Lifestyle and Risk of Developing Open-Angle Glaucoma

Abstract

Methods: Participants from the Rotterdam Study, a prospective population-based cohort study, were considered eligible if they participated at both baseline and follow-up and if they had no OAG at baseline. All participants underwent an identical ophthalmologic examination at all visits, including intraocular pressure measurements, optic nerve head assessment, and perimetry. Lifestyle-related factors were assessed by questionnaires by trained research assistants or measured during the examinations (body mass index and waist to hip ratio). Cox proportional hazard regression analysis was applied to calculate hazard ratios. Results: Of 3939 eligible participants, 108 (2.7%) developed OAG during 9.7 years' mean follow-up. No statistically significant effect of socioeconomic status, smoking, or alcohol intake was found. In women, each unit increase in body mass index resulted in a 7% decrease in the risk of developing OAG (P =.04). There was a significant increasing effect of body mass index on intraocular pressure (P Ͻ.001) in women. Conclusions: Obesity appears to be associated with a higher intraocular pressure and a lower risk of developing OAG. These associations were only present in women. Other lifestyle-related factors, such as socioeconomic status, smoking, and alcohol consumption, were not associated with OAG.

Correlation Between Intraocular Pressure and Body Mass Index in the Seated and Supine Positions

“…Gasser et al 27 found no correlation between BMI and primary open-angle glaucoma (POAG), and other studies have actually observed less incident POAG in obese women. 28,29 It may, however, be possible that weight loss and lowering of BMI may result in IOP reductions of similar magnitudes. This requires further study.…”

There is more to the relation between intraocular pressure and metabolic syndrome than meets the eye

“…9,10 Although the relation between T2D and POAG is not ironclad, 11,12 no population-based study has shown an inverse relation between the two conditions. In contrast, numerous prior reports support inverse associations between the other components of MetSyn (elevated blood pressure [summarized by Caprioli et al 13 ], higher body mass index, 14,15 and dyslipidemia 7 ) and POAG. Interestingly, the inverse relation between body mass index and POAG seems to be specific for women in some studies.…”

“…Interestingly, the inverse relation between body mass index and POAG seems to be specific for women in some studies. 14,15 Although the reasons why some components of MetSyn are associated with increased IOPV but not with increased risk of POAGVare complex and not completely understood, the consistent associations between insulin resistance and IOP and between T2D and POAG deserve more attention. Certainly, the work of Park et al 2 showing that elevated IOP is related to fasting blood glucose after menopause is intriguing and may provide important clues regarding the pathogenesis of both T2D and POAG.…”

Primary Open-Angle Glaucoma vs Normal-Tension Glaucoma

“…66 The presence of cardiovascular disease and structural vascular wall changes has been variably linked to the presence of GON during recent years, with some studies identifying strong associations in POAG [67][68][69] and NTG 39,70,71 patients individually and others revealing no such associations. [72][73][74][75] The variability in results between these previous studies could in part be accounted for by differences in the inclusion/exclusion of patients with already diagnosed systemic vascular disease, especially because arterial stiffness is a measure of vascular function. 76 Because most patients with glaucoma seen in day-to-day practice experience several vascular pathologies, a careful selection of only patients free from such diseases could bias results toward very rare occurrences.…”