The Complications of myopia: A review and meta-analysis

Author: Haarman AE, Enthoven CA, Tideman JWL, Tedja MS, Verhoeven VJM, Klaver CCW.

Geographical coverage: Worldwide

Sector: Burden of disease

Sub-sector: Epidemiology

Equity focus: Not reported

Study population: Individuals with varying degrees of myopia

Review type: Epidemiology review

Quantitative synthesis method: Meta-analysis

Qualitative synthesis method: Not applicable

Background

Myopia is associated with several sight-threatening complications, such as myopic macular degeneration (MMD), retinal detachment (RD), cataracts, open-angle glaucoma (OAG), and in some cases, blindness. In high myopia, posterior staphyloma (PS) commonly develops and contributes to the progression of myopic maculopathy. These complications become more likely as the axial length of the eye increases, particularly in older adults.

Objectives

The objective of this systematic review and meta-analysis was to quantify the risk of myopia-related complications—including MMD, RD, specific cataract subtypes, OAG, and visual impairment—based on the degree of myopia. Myopia was categorised by spherical equivalent into low (more than –0.50 to –3.00 dioptres), moderate (–3.00 to –6.00 dioptres), and high (more than –6.00 dioptres).

Main findings

The review showed a strong correlation between increasing myopia severity and the risk of several ocular complications. For MMD, odds ratios (ORs) rose significantly with myopia severity: approximately 13.6 for low, 72.7 for moderate, and 845.1 for high myopia. For RD, the pooled ORs were 3.15 (low), 8.69 (moderate), and 12.62 (high). Myopia was also associated with an increased risk of posterior subcapsular cataract (PSC) and nuclear cataracts, particularly in moderate and high myopes.

Regarding glaucoma, the pooled OR for OAG was 1.95 for any myopia versus emmetropia, 1.59 for low myopia, and 2.92 for moderate-to-high myopia. Finally, the odds of visual impairment were markedly higher in older adults with myopia—ranging from 1.71 for low, to 5.54 for moderate, and 87.63 for high myopia.

Methodology

The authors conducted a systematic review of studies published in English before June 2019, using the PubMed database. Eligible studies were observational and included data on one or more myopia-related complications. Two reviewers independently assessed the studies for inclusion and extracted data on population characteristics and risk estimates. Meta-analyses were performed using fixed- or random-effects models depending on heterogeneity. The authors adhered to PRISMA guidelines throughout the review process.

Applicability/external validity

While the studies included data from across multiple regions, all were published in English and identified via a single database. As a result, the findings may not be fully generalisable to populations in non-English-speaking countries or where data were not available in PubMed. Nonetheless, the global sample offers valuable insight into the growing burden of myopia complications.

Geographic focus

This review synthesised data from a wide range of international studies conducted in Asia, Europe, Australia, and North America. The global distribution of these studies enhances the relevance of the findings, although specific regional differences may still apply.

Summary of quality assessment

The overall quality of the evidence was rated as low. Limitations included heterogeneity in diagnostic definitions, study designs, and lack of adjustment for potential confounding factors. Despite these limitations, the association between myopia severity and complication risk was consistently observed across studies, suggesting strong underlying trends.