title: The Association of Refractive Error with Glaucoma in a Multiethnic Population.
abstract: OBJECTIVE
  To evaluate the association between refractive error and the prevalence of glaucoma by race or ethnicity.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Kaiser Permanente Northern California Health Plan members with refractive error measured at 35 years of age or older between 2008 and 2014 and with no history of cataract surgery, refractive surgery, or a corneal disorder.
  
  
  METHODS
  We identified 34 040 members with glaucoma or ocular hypertension (OHTN; cases) and 403 398 members without glaucoma (controls). Glaucoma cases were classified as primary angle-closure glaucoma (PACG); 1 of the 4 forms of open-angle glaucoma: primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), pigmentary glaucoma (PIGM), and pseudoexfoliation glaucoma (PEX); or OHTN. Refractive error, expressed as spherical equivalent (SE), was coded as a continuous trait and also as categories. Logistic regression analyses were used to estimate the association between refractive error and the prevalence of glaucoma overall and in specific racial or ethnic groups.
  
  
  METHODS
  The association between refractive error and glaucoma subtypes evaluated as odds ratios (ORs) with 95% confidence intervals (CIs).
  
  
  RESULTS
  In controls, the mean SE was -0.59 diopters (D) (standard deviation, 2.62 D). Each 1-D reduction in SE was associated with a 22% decrease in the odds of PACG (OR, 0.78; 95% CI, 0.77-0.80) and with increases in the odds of open-angle glaucoma ranging from 1.23 (95% CI, 1.20-1.26) for PIGM, to 1.07 (95% CI, 1.03-1.11) for PEX, and to 1.05 (95% CI, 1.04-1.06) for OHTN. In addition, we observed a stronger association between myopia and POAG among non-Hispanic whites (OR, 1.12; 95% CI, 1.11-1.13) and NTG among Asians (OR, 1.17; 95% CI, 1.15-1.20) and non-Hispanic whites (OR, 1.19; 95% CI, 1.15-1.22).
  
  
  CONCLUSIONS
  Myopia was associated with an increased prevalence of all forms of open-angle glaucoma and OHTN, whereas hyperopia was associated with a substantially increased prevalence of PACG. Although high myopia is a strong risk factor for glaucoma subtypes, low and moderate myopia also have a significant effect on glaucoma risk. Additionally, there were moderate racial differences in the association of myopia with the risk of POAG and NTG.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California; Division of Epidemiology, School of Public Health, University of California - Berkeley, Berkeley, California.
authors.forename: Ling
authors.initials: L
authors.lastname: Shen
authors.affiliation: Department of Ophthalmology, Redwood City Medical Center, Kaiser Permanente Northern California, Redwood City, California.
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Melles
authors.affiliation: School of Optometry/Vision Science Program, University of California - Berkeley, Berkeley, California.
authors.forename: Ravikanth
authors.initials: R
authors.lastname: Metlapally
authors.affiliation: Division of Epidemiology, School of Public Health, University of California - Berkeley, Berkeley, California.
authors.forename: Lisa
authors.initials: L
authors.lastname: Barcellos
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Catherine
authors.initials: C
authors.lastname: Schaefer
authors.affiliation: Institute for Human Genetics, University of California San Francisco - San Francisco, California; Department of Epidemiology and Biostatistics, University of California - San Francisco, San Francisco, California.
authors.forename: Neil
authors.initials: N
authors.lastname: Risch
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
authors.affiliation: School of Optometry/Vision Science Program, University of California - Berkeley, Berkeley, California.
authors.forename: Christine
authors.initials: C
authors.lastname: Wildsoet
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California. Electronic address: eric.jorgenson@kp.org.
authors.forename: Eric
authors.initials: E
authors.lastname: Jorgenson
mesh_terms: D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D005901:Glaucoma / Q000150:complications / Q000208:ethnology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012029:Refraction, Ocular / Q000502:physiology*; D012030:Refractive Errors / Q000208:ethnology* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies