The evolving epidemiologic link between myopia and glaucoma: A narrative review on pathophysiology, progression, and...

As the prevalence of myopia and glaucoma rises worldwide, patients with both conditions are increasing simultaneously. This narrative review summarizes the evidence linking myopia and open-angle glaucoma (OAG). Population-based studies and meta-analyses consistently show that myopia is associated with OAG, and that the risk increases with dose-response as myopia worsens. This may reflect the biomechanical and microvascular vulnerability of the axially elongated optic nerve head. However, the effect of myopia on glaucoma progression has been inconsistent across studies, resulting in an epidemiologic discordance in which the progression signal appears weaker than the association with glaucoma occurrence. This discordance may arise partly because progression is harder to detect reliably in myopic eyes, diverse phenotypes are analyzed as a single unstratified cohort, and the global, rate-based endpoints used in longitudinal studies are insensitive to the topographic effects of axial elongation. We therefore distinguish the rate of progression from its pattern. Young patients with high myopia and normal-tension glaucoma (NTG) show more rapid observed structural and functional deterioration. Whether the degree of myopia accelerates loss independently of NTG and intraocular pressure has not been established: where progression has been modeled against competing risk factors, intraocular pressure and disc hemorrhage have usually dominated. The signal that appears more consistent across cohorts is instead the location of damage, though it too has not yet been attributed to myopia rather than to NTG. We propose this rate-versus-pattern distinction as a conceptual framework for recognizing and monitoring high-risk myopic phenotypes.