Corneal hysteresis as a biomarker in glaucoma development among patients with myopia: a prospective study based on the UK Biobank

Background/aims We investigated the impact of potential risk factors on the development of incident glaucoma in individuals with myopia. Methods This prospective cohort study investigated participants aged 40–69 years from the UK Biobank. Participants were classified based on the degree of myopia: non-myopic (spherical equivalent (SE)≤−0.5D), mild myopia (−3.0D<SE<−0.5 D), moderate myopia (−6.0 D<SE<−3.0 D) and high myopia (SE≤−6.0D). Cox proportional-hazard models assessed the relationship of ocular and systemic risk factors with new glaucoma events across the myopia subgroups. Results Of 105 548 participants who did not have prior glaucoma, 35 870 were classified as myopic and 69 678 as non-myopic. A total of 1877 incident glaucoma cases (1.78%) were documented during a median 11.1 years of follow-up. Those who developed glaucoma had lower SE, lower corneal hysteresis (CH) and higher intraocular pressure. Systemic factors such as type 2 diabetes, dyslipidaemia, baseline fasting blood sugar and haemoglobin A1c were significantly higher in those who developed glaucoma, but only in the non-myopia and mild myopia subgroups. Degree of myopia and low CH (≤10.1 mm Hg) were significantly associated with increased glaucoma incidence. When we explored the impact of CH on the risk of incident glaucoma according to myopia grade, consistent elevation of risk with low CH was observed, with the highest risk being exhibited in the high myopia population (HR 1.67 (95% CI 1.10 to 2.57)). Conclusions Our results demonstrated a significant joint association between CH and myopia regarding glaucoma development, suggesting that altered ocular biomechanical properties could play a pronounced role in glaucoma development, particularly within the highly myopic population.