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Prevalence and predictors of myopic macular degeneration among Asian adults: pooled analysis from the Asian Eye Epidemiology Consortium
  1. Yee Ling Wong1,2,3,
  2. Xiangjia Zhu4,5,6,
  3. Yih Chung Tham1,7,
  4. Jason C S Yam8,9,10,
  5. Keke Zhang4,5,6,
  6. Charumathi Sabanayagam1,7,11,
  7. Carla Lanca1,
  8. Xiujuan Zhang8,
  9. So Young Han12,
  10. Wenwen He4,5,6,
  11. Pradeep Susvar13,
  12. Mihir Trivedi13,
  13. Nan Yuan8,
  14. Sarang Lambat14,
  15. Rajiv Raman13,
  16. Su Jeong Song12,
  17. Ya Xing Wang15,
  18. Mukharram M Bikbov16,
  19. Vinay Nangia14,
  20. Li Jia Chen8,10,
  21. Tien Yin Wong1,7,11,
  22. Ecosse Luc Lamoureux1,7,
  23. Chi-Pui Pang8,
  24. Ching Yu Cheng1,7,11,
  25. Yi Lu4,5,6,
  26. Jost B Jonas17,
  27. Seang Mei Saw1,2,7,11
  28. The Asian Eye Epidemiology Consortium (AEEC)
  1. 1 Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
  2. 2 Saw Swee Hock School of Public Health, National University of Singapore, Singapore
  3. 3 R&D Vision Sciences AMERA, Essilor International, Singapore
  4. 4 Eye Institute, Eye and ENT Hospital, Shanghai Medical College, Fudan University and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
  5. 5 NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
  6. 6 Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
  7. 7 Duke-NUS Medical School, Singapore
  8. 8 Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
  9. 9 Hong Kong Eye Hospital, China, Hong Kong SAR
  10. 10 Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
  11. 11 Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
  12. 12 Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
  13. 13 Department of Vitreoretina, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
  14. 14 Suraj Eye Institute, Nagpur, Maharashtra, India
  15. 15 Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Capital Medical University, Beijing, China
  16. 16 Ufa Eye Research Institute, Ufa, Bashkortostan, Russia
  17. 17 Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
  1. Correspondence to Seang Mei Saw, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower Level 6, Singapore 169856, Singapore; ephssm{at}


Aims To determine the prevalence and predictors of myopic macular degeneration (MMD) in a consortium of Asian studies.

Methods Individual-level data from 19 885 participants from four population-based studies, and 1379 highly myopic participants (defined as axial length (AL) >26.0 mm) from three clinic-based/school-based studies of the Asian Eye Epidemiology Consortium were pooled. MMD was graded from fundus photographs following the meta-analysis for pathologic myopia classification and defined as the presence of diffuse choroidal atrophy, patchy chorioretinal atrophy, macular atrophy, with or without ‘plus’ lesion (lacquer crack, choroidal neovascularisation or Fuchs’ spot). Area under the curve (AUC) evaluation for predictors was performed for the population-based studies.

Results The prevalence of MMD was 0.4%, 0.5%, 1.5% and 5.2% among Asians in rural India, Beijing, Russia and Singapore, respectively. In the population-based studies, older age (per year; OR=1.13), female (OR=2.0), spherical equivalent (SE; per negative diopter; OR=1.7), longer AL (per mm; OR=3.1) and lower education (OR=1.9) were associated with MMD after multivariable adjustment (all p<0.001). Similarly, in the clinic-based/school-based studies, older age (OR=1.07; p<0.001), female (OR=2.1; p<0.001), longer AL (OR=2.1; p<0.001) and lower education (OR=1.7; p=0.005) were associated with MMD after multivariable adjustment. SE had the highest AUC of 0.92, followed by AL (AUC=0.87). The combination of SE, age, education and gender had a marginally higher AUC (0.94).

Conclusion In this pooled analysis of multiple Asian studies, older age, female, lower education, greater myopia severity and longer AL were risk factors of MMD, and myopic SE was the strongest single predictor of MMD.

  • Epidemiology
  • public health
  • macula
  • degeneration

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  • Contributors YLW, XZ, YCT, JCYS, KZ, CS, CL, XZ, SYH, WH, PS, MT, NY, SL, RR, SJS, YXW, MMB, VN, LJC, TYW, ELL, C-PP, CYC, YL, JBJ and SMS conceived and designed the study. YLW, XZ, YCT, JCYS, KZ, CS, CL, JBJ and SMS analysed and interpreted the data. YLW, XZ, YCT, KZ, CS, JBJ and SMS wrote the manuscript. All authors reviewed and approved the final manuscript.

  • Funding The studies are supported by the following grants. The Singapore Epidemiology of Eye Diseases study is supported by the National Medical Research Council (grants: 0796/2003, IRG07nov013, IRG09nov014, STaR/0003/2008; CG/SERI/2010); Biomedical Research Council (grants: 08/1/35/19/550, 09/1/35/19/616); and Economic Development Board-Essilor Post-graduate Programme (S14–1103–IPP), Singapore. The Beijing Eye study is supported by the National Natural Science Foundation of China (Grant No. 81570835). The Central India Eye and Medical Study is supported by an unrestricted grant from Om Drishti Trust, Nagpur, India; Heidelberg Engineering Co., Heidelberg, Germany; Rotary Sight Saver Netherlands; Orbis, India; and Carl Zeiss Meditec Co., Jena, Germany. The Hong Kong High Myopia Study is supported by the General Research Fund, Research Grants Council, Hong Kong (Grant No. 14111515); Health and Medical Research Fund, Hong Kong (Grant No. 5160836), and the Direct Grants of the Chinese University of Hong Kong (Grant No. 4054193, 4054121, 4054199, 2018017), the Centaline Myopia Fund; and the CUHK Jockey Club Children Eye Care Programme. The Shanghai High Myopia Study is supported by the Shanghai High Myopia Study Group (NCT03062085 registered on, National Natural Science Foundation of China (Grant No. 81870642 and 81970780), Intelligent Medical Project of Shanghai Municipal Science and Technology Commission (Grant No. 2018ZHYL0220).

  • Competing interests YLW is an employee of Essilor International, Singapore.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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