Myopia Tipped to Drive Major Rise in Open-angle Glaucoma Cases by 2060

A global surge in myopia is expected to significantly contribute to a sharp increase in open-angle glaucoma cases over the coming decades, according to a new meta-analysis published in the American Journal of Ophthalmology.

Researchers found that the combined effects of an ageing population and rising myopia prevalence could see the global rate of open-angle glaucoma (OAG) climb substantially by 2060. The authors say myopia prevention and timely glaucoma screening will be critical to reducing the projected disease burden.

The team conducted a literature search of Embase, Google Scholar and PubMed, analysing studies published between 1991 and 2023. They pooled data from 20 of the 21 Global Burden of Disease regions, using United Nations population data to calculate age- and location-specific prevalence rates. A prediction model was then developed using trends, risk ratios and 95% confidence intervals.

The analysis estimated current OAG prevalence among people aged 40 years and older at 2.8% (95% CI, 2.6% to 3.0%). By 2060, this is expected to rise to 3.5% (95% CI, 3.2% to 3.8%).

In absolute terms, the number of people with OAG worldwide is projected to increase from 80.5 million (95% CI, 75.5 to 85.7 million) to 186.6 million (95% CI, 174.3 to 199.0 million) by 2060.

Demographic change and population ageing are expected to account for 72.8% of the increase, while rising myopia rates may drive the remaining 27.2%.

The study also highlighted concerns around glaucoma in people under 40 years of age, where disease duration is likely to be longer and progression risk higher. An exploratory analysis suggested that by 2060, high myopia alone could contribute an additional 6.1 million (95% CI, 5.5 to 6.7 million) early-onset OAG cases.

Regionally, East Asia is expected to experience the steepest rise in prevalence. However, South Asia is projected to have the greatest number of cases overall, largely due to population ageing. Together, the two regions could account for about 40% of the global OAG burden, with East Asia also expected to see the largest increase in younger patients.

Previous population studies have reported a 1.2-fold higher glaucoma hazard for each additional dioptre of myopic refractive error.

The researchers noted that myopia, particularly high myopia, not only increases glaucoma risk but can also complicate diagnosis and management. Myopia-related stretching of the lamina cribrosa may flatten the optic cup and reduce contrast between the neuroretinal rim and cup, making ophthalmoscopic detection of optic nerve head damage more difficult.

Study limitations included the lack of sub-analysis by myopia severity, the assumption that myopia did not develop in adulthood, and limited data from some regions. Early-onset estimates were also based on fewer studies.

Despite this, the authors said the analysis provides one of the first long-term projections of OAG in younger populations.

This article has been republished courtesy of Insight.