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Clinical and Epidemiologic Research: M. Kamran Ikram, Redmer van Leeuwen, Johannes R. Vingerling, Albert Hofman, and Paulus T. V. M. de Jong Relationship between Refraction and Prevalent as well as Incident Age-Related Maculopathy: The Rotterdam Study Invest. Ophthalmol. Vis. Sci. 2003; 44: 3778-3782 [Abstract] [Full text] [PDF]

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Mechanism behind Relationship of Hyperopia to ARM

Ephraim Friedman   (26 September 2003)

Mechanism behind Relationship of Hyperopia to ARM 26 September 2003
Ephraim Friedman Massachusetts Eye and Ear Infirmary Send letter to journal: Re: Mechanism behind Relationship of Hyperopia to ARM ephraimfriedman{at}mac.com Ephraim Friedman	The authors of the paper "Relationship between Refraction and Prevalent as well as Incident Age-Related Maculopathy: The Rotterdam Study"1 published in the September issue of the journal are to be congratulated on the latest contribution to our understanding of the pathogenesis of AMD to emanate from the population they have been so carefully studying. While they provide strong confirmation of the risk associated with hyperopia, of perhaps greater significance is their analysis of the possible pathophysiologic mechanism by which a short axial length might lead to ARM. If, as the authors suggest, the scleral stiffness associated with hyperopia can lead to ARM by increasing choroidal vascular resistance and impairing retinal pigment epithelial function, then increased scleral stiffness associated with age might also have the same effect. Friedenwald2 pointed out that the coefficient of scleral rigidity was inversely proportional to axial length, directly proportional to age and could be considered as an "index of senescence." In addition to age and hyperopia, it is not unreasonable to speculate that the same mechanism might apply to atherosclerosis, systemic hypertension, and smoking, other factors that are known to increase the risk of AMD. The implications of this paper may go beyond the risk of hyperopia. Ephraim Friedman, MD Professor of Ophthalmology Harvard Medical School References 1. Ikram MK, van Leeuwen R, Vingerling JR, Hofman A, de Jong PTVM. Relationship between refraction and prevalent as well as incident age-related maculopathy: the Rotterdam Study. Invest Ophthalmol Vis Sci. 2003;44:3778-3782. 2. Friedenwald J. Correlation of the theory and practice of tonometry. Am J Ophthalmol. 1937;20:985-1024.