Factors associated with pathologic myopia onset and progression: a systematic review and meta-analysis

Fabian Sl Yii*, Linda Nguyen, Niall Strang, Miguel Bernabeu, Andrew Tatham, Tom MacGillivray, Baljean Dhillon

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Abstract

Purpose

To synthesise evidence across studies on factors associated with pathologic myopia (PM) onset and progression based on the META-analysis for Pathologic Myopia (META-PM) classification framework.

Methods

Findings from six longitudinal studies (5–18 years) were narratively synthesised and meta-analysed, using odds ratio (OR) as the common measure of association. All studies adjusted for baseline myopia, age and sex at a minimum. The quality of evidence was rated using the Grades of Recommendation, Assessment, Development and Evaluation framework.

Results

Five out of six studies were conducted in Asia. There was inconclusive evidence of an independent effect (or lack thereof) of ethnicity and sex on PM onset/progression. The odds of PM onset increased with greater axial length (pooled OR: 2.03; 95% CI: 1.71–2.40; p < 0.001), older age (pooled OR: 1.07; 1.05–1.09; p < 0.001) and more negative spherical equivalent refraction, SER (OR: 0.77; 0.68–0.87; p < 0.001), all of which were supported by an acceptable level of evidence. Fundus tessellation was found to independently increase the odds of PM onset in a population-based study (OR: 3.02; 2.58–3.53; p < 0.001), although this was only supported by weak evidence. There was acceptable evidence that greater axial length (pooled OR: 1.23; 1.09–1.39; p < 0.001), more negative SER (pooled OR: 0.87; 0.83–0.92; p < 0.001) and higher education level (pooled OR: 3.17; 1.36–7.35; p < 0.01) increased the odds of PM progression. Other baseline factors found to be associated with PM progression but currently supported by weak evidence included age (pooled OR: 1.01), severity of myopic maculopathy (OR: 3.61), intraocular pressure (OR: 1.62) and hypertension (OR: 0.21).

Conclusions

Most PM risk/prognostic factors are not supported by an adequate evidence base at present (an indication that PM remains understudied). Current factors for which an acceptable level of evidence exists (limited in number) are unmodifiable in adults and lack personalised information. More longitudinal studies focusing on uncovering modifiable factors and imaging biomarkers are warranted.
Original languageEnglish
JournalOphthalmic and Physiological Optics
Early online date2 Apr 2024
DOIs
Publication statusE-pub ahead of print - 2 Apr 2024

Keywords

  • epidemiology
  • longitudinal
  • META-PM
  • pathologic myopia
  • prognostic factors
  • risk factors

ASJC Scopus subject areas

  • Sensory Systems
  • Ophthalmology
  • Optometry

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