Diabetes, Triglyceride Levels, and Other Risk Factors for Glaucoma in the National Health and Nutrition Examination Survey 2005–2008

Ko, Fang; Boland, Michael V.; Gupta, Priya; Gadkaree, Shekhar K.; Vitale, Susan; Güallar, Eliseo; Zhao, Di; Friedman, David S.

doi:10.1167/iovs.15-18373

Cited by 72 publications

(65 citation statements)

References 24 publications

(27 reference statements)

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“…Kang and colleagues also found no relationship between risk of POAG and total cholesterol, but consumption of a high ratio of n-3 to n-6 polyunsaturated fat was associated with an increased risk of POAG [195]. Likewise, Ko and colleagues found an association between self-reported diabetes and glaucoma in the National Health and Nutrition Examination Survey, but this association was not significant after adjustment for triglyceride levels [13]. …”

Section: Glaucoma Risk Factors and Correlation With Diabetesmentioning

confidence: 99%

“…Many epidemiologic studies have examined the relationship between diabetes and glaucoma risk with somewhat mixed results [11–13,15–19,199,205–211]. Some of these discrepancies may be related to the study sample, sample size, patient drop-out, detection bias, reverse causation, and variations in the diagnostic criteria and methods for defining glaucoma and diabetes.…”

Section: Epidemiology Of Glaucoma In Diabetic Populationsmentioning

confidence: 99%

“…However, this figure can vary significantly by age and race [14,215]. In contrast, the prevalence of glaucoma that has been reported specifically in diabetic populations ranges from 2.5% to 15.6% [13,204,210,216–221]. In total, the majority of these studies suggest that glaucoma prevalence is approximately two to three times higher in diabetic populations compared to nondiabetic populations.…”

Section: Epidemiology Of Glaucoma In Diabetic Populationsmentioning

confidence: 99%

“…Current estimates of the prevalence of DR have been estimated as 34.6% among all patients with diabetes (both type 1 and type 2) and as a result, the implications of diabetic eye disease are far-reaching [9]. In addition to retinopathy, diabetes has been associated with a number of other potentially vision-threatening ocular complications including cataract, uveitis, and glaucoma [10–13]. …”

Section: Introductionmentioning

confidence: 99%

“…Whether or not an association exists between diabetes mellitus and glaucoma has been an issue of debate in the past, but findings from several studies in recent years seem to suggest that the risk of glaucoma among diabetic patients may be greater than once believed [11–13,15–19]. In this paper, we review the medical literature characterizing the proposed relationship and risk factors for glaucoma in patients with diabetes as well as the potential clinical implications of this association for diabetic individuals.…”

Section: Introductionmentioning

confidence: 99%

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Presence and Risk Factors for Glaucoma in Patients with Diabetes

2016

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Diabetes mellitus represents a growing international public health issue with a near quadrupling in its worldwide prevalence since 1980. Though it has many known microvascular complications, vision loss from diabetic retinopathy is one of the most devastating for affected individuals. In addition, there is increasing evidence to suggest that diabetic patients have a greater risk for glaucoma as well. Though the pathophysiology of glaucoma is not completely understood, both diabetes and glaucoma appear to share some common risk factors and pathophysiologic similarities with studies also reporting that the presence of diabetes and elevated fasting glucose levels are associated with elevated intraocular pressure – the primary risk factor for glaucomatous optic neuropathy. While no study has completely addressed the possibility of detection bias, most recent epidemiologic evidence suggests that diabetic populations are likely enriched with glaucoma patients. As the association between diabetes and glaucoma becomes better-defined, routine evaluation for glaucoma in diabetic patients, particularly in the telemedicine setting, may become a reasonable consideration to reduce the risk of vision loss in these patients.

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Section: Glaucoma Risk Factors and Correlation With Diabetesmentioning

confidence: 99%

Section: Epidemiology Of Glaucoma In Diabetic Populationsmentioning

confidence: 99%

Section: Epidemiology Of Glaucoma In Diabetic Populationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Presence and Risk Factors for Glaucoma in Patients with Diabetes

2016

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Racial/Ethnic Disparities in Ophthalmology Clinical Trials Resulting in US Food and Drug Administration Drug Approvals From 2000 to 2020

2021

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IMPORTANCE Diverse, representative enrollment in pivotal clinical trials is vital to sufficiently power subgroup analyses and ensure equity and validity of trial results. OBJECTIVE To evaluate the racial/ethnic representation, trends, and disparities in clinical trials leading to US Food and Drug Administration (FDA) ophthalmology drug approvals from 2000 to 2020. DESIGN, SETTING, AND PARTICIPANTSThis cohort study used data from participants in clinical trials of drugs for neovascular age-related macular degeneration (AMD), open-angle glaucoma (OAG), and expanded indications for diabetic retinopathy (DR) from January 1, 2000, to December 31, 2020. Trial data were sourced from FDA reviews, ClinicalTrials.gov, and relevant linked studies. National expected racial/ethnic proportions were sourced from public National Eye Institute prevalence data as well as published rates scaled using US Census Bureau data. MAIN OUTCOMES AND MEASURESThe primary outcome measures were the distribution of and change over time in the racial/ethnic proportion of participants in clinical trials leading to FDA approval of drugs for AMD, OAG, and DR. RESULTSDuring the 20-year period, 31 clinical trials were identified for 13 medications with 18 410 participants. The distribution of trial participants was different from the expected trial distribution for most approvals with regard to race/ethnicity (12 drugs) and sex (10 drugs). Compared with the first decade (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010), trials conducted in the second decade (2011-2020) showed increases in enrollment of Asian (odds ratio [OR], 2.30; 95% CI, 1.97-2.68; P < .001) and Hispanic or Latinx participants (OR, 1.74; 95% CI, 1.49-2.03; P < .001) for AMD, Asian participants (OR, 2.21; 95% CI, 1.46-3.42; P < .001) for DR, and Black (OR, 1.60; 95% CI, 1.43-1.78; P < .001) and Hispanic or Latinx participants (OR, 10.31; 95% CI, 8.05-13.35; P < .001) for OAG. There was a decrease in Black participants in DR trials (OR, 0.58; 95% CI, 0.42-0.79; P < .001). Based on these trends, the enrollment incidence ratio is expected to worsen by 2050, with overrepresentation of white participants vs underrepresentation of Black and Hispanic or Latinx participants in trials of drugs for AMD (1.08 vs 0.04 vs 0.77), DR (1.83 vs 0.87 vs 0.59), and OAG (1.62 vs 0.90 vs 0.37). CONCLUSIONS AND RELEVANCEIn this cohort study, Black, Hispanic or Latinx, and other non-White participants were underrepresented in clinical trials leading to FDA ophthalmology drug approvals compared with the expected disease burden and racial/ethnic distribution in the US. Although there was meaningful improvement from 2000 to 2020, further efforts to increase minority enrollment in clinical trials seem to be warranted.

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