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.
- public health
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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 http://clinicaltrials.gov), 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.
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