作者: J. Willem L. Tideman (1,2), Margaretha C.C. Snabel (3), Milly S. Tedja (1,2), Gwyneth A.van Rijn (4), King T.Wong (1), Robert W.A.M Kuijpers (1,5), Johannes R. Vingerling (1,2), Albert Hofman (2), Gabrielle H.S. Buijtendijk (1,2), Jan E.E. Keunen (6), Camiel J.F. Boon (4), Annette J.M. Geerards (7), Gergorius P.M Luyten (4), Virginie J.M. Verhoeven (1,2,8), Caroline C.W. Klaver (1,2)
- 荷兰鹿特丹Erasmus医疗中心眼科系
- 荷兰鹿特丹Erasmus医疗中心流行病学系
- 德partment of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands
- 荷兰莱顿莱顿大学医学中心眼科科
- 德partment of Ophthalmology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
- 荷兰Nijmegen Radboud大学医学中心眼科系
- The Rotterdam Eye Hospital, Rotterdam, the Netherlands
- 德partment of Clinical Genetics, Erasmus Medical Centre, Rotterdam, the Netherlands
Date:德cember 2016
Reference:Jama Ophthalmol 2016; 134（12）：1355-1363-LINK
Summary
Myopia is increasingly frequent in many developed countries and we now know it isn’t simply a matter of poor vision which we ‘fix’ with spectacles or contact lenses. It can lead to myopic maculopathy, glaucoma, cataract and retinal detachment and having 'high' myopia increases these risks further. These eye conditions can all potentially lead to reduced vision at best and blindness at worst. As myopia increases, the eye’s total axial length has been seen to increase too, and it is this elongation which leaves the eye at risk from ocular pathologies.
构成“高”近视的分类可能会有所不同。世界卫生组织（WHO）决定在2015年的阈值-5.00d且更强的阈值（1）。出于他们的研究目的，Tideman等人将参与者分类为高度近视，当时他们的球形等效（SE）为-6.00D，轴向长度（AXL）为26mm或更多。
This study used cross-sectional data collected from population-based studies undertaken by the Rotterdam study (I, II & III) and the Erasmus Rucphen Study. These results were combined with case-control data from the Myopia Study, with participants across all studies being 25 years or older. The authors wished to explore a link between visual impairment as a result of increased AXL, refractive error and to be able to apply this to the wider population.
临床相关性
It’s all about the risk
- We can see how myopia is likely to be a leading cause of blindness in the near future after the study findings suggest that “visual impairment will increase 7- to 13-fold by 2055 in high-risk areas”.
- 当我们看到那些AXL为26mm或更高的AXL时，我们也可以更了解个人的风险。那些轴向长度较长的人的视力障碍的可能性更高 - 如果AXL小于26mm，则如果AXL为26mm或更长的机会，这会从3.8％的机会增加。由于近视的并发症，其一生中有90％的视力障碍的机会与30mm或更长时间的AXL有关。
- Eye Care Professionals are in a prime position to communicate this robust information we have on the risks associated with increased myopia and what their options are to reduce that risk.
- Start considering myopia management early.
- The participants who were most at risk of visual impairment were in the older age group and they had therefore had longer eyes and higher myopia for a longer time.
- Don’t forget the lower myopes!
- We need to consider all myopes as potentially being at risk of axial elongation and an increasing risk of impairment later in life, as we know from this and other studies that those who ‘only’ have -1.00D refractive error will already have double the risk of myopic maculopathy and posterior sub-capsular cataract compared to an emmetrope.(2)
Limitations and future research
This is a robust analysis taking in the data of more than 15,000 individuals, across multiple studies. The key area for future research is to measure how myopia control interventions for today's generation influence their rates of pathology and vision impairment in the future. This is a very long-term question, as our current generation of children with access to myopia management will need to age another 50-60 years before their outcomes could be compared to the ages analyzed in this paper. To this point, the authors recognized that their calculated risk estimates will become overstated with adoption of (successful) myopia strategies to slow myopia progression.
种族特定研究：The authors made predictions of varying prevalence for different countries, but these were based on values originally gathered from Europeans and they were aware this may not be directly applicable to other ethnicities. They were able to allow for this by using reported prevalence estimates for each country. At the time of publishing (2016), Tideman et al were unaware of any likely ethnic differences and felt confident they were making feasible predictions. Similar research across different ethnicities would help determine whether this observation holds true.
Changes in prevalence:The study revealed a steady shift from hyperopia to myopia when they looked at the birth decades of the participants, particularly from 1920 onward, with a higher myopic prevalence in the younger group (25yrs to 60yrs). This suggested that the population had been getting more myopic with time and that the chance of impairment with age was increasing alongside it. The authors predicted that by 2055 there would be a 2 to 3-fold increase risk of visual problems in Europe, a 3 to 5-fold chance in Singapore and a 3 to 6-fold in the Republic of Korea. This was based on their findings where the last study to be included in their analysis was from 2012. It is possible that the likelihood of myopic pathologies could have increased beyond their expectations since then. Further follow-on studies could verify if this has changed significantly.
完整的故事
目的
眼睛的总轴向长度是从角膜表面的最前部到地球背面的最远点，并且与眼睛和近视的长度长期存在。在近视本身的程度和诸如近视刺激和撕裂/分离的视网膜等近视范围之间，多年来的意识也越来越多。这项研究的作者希望证明眼睛的轴向长度和折射率之间存在联系，以及随着年龄的增长而产生的近视病理。
Study design
Tideman et al collated data from the population-based Rotterdam Studies with Study I (1990-93), Study II (2000-02) and Study III (2006-08) and combined them with findings from the Erasmus Ruchpen Family study (2002-05, also population-based) and the Myopia Study (2010-12, case control data). This gave information on the refractive error, axial length and age of 15,693 individuals.
The participants were adults only with an age range of 25yrs to 75yrs and over, with a mean age of 61.3 yrs. Across the cohort, axial length varied from 15.3mm to 37.8mm and the refractive error ranged from +14.00D to -25.00D as a spherical equivalent (SE). The number of those with ‘high’ myopia of -6.00D or stronger was 796. The axial lengths were available for 9,074 people after AXL measuring was undertaken at a later stage in the Rotterdam studies and some of the participants from the Myopia Study were excluded from the data for the AXL and SE due to the study design.
结果
The prevalence of vision impairment was found to vary from between 1.0% - 4.1% in the population-based studies and 5.4% in the Myopia Study. This was all compared to the control prevalence which was 0.3%.
逻辑回归技术被用来计算ate the odds ratio (OR) for visual impairment that would arise as a result of AXL and the refractive error. For having a 26-28mm axial length, the under 60yrs group had double the risk of the reference group who had 24-26mm length, compared to the over 60yrs group that had a 3x risk for the same AXL. The statistics then took a large jump with the under 60yrs group having an 11x chance for a 28-30mm AXL and 25x for if it was over 30mm. The over 60yrs group showed a similar jump with the 28-30mm AXL, but they then showed around a 94x risk if the AXL was 30mm or more.
对于SE（在二极管中），结果也有类似的跳跃。对于-3.00d至-15.00D之间的折射率，在60年代，视觉障碍的风险为1.5倍至6.8倍，相同的折射范围在60s以上的折射率相似，风险在1.7倍至7.8倍之间。当折射率误差为-15.00d或更高时，年龄段的年龄组有28倍风险的差异更大，而老年组的差异近88倍。
The AXL and the refractive error were significantly related to each other, but also to impairment likelihood. Of those who had been classed as having high myopia, 39% had developed some form of visual impairment caused by their myopia by the age of 75yrs old. Those with longer axial length had a higher chance of having myopic-linked vision impairment and this increased from a 3.8% chance if the AXL was less than 26mm to a 25% chance if the AXL was 26mm or longer. An AXL of 30mm or longer was associated with a 90% chance of vision impairment in their lifetime due to complications of myopia.
Conclusions
The worrying findings from this analysis are significant in explaining the realistic probabilities of ocular conditions arising from high myopia and increased AXL. The authors suggested that those at the stronger end of the myopic scale may find their risk is “unavoidable” as we currently have no treatments that halt or reverse the impairments high myopia can give – sadly the damage is already done.
但是，研究中的年龄段（60岁以上或更长时间）不会有现在我们在需要时干预他们青年时代的近视发展方案。If myopia and its risk of visual problems has a higher prevalence and those who end up with those visual problems have them earlier in life, then it’s very important that we have myopia-reducing strategies (and use them!) so we can avoid axial elongation, high myopia and its associated risks.
简单地说,眼保健从业者现在有很多tools at their fingertips to slow myopia progression- 减少眼睛长度……降低未来视觉障碍的风险！
Abstract
标题Association of axial length with risk of uncorrectable visual impairment for Europeans with myopia
重要性近视（即近视）正在成为世界许多地方年轻人失明的最常见眼睛障碍。由于眼轴的伸长，由于近视而引起的视觉障碍与视网膜和地球的结构变化有关。轴向长度 - 前室深度，晶状体厚度和玻璃腔深度的总和 - 近视与随着时间的流逝的视觉障碍的发展有关。
Objective评估轴向长度，球形等效性和视觉障碍风险之间的关联，并对患病率高的地区进行视觉障碍的投影。
德sign, Setting, and ParticipantsThis cross-sectional study uses population-based data from the Rotterdam Study I (1990 to 1993), II (2000 to 2002), and III (2006 to 2008) and the Erasmus Rucphen Family Study (2002 to 2005) as well as case-control data from the Myopia Study (2010 to 2012) from the Netherlands. In total, 15 404 individuals with data on spherical equivalent and 9074 individuals with data on axial length were included in the study; right eyes were used for analyses. Data were analyzed from September 2014 to May 2016.
德sign, Setting, and ParticipantsVisual impairment and blindness (defined according to the World Health Organization criteria as a visual acuity less than 0.3) and predicted rates of visual impairment specifically for persons with myopia.
Main Outcomes and MeasuresVisual impairment and blindness (defined according to the World Health Organization criteria as a visual acuity less than 0.3) and predicted rates of visual impairment specifically for persons with myopia.
ResultsOf the 15 693 individuals included in this study, the mean (SD) age was 61.3 (11.4) years, and 8961 (57.1%) were female. Axial length ranged from 15.3 to 37.8 mm; 819 individuals had an axial length of 26 mm or greater. Spherical equivalent ranged from −25 to +14 diopters; 796 persons had high myopia (ie, a spherical equivalent of −6 diopters or less). The prevalence of visual impairment varied from 1.0% to 4.1% in the population-based studies, was 5.4% in the Myopia Study, and was 0.3% in controls. The prevalence of visual impairment rose with increasing axial length and spherical equivalent, with a cumulative incidence (SE) of visual impairment of 3.8% (1.3) for participants aged 75 years with an axial length of 24 to less than 26 mm and greater than 90% (8.1) with an axial length of 30 mm or greater. The cumulative risk (SE) of visual impairment was 5.7% (1.3) for participants aged 60 years and 39% (4.9) for those aged 75 years with a spherical equivalent of −6 diopters or less. Projections of these data suggest that visual impairment will increase 7- to 13-fold by 2055 in high-risk areas.
Conclusions and RelevanceThis study demonstrated that visual impairment is associated with axial length and spherical equivalent and may be unavoidable at the most extreme values in this population. Developing strategies to prevent the development of myopia and its complications could help to avoid an increase of visual impairment in the working-age population.
关于Ailsa
Ailsa Lane is a contact lens optician based in Kent, England. She is currently completing her Advanced Diploma In Contact Lens Practice with Honours, which has ignited her interest and skills in understanding scientific research and finding its translations to clinical practice.
