Increase in Myopia Mirrors Rise in Retinal Detachment

By David Douglas

December 09, 2020

NEW YORK (Reuters Health) - Both myopia and rhegmatogenous retinal detachment (RRD) are increasing in the Netherlands and may be related, according to a nationwide study.

In a paper in JAMA Ophthalmology, Dr. Redmer van Leeuwen of University Medical Center Utrecht and colleagues note that RRD is one of the most common sight-threatening emergencies in the Western world; even with timely surgery it may result in severe visual impairment.

To determine whether the incidence is changing the researchers compared results of an earlier study of all patients who underwent surgical repair for a primary RRD in the Netherlands during 2009 and compared them with those for 2016. All vitreoretinal surgeons in the Netherlands provided data, using the same definitions and the same inclusion and exclusion criteria as in the earlier study.

To examine a possible change in the prevalence of myopia, the team also analyzed data from the prospective population-based Rotterdam Study in which participants underwent an extensive ophthalmological examination. This cohort of close to 15,000 people, they say, is representative of the middle-aged and elderly population of the Netherlands.

In 2009, nearly 3,000 patients underwent surgery for RRD, giving an overall annual incidence rate of 18.2 per 100,000 person-years. However, despite a population increase of only 3% in the intervening years, the corresponding number of patients in 2016 was 4,447, for an overall annual incidence rate of 26.2 per 100,000 person-years, a 44% increase.

The increase was observed in both phakic and pseudophakic eyes suggesting, say the researchers, "that cataract extraction could not solely account for the overall rise."

Moreover, within the same period, there was a relative increase of 15.6% of low myopia in people aged 55 to 75 years. For medium and high myopia, the corresponding relative increases were 20.3% and 26.9%.

The difference in primary RRD incidence "could not be explained by a different age distribution or cataract surgical rate." An increase in myopia prevalence may be an alternative explanation for the rise in incident RRD cases, the researchers say.

"More studies in other countries are needed to confirm our findings and hypothesis," they add.

In an accompanying editorial, Dr, Tien Y. Wong of Singapore National Eye Center agrees, pointing out, "To further elucidate the epidemiological association between myopia and RRD, a potential study should aim to assemble a sufficiently large cohort of patients with varying degree of myopia, with long-term follow-up for the development of myopia associated complications, including RRD."

Dr. Wong told Reuters Health by email, "Because myopia prevalence is increasing all over the world, the implication is a potential 'epidemic' of myopia-related sight-threatening complications, including retinal detachment."

In an email to Reuters Health, Dr. Christina Y. Weng, an associate professor of ophthalmology at Baylor College of Medicine, in Houston, Texas, said, "The upward trend in the incidence of primary RRD in the Netherlands between 2009-2016 is concerning."

"While refractive error was not measured in this specific patient cohort, the global rise in myopia prevalence may be driving these observations and should be further studied," added Dr. Weng, who was not involved in the new study.

SOURCE: and JAMA Ophthalmology, online November 25, 2020.