Journal List > J Korean Ophthalmol Soc > v.59(6) > 1096563

Nah, Ohn, Kim, and Lee: The Relationships of Intraocular Pressure, Cerebrospinal Fluid Pressure, and Trans-lamina Cribrosa Pressure Differences with Myopia

Abstract

Purpose

To investigate the relationships between myopia and the three parameters of intraocular pressure (IOP), estimated cerebrospinal fluid pressure (CSFP), and the trans-lamina cribrosa pressure difference (TLCPD).

Methods

A total of 6,933 adults (≥19 years of age) who participated in the Korea National Health and Nutrition Examination Survey (2008–2012). These subjects were divided into two groups: young age group (19–49 years of age) and old age group (≥50 years of age). The estimated CSFP was calculated as CSFP (mmHg) = 0.44 body mass index (kg/m2) + 0.16 diastolic blood pressure (mmHg) – 0.18 age (years) – 1.91. The TLCPD was calculated by subtracting the CSFP from the IOP.

Results

The mean estimated CSFP in the total population was 13.7 ± 0.1 mmHg (young, 14.2 ± 0.1 mmHg; old, 11.5 ± 0.1; p < 0.01), the mean IOP in the total population was 14.0 ± 0.1 mmHg (young, 14.0 ± 0.1 mmHg; old, 14.1 ± 0.1; p = 0.724), and the mean TLCPD in the total population was 0.7 ± 0.1 mmHg (young, 0.3 ± 0.1 mmHg; old, 3.0 ± 0.2; p < 0.001). After adjusting for confounding factors, multivariate linear regression analyses revealed significant positive associations between the degree of myopia and the estimated CSFP (p < 0.001; β, 0.12; spherical equivalent [SE], 0.03), as well as IOP (p < 0.001; β, 0.29; SE, 0.05). As a result, a higher TLCPD also showed a significant association with more myopic refractive error (p=0.002; β, 0.18; SE, 0.06). In subgroup analyses, a similar association was shown only in the young age group (estimated CSFP, p < 0.001; β, 0.12; SE, 0.03; IOP, p < 0.001; β, 0.28; SE, 0.05; TLCPD, p = 0.005; β, 0.17; SE: 0.06), while the old age group did not show a significant association between TLCPD and the degree of myopia (p = 0.274; β, 0.18; SE, 0.16).

Conclusions

The calculated TLCPD showed an association with high myopia. It was consistent with the potential role of high myopia in the pathogenesis of open-angle glaucoma.

References

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Figure 1.
Spherical equivalent and estimated cerebrospinal fluid pressure. Association between estimated cerebrospinal fluid pressure and spherical equivalent in the total study population (A), young (B) and old age group (C).
jkos-59-527f1.tif
Figure 2.
Spherical equivalent and intraocular pressure. Association between Intraocular pressure and spherical equivalent in the total study population (A), young (B), and old age group (C).
jkos-59-527f2.tif
Figure 3.
Spherical equivalent and Trans-lamina cribrosa pressure difference. Association between Trans-lamina cribrosa pressure difference and spherical equivalent in the total study population (A), young (B), and old age group (C).
jkos-59-527f3.tif
Figure 4.
Degree of myopia and estimated cerebrospinal fluid pressure. Estimated cerebrospinal fluid pressure according to the degree of myopia in the total study population (A), young (Group 1) (B), and old (C) age group (Group 2). *0.001 ≤ p < 0.05; ** p < 0.001.
jkos-59-527f4.tif
Figure 5.
Degree of myopia and intraocular pressure. Intraocular pressure according to the degree of myopia in the total study population (A), young (Group 1) (B), and old (C) age group (Group 2). *0.001 ≤ p < 0.05; ** p < 0.001.
jkos-59-527f5.tif
Figure 6.
Degree of myopia and trans-lamina pressure difference. Trans-lamina pressure difference according to the degree of myopia in the total study population (A), young (Group 1) (B), and old age group (Group 2) (C). *0.001 ≤ p < 0.05.
jkos-59-527f6.tif
Table 1.
Demographics and general health characteristics of the study population
Parameter Total study population (n = 6,740) Young age group (19–49, n = 5,275) Old age group (≥50, n = 1,465) p-value
Demographics        
 Age (years) 38.0 ± 0.2 32.3 ± 0.2 56.1 ± 0.2 <0.001
 Female (%) 49.8 ± 0.6 48.6 ± 0.7 53.4 ± 1.4 0.001
Area of residence (%)       0.503
 Urban region 73.7 ± 1.9 73.4 ± 2.0 74.9 ± 2.2  
 Rural region 26.3 ± 1.9 26.6 ± 2.0 25.1 ± 2.2  
Medical comorbidities (%)        
 Hypertension 17.9 ± 0.7 13.3 ± 0.6 40.3 ± 1.6 <0.001
 Diabetes mellitus 4.0 ± 0.3 2.4 ± 0.3 11.9 ± 1.1 <0.001
 Hypercholesterolemia 7.3 (0.4) 5.5 (0.3) 15.7 (1.1) <0.001
Anthropometric measurements        
 Height (cm) 165.5 ± 0.1 166.4 ± 0.1 161.4 ± 0.3 <0.001
 Weight (kg) 64.5 ± 0.2 64.7 ± 0.2 63.3 ± 0.3 <0.001
 BMI (%)       <0.001
  <25 kg/m2 70.5 ± 0.7 72.0 ± 0.7 63.1 ± 1.4  
  ≥25 kg/m2 29.5 ± 0.7 28.0 ± 0.7 36.9 ± 1.4  
Pressure parameters (mmHg)        
 Systolic BP 114.6 ± 0.2 111.7 ± 0.3 123.2 ± 0.6 <0.001
 Diastolic BP 76.4 ± 0.2 75.3 ± 0.3 80.3 ± 0.4 <0.001
 Estimated CSFP 13.7 ± 0.1 14.2 ± 0.1 11.5 ± 0.1 <0.001
 IOP 14.0 ± 0.1 14.0 ± 0.1 14.1 ± 0.1 <0.001
 TLCPD 0.7 ± 0.1 0.3 ± 0.1 3.0 ± 0.2 <0.001
Refractive error (diopter) –1.3 (0.0) –1.8 (0.0) –0.3 (0.1) <0.001
Refractive status* (%)       <0.001
 Emmetropia & hyperopia 37.1 ± 0.7 30.2 ± 0.6 70.3 ± 1.4  
 Mild myopia 42.4 ± 0.6 46.2 ± 0.7 23.8 ± 1.3  
 Moderate myopia 15.2 ± 0.5 17.4 ± 0.6 4.3 ± 0.6  
 High myopia 5.3 ± 0.4 6.1 ± 0.4 1.6 ± 0.4  

Values are presented as mean ± SD unless otherwise indicated.

BMI = body mass index; BP = blood pressure; CSFP = cerebrospinal fluid pressure; IOP = intraocular pressure; TLCPD = trans-lamina cribrosa pressure difference.

* Emmetropia & hypertropia (spherical equivalent [SE]) > −0.50 D), mild myopia (−2.99 D ≤ SE ≤ −0.50 D), moderate myopia (−5.99 D ≤ SE ≤ −3.00 D), high myopia (SE ≤ −6.00 D)

Rao-Scott χ2 test (for categorical variables) or Wald's F tests (for continuous variables) was used.

Table 2.
Multivariate analysis of association between refractive error (D) and three pressure parameters (estimated cerebrospinal pressure, intraocular pressure, and trans-lamina cribrosa pressure difference) in total, young age, and old age population
Parameters Model 1*
Model 2
Beta SE p-value Beta SE p-value
Estimated cerebrospinal fluid pressure            
 Total population –0.04 0.02 0.033 –0.03 0.01 <0.001
 Young age group (19–49) –0.03 0.02 0.046 –0.03 0.01 <0.001
 Old age group (≥50) –0.07 0.05 0.135 –0.05 0.02 0.029
Intraocular pressure            
 Total population –0.12 0.02 <0.001 –0.11 0.02 <0.001
 Young age group (19–49) –0.12 0.02 <0.001 –0.11 0.02 <0.001
 Old age group (≥50) –0.12 0.05 0.010 –0.09 0.05 0.065
Trans-lamina cribrosa pressure difference            
 Total population –0.07 0.02 0.001 –0.08 0.02 <0.001
 Young age group (19–49) –0.07 0.03 0.002 –0.08 0.02 <0.001
 Old age group (≥50) –0.05 0.06 0.468 –0.04 0.05 0.287

* Model 1: adjusted for age and sex

Model 2: adjusted for age, sex, area of residence, body mass index, diastolic blood pressure, hypertension, diabetes mellitus, and hypercholesterolemia

p < 0.05.

Table 3.
Multivariate analysis of association between the degree of myopia and three pressure parameters (estimated cerebrospinal pressure, intraocular pressure, and trans-lamina cribrosa pressure difference) in total, young age, and old age population
Parameters Model 1
Model 2
Beta SE p-value Beta SE p-value
Estimated cerebrospinal fluid pressure            
 Total population 0.13 0.05 0.006* 0.08 0.02 <0.001*
 Young age group (19–49) 0.12 0.05 0.013* 0.08 0.02 <0.001*
 Old age group (≥50) 0.28 0.13 0.031* 0.13 0.05 0.023*
Intraocular pressure            
 Total population 0.30 0.05 <0.001* 0.29 0.04 <0.001*
 Young age group (19–49) 0.29 0.05 <0.001* 0.28 0.05 <0.001*
 Old age group (≥50) 0.42 0.14 0.003* 0.36 0.14 0.010*
Trans-lamina cribrosa pressure difference            
 Total population 0.15 0.06 0.006* 0.18 0.05 <0.001*
 Young age group (19–49) 0.17 0.07 0.009* 0.17 0.06 0.003*
 Old age group (≥50) 0.13 0.19 0.483 0.25 0.16 0.080

SE = spherical equivalent.

* p < 0.05

Model 1: adjusted for age and sex

Model 2: adjusted for age, sex, area of residence, body mass index, diastolic blood pressure, hypertension, diabetes mellitus, and hypercholesterolemia.

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