Prevalence and Risk Factors for Myopic Retinopathy in a Japanese Population: The Hisayama Study

doi:10.1016/j.ophtha.2012.02.034

Ophthalmology

Volume 119, Issue 9, September 2012, Pages 1760-1765

https://doi.org/10.1016/j.ophtha.2012.02.034 Get rights and content

Purpose

To examine the prevalence of myopic retinopathy and its risk factors in a general Japanese population.

Design

Population-based, cross-sectional study.

Participants

In 2005, a total of 1969 Hisayama residents aged ≥40 years consented to participate in this study. Of these, 1892 subjects with adequate data were enrolled.

Methods

Each participant underwent comprehensive physical and eye examinations that included measurements of refractive error, axial lengths, and color fundus photography. Myopic retinopathy was defined as the presence of diffuse chorioretinal atrophy, patchy chorioretinal atrophy, lacquer cracks, or macular atrophy.

Main Outcome Measures

Prevalence of myopic retinopathy.

Results

Thirty-three participants had myopic retinopathy and the prevalence was 1.7% (2.2% in women and 1.2% in men). The prevalence of myopic retinopathy increased significantly with advancing age. Diffuse chorioretinal atrophy, patchy chorioretinal atrophy, lacquer cracks, and macular atrophy were present in 1.7%, 0.4%, 0.2%, and 0.4% of subjects, respectively. In multivariate analysis, myopic retinopathy was significantly associated with older age (per 1 year: odds ratio [OR], 1.12; 95% confidence interval [CI], 1.07–1.18), female gender (OR, 3.29; 95% CI, 1.09–9.92), and longer axial length (per 1 mm: OR, 4.20; 95% CI, 3.03–5.83).

Conclusions

The prevalence of myopic retinopathy was 1.7% in a general Japanese population. Older age, female gender, and longer axial length were significant risk factors for myopic retinopathy.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Section snippets

Study Population

The Hisayama Study is an ongoing, long-term, cohort study on cardiovascular disease and its risk factors in Hisayama, a town adjoining Fukuoka City, a metropolitan area in southern Japan.13, 14 As a part of the study, we performed a cross-sectional eye examination among Hisayama residents aged ≥40 years in 2005. Among the total of 4439 residents in this age group, 1969 individuals consented to participate in the study. Of these, 1895 (96.2%) underwent the ophthalmic examination. After excluding

Results

Table 1 shows the comparison of characteristics of the study population by gender. Men were older, taller, and had longer axial lengths than women. The frequencies of diabetes, hypertension, smoking habits, and alcohol intake, and mean white blood cell count were higher for men than for women, whereas mean total cholesterol was higher for women. There was no difference in mean body mass index, mean SE refraction, or frequencies of history of cataract surgery between the genders.

The prevalence

Discussion

To our knowledge, this is the first population-based study to investigate the prevalence of and risk factors for myopic retinopathy in Japan. The findings showed that the overall prevalence of myopic retinopathy was 1.7%, and that older age, female gender, and longer axial length were independently associated with myopic retinopathy.

In a Japanese hospital-based study, Tokoro¹⁷ reported a prevalence of myopic retinopathy of 2.2% and estimated the general population prevalence to be approximately

References (27)

W.M. Hsu et al.
Prevalence and causes of visual impairment in an elderly Chinese population in Taiwan: the Shihpai Eye Study
Ophthalmology
(2004)
H. Buch et al.
Prevalence and causes of visual impairment and blindness among 9980 Scandinavian adults: the Copenhagen City Eye Study
Ophthalmology
(2004)
C. Cedrone et al.
Incidence of blindness and low vision in a sample population: the Priverno Eye Study, Italy
Ophthalmology
(2003)
S.A. Cotter et al.
Causes of low vision and blindness in adult Latinos: the Los Angeles Latino Eye Study
Ophthalmology
(2006)
J. Vongphanit et al.
Prevalence and progression of myopic retinopathy in an older population
Ophthalmology
(2002)
H.H. Liu et al.
Prevalence and progression of myopic retinopathy in Chinese adults: the Beijing Eye Study
Ophthalmology
(2010)
L. Xu et al.
Refractive error in urban and rural adult Chinese in Beijing
Ophthalmology
(2005)
K. Attebo et al.
Refractive errors in an older population: the Blue Mountains Eye Study
Ophthalmology
(1999)
S. Panda-Jonas et al.
Retinal photoreceptor density decreases with age
Ophthalmology
(1995)
A. Iwase et al.
Prevalence and causes of low vision and blindness in a Japanese adult population: the Tajimi Study
Ophthalmology
(2006)

L. Xu et al.

Causes of blindness and visual impairment in urban and rural areas in Beijing: the Beijing Eye Study

Ophthalmology

(2006)

C.C. Klaver et al.

Age-specific prevalence and causes of blindness and visual impairment in an older population: the Rotterdam Study

Arch Ophthalmol

(1998)

H.G. Krumpaszky et al.

Blindness incidence in Germany: a population-based study from Wurttemberg-Hohenzollern

Ophthalmologica

(1999)

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: Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

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Original articlePrevalence and Risk Factors for Myopic Retinopathy in a Japanese Population: The Hisayama Study

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Study Population

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Prevalence and causes of low vision and blindness in a Japanese adult population: the Tajimi Study

Ophthalmology

Causes of blindness and visual impairment in urban and rural areas in Beijing: the Beijing Eye Study

Ophthalmology

Age-specific prevalence and causes of blindness and visual impairment in an older population: the Rotterdam Study

Arch Ophthalmol

Blindness incidence in Germany: a population-based study from Wurttemberg-Hohenzollern

Ophthalmologica

Original article
Prevalence and Risk Factors for Myopic Retinopathy in a Japanese Population: The Hisayama Study