched for additional references.

Studies including participants ≥ 20 years old, population-based prospective cohort studies, population-based cross-sectional studies when prospective cohort studies were unavailable or insufficient and studies determining and reporting the strength of association or risk-specific prevalence or incidence rates were included in the review. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to summarize the overall quality of the body of evidence.

A total of 498 citations for the period January 2000 through February 2006 were retrieved and an additional 313 were identified when the search was expanded to include articles published between 1990 and 1999. An additional 6 articles were obtained from bibliographies of relevant articles. Of these, 36 articles were retrieved for further evaluation. Upon review, 1 meta-analysis and 15 population-based epidemiological studies were accepted for this review

Four cross-sectional studies assessed the association of myopia and POAG. These data suggest an association between myopia defined as a spherical equivalent of -1.00D or worse and prevalent POAG. However, there is inconsistency in results regarding the statistical significance of the association between myopia when defined as a spherical equivalent of -0.5D. The quality of the evidence is very low.

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: hyvä


  1. Burr JM, Mowatt G, Hernández R ym. The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. Health Technol Assess 2007;11:iii-iv, ix-x, 1-190 «PMID: 17927922»PubMed
  2. Hollands H, Johnson D, Hollands S ym. Do findings on routine examination identify patients at risk for primary open-angle glaucoma? The rational clinical examination systematic review. JAMA 2013;309:2035-42 «PMID: 23677315»PubMed
  3. Health Quality Ontario. Routine eye examinations for persons 20-64 years of age: an evidence-based analysis. Ont Health Technol Assess Ser 2006;6:1-81 «PMID: 23074485»PubMed