Continued Increase of Axial Length and Its Risk Factors in Adults With High Myopia
Continued Increase of Axial Length and Its Risk Factors in Adults With High Myopia
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DOI：
10.1001/jamaophthalmol.2021.3303
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发表时间：
2021-08-26
影响因子：
8.1
通讯作者：
Ohno-Matsui, Kyoko
中科院分区：
文献类型：
--
作者：
Du, Ran;Xie, Shiqi;Ohno-Matsui, Kyoko
重要：由于眼轴过度增加而导致的病理性近视与严重的视力损害有关。需要系统的分析来确定高度近视成人的眼轴伸长率及其相关的危险因素，这是基于对大量人群的长期随访。目的确定与高度近视成人眼轴延长相关的危险因素。设计、设置和参与者这项队列研究使用了2011年1月3日至2018年12月28日在单一医院数据库中收集的43 201例患者的就诊病历。对15745例患者的性别、最佳矫正视力(BCVA)、眼轴长度、近视性黄斑病变类型、脉络膜新生血管(CNV)的有无进行了复习。分析2019年4月3日至2020年8月5日的数据，计算每次检查时MAIN结果和测量轴长的变化。眼轴年增长与年龄、性别、基线眼轴长度、近视性黄斑病变类型和CNV病史之间的相关性的意义被确定。结果1877例高度近视患者共9161人次，平均年龄62.10(12.92)岁，其中女性1357例(72.30%)。平均眼轴为29.66(2.20)mm，平均眼轴增长率为0.05(0.24)mm/a，其中近视性黄斑病变7096眼(77.46%)，CNV 2477眼(27.04%)。女性发生眼轴严重延长的优势比为1.46(95%CI，1.38~1.55)，40岁以上者为0.44(95%CI，0.35~0.56)至0.63(95%CI，13 0.50~0.78)，BCVA<20/400者为1.33(95%CI，1.15~1.54)，BCVA<20/400者为1.67(95%CI，1.54~1.81)，眼轴长度为28.15 mm或以上时为2.46~2.88；有黄斑病变时为1.06(95%CI，0.96~1.17)~1.39(95%CI，1.24~1.55)；有CNV史时为1.37(95%CI，1.29~1.47)。延长的危险因素似乎是不可改变的，因此预防近视可能是未来减少病理性近视及其并发症发生率的最佳途径。
IMPORTANCE Pathologic myopia due to an excessive increase of axial length is associated with severe visual impairments. Systematic analyses to determine the rate of and the risk factors associated with the axial elongation in adults with high myopia based on long-term follow-up of a large population are needed. Objective To determine the risk factors associated with axial elongation in adults with high myopia.DESIGN, SETTING, AND PARTICIPANTS This cohort study used the medical records of 43 201 patient visits in a single-hospital database that were collected from January 3, 2011, to December 28, 2018. A total of 15 745 medical records with the patients' sex, best-corrected visual acuity (BCVA), axial length, type of myopic maculopathy, and the presence or absence of choroidal neovascularization (CNV) were reviewed. Data were analyzed from April 3, 2019, to August 5, 2020.MAIN OUTCOMES AND MEASURES Changes in the axial length at each examination were calculated. The significance of the associations between the annual increase of the axial length and age, sex, baseline axial length, types of myopic maculopathy, and a history of CNV was determined. Generalized linear mixed models were used to evaluate the strength of the risk factors associated with an increase of the axial length in high myopia.RESULTS Among 1877 patients with 9161 visits included in the analysis, the mean (SD) age was 62.10 (12.92) years, and 1357 (72.30%) were women. The mean (SD) axial length was 29.66 (2.20) mm with a mean (SD) growth rate of 0.05 (0.24) mm/y. Among the 9161 visits, 7096 eyes (77.46%) had myopic maculopathy and 2477 eyes (27.04%) had CNV. The odds ratio for inducing a severe elongation of the axial length was 1.46 (95% CI, 1.38-1.55) for female sex, 0.44 (95% CI, 0.35-0.56) to 0.63 (95% CI, 13 0.50-0.78) for older than 40 years, 1.33 (95% CI, 1.15-1.54) for BCVA of less than 20/400, 1.67 (95% CI, 1.54-1.81) to 2.67 (95% CI, 2.46-2.88) for baseline axial length of 28.15 mm or greater, 1.06 (95% CI, 0.96-1.17) to 1.39 (95% CI, 1.24-1.55) for the presence of maculopathy, and 1.37 (95% CI, 1.29-1.47) for prior CNV.CONCLUSIONS AND RELEVANCE This cohort study found continuing axial elongation in adults with high myopia. The risk factors for elongation do not appear to be modifiable, so prevention of myopia may be the best approach to reduce the incidence of pathologic myopia and its complications in the future.