角膜中央厚度对高眼压症和开角型青光眼眼内压测量值的影响

目的研究角膜中央厚度对高眼压症和原发性开角型青光眼病人的眼内压测量值的影响.方法对44例(88眼)临床诊断为高眼压症的患者,31例(61眼)原发性开角型青光眼患者及52例(104眼)与高眼压症患者屈光状态相近的正常人的角膜中央厚度及眼内压进行检测,用统计学方法比较3组的角膜中央厚度的差异及高眼压症患者的眼内压值与角膜中央厚度的相关关系.结果①高眼压症组的角膜中央厚度的平均值585.6±35.7μm明显高于原发性开角型青光眼(54.1±38.7μm)(P＜0.01)及正常对照组(535.5±29.4μm)(P＜0.01),而原发性开角型青光眼的角膜中央厚度与正常对照组相比无显著性差异(P＜0.05).②将高眼压症患者的角膜中央厚度与眼内压测量值进行简单线性相关分析,可见角膜中央厚度与眼内压测量值呈明显正相关,相关系数为0.636(P＜0.01).角膜中央厚度每增加50μm可使眼内压测量值升高约2mmHg.结论①高眼压症患者的角膜中央厚度明显大于原发性开角型青光眼和正常眼,高眼压症患者的角膜中央厚度与眼内压呈明显的正相关,提示高眼压症患者是由于角膜中央厚度高于正常范围而造成眼内压测量值的升高.②角膜中央厚度值可作为高眼压症及原发性开角型青光眼的诊断与鉴别诊断的重要依据.提示临床工作中,可将角膜中央厚度检测作为排除青光眼的常规检查手段.③当角膜中央厚度在520±50μm的范围内,眼压读数相对准确,如果角膜中央厚度超过570μm,眼压读数相应增高,这可能是高眼压症患者眼压测量值高于正常范围的重要原因之一.     

原发性开角型青光眼的系统性危险因素

眼压异常升高是原发性开角型青光眼最主要的危险因素。临床目前一直沿用以眼压为靶点的青光眼诊疗模式。近年来发现,循环血流、体质指数、颅内压、营养代谢、中医偏颇体质类型、某些系统性疾病等多种系统性危险因素可能与青光眼发生、发展和转归相关。纠正系统性危险因素能否延缓青光眼进展被日益关注,成为潜在的青光眼辅助诊疗靶点。本文对各类青光眼系统性危险因素进行介绍,倡导重视系统性危险因素,提出以系统危险因素评估和个性化眼体同治相结合的青光眼诊疗体系。（眼科,2022,31:325-329）     

高度近视眼进展与眼内压的相关分析

目的:通过对高度近视眼进展与眼内压的相关关系的分析,探讨高度近视眼与原发性开角型青光眼的内在联系。方法:选取高度近视眼患者104例208眼,随机平均分成2组,治疗组给予派立明眼药水滴眼降眼压治疗3次/d,对照组给予人工泪液滴眼3次/d。定期进行裸眼视力、矫正视力、自动验光仪散瞳验光、裂隙灯显微镜、眼底、视野检查以及A型超声波测量眼轴、非接触眼压计监测眼压,连续随访2a,比较两组在屈光状态、眼轴长度、眼内压、视野的差异。结果:随访2a两组视野并未呈现明显变化。治疗组平均眼内压13.25±4.43mmHg,平均屈光度-8.38±1.93D,对照组平均眼内压15.53±4.37mmHg,平均屈光度-9.32±1.81D,两组比较差异具有统计学意义;眼轴治疗组为25·94±1.08mm,对照组为25.56±1.02mm,两两比较差异无统计学意义。但随着眼轴的延长,高度近视眼的屈光度增加。结论:高度近视眼进展与眼内压可能有一定的内在联系,应重视对高度近视眼的眼内压监测,防止由于高度近视眼的眼底改变而漏诊青光眼。     

超高度近视眼屈光力及眼轴影响因素分析

目的 研究超高度近视患者屈光力及眼轴影响因素,并分析超高度近视患者易发青光眼的危险因素.方法 选取216例(354眼)受试者按照屈光力不同分成3组AA组260眼(＞-9.00～12.00 D)、B组75眼(＞-12.00～15.00 D)、C组19眼(＞-15.00D),对其屈光力、眼轴长度(axial length,AL)、前房深度(anterior chamber depth,ACD)、前房角(anterior chamber angle,ACA)、中央角膜厚度(central corneal thickness,CCT)、眼压(intraocular pressure,IOP)等相关眼部参数进行测量,分析各参数之间的相互关系.结果 超高度近视眼等效球镜度数(spherical equivalent,SE)与AL、角膜最大屈光力(K2)、年龄之间呈负相关(均为P＜0.05),与ACD及ACA之间呈正相关(均为P＜0.05).AL与Goldmann眼压值(Goldmann-correlated IOP value,IOPg)、角膜代偿的眼压值(corneal compensated intraoeular pressure,IOPcc)和年龄之间呈正相关关系(均为P＜0.001),而与角膜最小屈光力(K1)、K2之间呈显著负相关关系(均为P＜0.001).IOPcc与K1、K2呈显著负相关关系(均为P＜0.001);IOPg与GCT和AL呈显著正相关关系(均为P＜0.001),而与K1、K2呈负相关关系(均为P＜0.05).ACD与ACA、IOPg之间,ACA与IOPg、IOPcc之间均呈正相关关系(均为P ＜0.05).B组的SE与IOPcc呈显著负相关关系(P＜0.01).影响超高度近视眼屈光力的主要因素为SE、AL、K2及ACD,而影响AL的主要因素为K1、K2、IOPg及年龄.结论 AL延长是超高度近视眼发展的重要影响因素,AL越长近视越严重,而IOP可以通过影响AL而影响超高度近视眼的屈光力,从而加快超高度近视的发展.     

选择性激光小梁成形术治疗原发性开角型青光眼观察

目的 观察选择性激光小梁成形术(SLT)治疗原发性开角型青光眼(POAG)的有效性和安全性.方法 原发性开角型青光眼患者23例36只眼,原发性开角型青光眼小梁切除术后高眼压患者6例6只眼,眼压(25.15±8.23)mmHg,倍频Q-开关532nmNd:YAG激光,单脉冲,脉冲时间3ns,光斑直径400um.应用房角镜鼻侧或颞侧房角180°范围内进行治疗,能量0.60～1.50mJ,点数(50±5)点.测量术后第1h眼压,术后1d,1周,2周,3周,1月,3月,6月,1年随访,对比术前术后眼压、最佳矫正视力、视野及杯盘比变化.结果 患者术前眼压(25.15±8.23)mmHg,术后1h为(18.14±5.36)mmHg,1d为(14.52±3.63)月mmHg,1周为(18.12±2.38)mmHg,1月为(17.96±3.35)mmHg,3月为(18.05±2.58)mmHg,6月为(17.48±2.12)mmHg,1年为(17.89±3.13)mmHg;术前患者杯盘比为0.65±0.30,术后1年为0.63±0.20;术前视力0.60±0.30,术后1年视力0.61±0.32;视野术前术后无变化.结论 选择性激光小梁成形术可以有效地降低原发性开角型青光眼及原发性开角型青光眼小梁切除术后高眼压患者的眼内压.

Abstract：

Objective To evaluate the efficiency and safety of selective laser trabeculoplasty (SLT) on primary open angle glaucoma (POAG). Methods A total of 36 eyes of 23 patients with POAG, 6 eyes of 6POAG patients with high intraocular pressure (IOP) after SLT therapy, IOP (25.15± 8.23) mmHg, and they were treated with a frequency-doubled, Q-switched Nd:YAG laser (532nm). A total of approximately 50± 5nonoverlaping spots were placed over 180° of the gonioscope nasal or temporal side at the energy levels ranging from 0.60-1.50m J/pulses. Every patient was asked for follow-up at 1h, 1d, 1w, 2w, 3w, 1m, 3m, 6m and 1yafter treatment. IOP, visual acuity, C/D and visual field were examined each time. Results The pretreatment IOP was (25.15± 8.23) mmHg. At the end of first 1h, 1d, 1w, 1m, 6m, 1y of the follow-up, the IOP was (18.14± 5.36)mmHg, (14.52± 3.63)mmHg, (17.96± 3.35)mmHg, (18.05± 2.58)mmHg, (17.48± 2.12)mmHg, (17.89± 3.13) mmHg respectively. The pretreatment cup/disc ratio was 0.65± 0.30, at the end of 1y of the follow-up, the C/D ratio was 0.63± 0.20; the pretreatment visual acuity was 0.60± 0.30, at the end of 1y of the follow-up, the visual was 0.61± 0.32, without significant difference in visual field. Conclusions SLT is a kind of effective method to treat POAG and special patients with high intraocular pressure after SLT therapy.     

原发性开角型青光眼患者确诊时视野损害程度的相关因素分析

目的　分析原发性开角型青光眼（ｐｒｉｍａｒｙｏｐｅｎ-ａｎｇｌｅｇｌａｕｃｏｍａ,ＰＯＡＧ）患者确诊时的视野损害程度及其相关因素。方法　收集２０１４年５月至２０１５年１０月在我院门诊就诊的ＰＯＡＧ患者１１３例１１３眼。根据视野损害分级将患者分为早期视野损害组（视野损害０～１级）和中晚期视野损害组（视野损害２～５级）。对两组患者的确诊年龄、性别、身体质量指数、青光眼相关症状、家族史、高度近视、中央角膜厚度、眼压等相关因素进行统计分析。结果　早期视野损害组３１眼（２７．４３％）,中晚期视野损害组８２眼（７２．５７％）。早期视野损害组的确诊年龄为（５２．８１±１６．５７）岁,眼压为（２３．６７±１１．４４）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍ-Ｈｇ）,与中晚期视野损害组的（４５．６２±１７．１２）岁和（３０．５８±１２．１３）ｍｍＨｇ相比,差异均有统计学意义（Ｐ＝０．０４７、０．００７）;早期视野损害组合并高度近视的患者比例（９．６８％）及有青光眼相关症状的患者比例（２９．０３％）均小于中晚期视野损害组（２９．２７％、５３．６６％）,差异均有统计学意义（Ｐ＝０．０２９、０．０１９）。早期视野损害组的性别比例、身体质量指数、家族史、中央角膜厚度与中晚期视野损害组相比,差异均无统计学意义（均为Ｐ＞０．０５）。眼压与患者确诊时的视野损害严重程度呈正相关（ｒ＝０．４１１,Ｐ＝０．０００）。结论　大多数ＰＯＡＧ患者确诊时已发生较严重的视野损害,高眼压、青光眼相关症状、合并高度近视、确诊时年龄偏低可能是ＰＯＡＧ患者确诊时发生较严重视野损害的危险因素。     

人眼轴长度与眼内压的相关性研究

观察眼轴长度与非接触眼压测量值之间的关系。 方法:选择在我院眼科门诊就诊的患者及行准分子激光角膜手术术前常规检查的近视患者共508例1010眼,年龄17～53(平均26.65±6.55)岁,分别测量眼轴长度及非接触眼压值,并按眼轴长度分为＜24mm,24～25.99mm,≥26mm三组,应用相关直线回归分析方法分析眼轴长度与眼内压之间的关系,方差分析比较3组眼压的差别。 结果：眼轴长度与眼内压值之间呈正相关性（r=0.138,P＜0.01,Y=7.331+0.296X),≥26mm组的眼内压升高幅度最大。 结论：眼轴长度与眼内压之间存在一定的内在联系,这种联系随着眼轴长度的增加而更为密切,提示临床应重视对高度近视眼的眼内压监测。     

原发性开角型青光眼患者不同体位眼灌注压昼夜波动趋势分析

Objective To characterize the circadian fluctuation of ocular perfusion pressure (OPP) in different position  in patients with newly diagnosed, untreatedprimary open-angle glaucoma（POAG）. Design Cohort study. Participants Nineteen patients with POAG (19 eyes) and eighteen healthy controls (18 eyes) were included in the Peking University Shenzhen Hospital. Methods POAG patients and healthy controls were included and underwent 24-hour monitoring of IOP and blood pressure. On 10:00, 14:00, 18:00 and 22:00 o’clock in the daytime, all the subjects were monitored in sitting position, then POAG patients were monitored again after lying down for 5 minutes. On 2:00, 5:00 and 7:00 o’clock at night all the subjects were monitored in supine position, then POAG patients were monitored again after sitting for 5 minutes. Calculating the mean ocular perfusion pressure (MOPP), the systolic ocular perfusion pressure (SOPP) and diastolic perfusion pressure (DOPP) by the formula and analyzing the data. Main Outcome Measures  MOPP, SOPP, DOPP. Results In both groups of habitual position (sitting position in day and supine position in night), the nocturnal MOPP, SOPP and DOPP were lower than diurnal. In both groups, the nocturnal MOPP was lower than diurnal in habitual position (POAG group t=4.092, P=0.000; healthy group t=4.513, P=0.000). However, there was no obvious difference between those two groups (t=-0.973, P=0.350). POAG group had higher 24-hour fluctuation of MOPP (t=2.204, P=0.039), higher nocturnal fluctuation of SOPP (t=3.097, P=0.018), higher nocturnal and 24-hour fluctuation of DOPP than healthy group, all the differences had statistical significance (all P<0.05).  In POAG group , there was no statistical difference between the nocturnal MOPP and the diurnal MOPP in sitting position or in supine position of 24 h (all P>0.05). POAG group had higher 24-hour mean MOPP in sitting position than in supine position, the difference had statistical significance (t=4.306, P=0.001).  Comparing the MOPP of  POAG group  in habitual position with in sitting position of 24 h, there was no statistical difference(t=-2.101, P=0.080). However, POAG group had higher 24-hour mean MOPP in habitual position than in supine position of 24 h, the difference had statistical significance (t=2.707, P=0.035). Conclusions There circadian fluctuation of  OPP in different position in POAG pations can not be treated as the same. The nocturnal MOPP  was lower than diurnal in habitual position, but there was no obvious difference in the 24h-sitting position and 24h-supine position.  (Ophthalmol CHN, 2017, 26: 20-25）     

Analysis of 24-hour Monitoring of Intraocular Pressure in 1055 Eyes

Purpose：To investigate the clinical significance of 24-hour monitoring of intraocular pressure （IOP）.Methods：A total of 571 cases （1055 eyes） undergoing 24-hour monitoring of IOP in the Second People＇s Hospital of Zhengzhou between June 2012 and March 2013 were retrospectively analyzed.Results：Among all 1055 eyes,298 had suspected glaucoma （28.2％）; 390 （37.0％） were diagnosed with glaucoma but received no treatment （312 with primary open angle glaucoma （POAG） and 78 with primary angle closure glaucoma （PACG）） ;215（20.4％） were diagnosed with glaucoma and received medical treatment ; 132 （12.5 ％） underwent glaucoma filtration surgery; and there were 20 others.Through 24-hour IOP monitoring,104 among 298 cases with suspected glaucoma were diagnosed with normal tension glaucoma （NTG）,110 with POAG,and 28 with the secondary glaucoma.Condition assessment and treatment plans were presented for 390 glaucoma cases receiving no treatment.Adjustment was made in the medical treatment of 138 eyes.Following glaucoma filtration surgery,52 eyes received clinical advice on subsequent treatment.Conclusion：The simplified 24-hour IOP monitoring method is readily accepted by patients,which is of great significance for providing guidance on the diagnosis of glaucoma and the assessment of the efficacy of glaucoma surgery.However,one-time 24-hour IOP monitoring is not sufficiently efficacious to make a definite diagnosis of NTG.Therefore,long-term follow-up and repeated 24-hour IOP monitoring are required to diagnose NTG,along with a variety of related examinations.     

2.6 mm切口人工晶状体植入治疗白内障合并高度近视的疗效观察

目的：观察使用Monarch Ⅱ折叠推注系统，通过2．6mm角膜切口植入低度数或负度数丙烯酸脂(AcrySof)折叠式人工晶状体治疗白内障合并高度近视的临床疗效。方法：对52例(68眼)白内障合并高度近视患者行超声乳化白内障吸除，使用Monarch Ⅱ折叠推注系统通过2.6mm角膜切口植入低度数或负度数AcrySof折叠式人工晶状体，观察术中和术后并发症、术后视力。术后随访时间平均6个月(3-12个月)。结果：所有人工晶状体均能顺利植入眼内，没有发生人工晶状体断裂、擦痕、断襻或襻变形等情况，术中无并发症发生。术后3个月最佳矫正视力0．12～0．25者8眼(11．8％)，0．3．0．5者21眼(30．9％)，0．6～1．0者36眼(52．9％)，大于1．0者3眼(4．4％)；随访期间出现黄斑囊样水肿2眼，无出现视网膜脱离和后发性白内障者。结论：在白内障合并高度近视超声乳化吸除、低度数或负度数折叠式人工晶状体植人手术中，应用Monarch Ⅱ折叠推注系统可以将通常需要3．5mm左右的切口减少为2．6mm，是一种安全有效的方法。     

儿童眼压与近视屈光度的相关性

目的：探讨眼压高低与儿童近视屈光度数的关系。方法：横断面研究。共纳入2017年3─7月在河南 安阳城区开展的“安阳儿童眼病研究”随访的小学六年级学生2 126例,年龄为（12.2±0.4）岁。采用 自动电脑验光仪测量睫状肌麻痹后的屈光度并计算等效球镜度（SE）,非接触式眼压计测量眼压（IOP）, 非接触光学测量仪Lenstar LS900获得眼轴长度、角膜厚度、前房深度和晶状体厚度等数据。将受检者 的IOP按照三分位数,分为低[IOP<14 mmHg（1 mmHg=0.133 kPa）]、中（14 mmHg≤IOP≤16 mmHg） 和高水平组（IOP>16 mmHg）。正视组的定义为-0.5 D≤SE≤0.5 D,远视组的定义为SE>0.5 D。近 视组的定义为SE<-0.5 D,其中分为低度近视组（-0.5 D≤SE<-3.0 D）、中度近视组（-6.0 D≤SE< -3.0 D）和高度近视组（SE<-6.0 D）。统一纳入右眼数据进行分析。采用独立样本t检验、单因素方 差分析及线性回归模型分析IOP与屈光度的关系。结果：所有受检者的IOP为（15.06±3.40）mmHg, SE为（-1.36±2.08）D。低、中和高IOP水平组的近视屈光度逐渐增大,差异有统计学意义（F=3.863, P=0.021）。低IOP水平组的SE为（-1.22±1.96）D,明显低于高IOP水平组（[ -1.52±2.22）D]（P=0.021）。 不同屈光不正类别的IOP比较,差异有统计学意义（F=2.695,P=0.029）。远视组的IOP最低 [（14.77±3.31）mmHg],高度近视组的IOP最高[（16.32±3.55）mmHg],2组的IOP相差1.55 mmHg （P=0.047）。以IOP为因变量,校正相关因素后的线性回归模型中,显示较高的IOP与较高的近视程 度明显相关（β=-0.168,P=0.013）。结论：较高的眼压与较高的近视程度明显相关,眼压在儿童青少 年近视发展过程中可能发挥作用,但因果关系仍需进一步研究。     

Anterior Scleritis,Scleral Thinning,and Intraocular Pressure Measurement

We report a case of unilateral glaucoma with falsely low intraocular pressure reading as a result of scleral thinning from anterior scleritis.     

有晶状体眼前房人工晶体植入矫正超高度近视初步报告

目的 :观察有晶体眼前房人工晶体植入矫正超高度近视的临床效果。方法 :11例 ( 18眼 )度数在 -11 0 0D～ -30 0 0D (平均 2 1 2 5D)之间的超高度近视患者表麻下前房内植入Phakic6H12 5型人工晶体 ,随访 6～ 12个月 (平均 9 7月 )。结果 :18眼术后裸眼视力均≥术前矫正视力 ( 0 6 4>0 39) ,两者比较差别有显著性意义 (P <0 0 5 )。术后散光明显减轻 ,与术前相比较差别有显著性意义 (P <0 0 5 )。手术前后眼压比较差别无显著性意义 (P >0 0 5 )。三眼轻微瞳孔变形 ,一例 (双眼 )出现眩光感。结论 :初步观察有晶体眼前房人工晶体植入矫正超高度近视具有安全性、稳定性、可预测性 ,是一种颇具前途的矫正超高度近视的手术。不适宜作LASIK的超高度近视患者可谨慎选择该手术。     

青壮年近视患者的眼压变化及其规律探讨

目的 :探讨青壮年近视患者的眼压变化及其变化规律。方法 :对 46 6例 ( 891眼 )年龄在 16岁～ 46岁、屈光度从 -0 5 0D～ -2 3 5 0D的近视患者的眼压及其相关因素进行统计分析并与非近视组对照。结果 :近视患者眼压水平随屈光度增加而升高 (P <0 0 0 5 ) ;近视组平均眼压较非近视组高约 0 9mmHg ( 1mmHg =0 133kPa) ,高度近视组较非近视组高约 1 3mmHg ;不论中、低度近视还是高度或超高度近视其平均眼压水平均高于非近视组 (P <0 0 5 ) ;在近视组内 ,中、低度近视的平均眼压与高度或超高度近视之间有显著性差异 (P <0 0 5 ) ,但中度与低度近视之间、高度与超高度近视之间无明显差异。屈光度从 0D增加到 >8D时 ,眼压均值上升辐度大 ,净升值高达 1 2 7mmHg ,屈光度从 -8D上升到 -12D时 ,眼压均值升辐小 ,净升值低 ,仅 0 14mmHg。近视男性眼压高于女性 (P =0 0 0 0 1)。近视眼压与年龄及眼别无显著相关性。结论 :平均眼压随屈光度增加而升高 ,应加强对近视患者的眼压监测 ,对男性患者更为重要 ,降低眼内压也许是控制近视发展的一个重要手段     

眼压与屈光不正关系的探讨

目的:了解眼压与屈光不正的关系,分析眼压与不同程度近视间的相关关系。 方法:用非接触眼压计测得142人右眼的眼压,测三次取平均值;用电脑验光仪测得右眼屈光度,测三次取平均值。 结果:患者右眼眼压均值为(13.04±2.97)mmHg,中度近视眼压均值最高,与高度近视眼压均值差异有显著性(P<0.01),并且与正视及低度近视眼压均值差异也有显著性(P<0.05);小于19岁人的眼压明显高于大于30岁人的眼压,之间差异有显著性(P<0.01):男性与女性眼压均值差异无显著性(P>0.05)。 结论:当中度近视眼眼压相对高,或在小于19岁时眼压相对高的情况,可能预示该眼屈光度处于不稳定状态。眼科学报 2003;19:208-210。     

眼压对青少年近视进展的影响

目的：探讨不同眼压水平对青少年近视进展的影响。方法：前瞻性队列研究。选取2014 年7 月至2015 年12 月就诊于长沙爱尔眼科医院的6～18 岁儿童青少年近视患者112 例（112 眼）。根据基线平均眼压（IOP）值分成3组：高眼压组（21 mmHg < 平均IOP < 30 mmHg）、中等眼压组（15 mmHg<平均IOP≤21 mmHg）和低眼压组（10 mmHg < 平均IOP≤15mmHg）。每6个月随访1次,共3次;记录24 h IOP、等效球镜度（SE）、眼轴长度（AL）和中央角膜厚度（CCT）。组间IOP、SE、AL比较采用单素方差分析,随访中IOP、SE、AL及各指标进展值采用重复测量的方差分析,并采用Logistic回归分析可能导致近视进展的影响因素。结果：最终103 例完成随访研究。青少年SE进展程度为：高眼压组（-0.87±0.90）D/年,中等眼压组（-0.59±0.89）D/年,低眼压组（-0.33±0.32）D/年（F=5.848,P=0.017）。AL的增长情况为：高眼压组（0.40±0.29）mm/年,中等眼压组（0.18±0.31）mm/年和低眼压组（0.17±0.30）mm/年（F=5.265,P=0.007）。平均IOP较高的青少年更可能发生SE的进展（OR=0.454,95%CI=0.317～0.716,P=0.007）,而年龄较小的儿童青少年其AL更容易延长（OR=1.433,95%CI=0.994～1.506,P=0.015）。结论：IOP水平较高的儿童青少年近视进展较快,表现在SE的增加和AL的延长,说明IOP水平在儿童青少年近视进展中起到了重要的作用。     

近视PRK术后眼压减低的临床观察

对准分于激光光学屈光性角膜切削术（PRK）术后随访1年以上的病例，观察和统计分析术后眼压测量值减低的情况。随机抽样156眼，平均年龄30．28．65岁，术前平均眼压2．37kPa，按等值球镜屈光度分为3组统计分析术后眼压。PRK术后1年时平均眼压1．45kPa，较术前减低了0．92kPa有统计学意义。PRK手术后眼压测量值较术前明显减低，在术后6月后趋于稳定。术后1年时眼压测量值与术前近视屈光度成反比关系。     

Factors Associated with High Myopia After 7 Years of Follow-up in the Correction of Myopia Evaluation Trial (COMET) Cohort

Purpose: To evaluate factors associated with the development of high myopia (worse than ?6.00 D) over 7 years of follow-up in the COMET cohort. Methods: COMET enrolled 469 ethnically diverse children (6–11 years) with myopia between ?1.25 and ?4.50 D. They were randomized to either progressive addition lenses (PALs) or single vision lenses (SVLs), and followed for 5 years in their original lens assignment and 2 additional years wearing either spectacles (PALs or SVLs) or contact lenses. Refractive error was measured annually by cycloplegic autorefraction and axial length by A-Scan ultrasonography. Myopia for each child was defined as the mean spherical equivalent refractive error (SER) of the 2 eyes. Analyses were based on 7 years of follow-up. Time to high myopia was analyzed by Cox proportional hazard models and linear regression. Parental refraction data were available from 240 COMET subjects. Results: Younger (6–7 years) versus older (11 years) age at baseline was a significant risk factor (adjusted hazard ratio (HR) = 6.6, 95% CI = 3.4, 12.7) for having high myopia within 7 years. More (SER from ?2.26 to ?4.50 D) vs. less (SER from ?1.25 to ?2.25 D) baseline myopia was also a significant risk factor for high myopia at 7 years (adjusted HR = 7.4, 95% CI = 4.4, 12.4). Gender, ethnicity, and treatment assignment were not associated with the risk of high myopia within 7 years. Increased number of myopic parents was associated with a significant risk of high myopia in the children (p = 0.008). Conclusions: Children who developed high myopia during 7 years of follow-up were younger and had more myopia at baseline. They also were more likely to have two myopic parents. These children may be at greater risk for sight-threatening conditions later in life.