Risk Factors Associated With a Large Vertical Cup-to-Disc Ratio: Korean National Health and Nutritional Examination Survey

Abstract

Précis: Higher intraocular pressure, higher systolic blood pressure, and higher serum aspartate transaminase to alanine aminotransaminase level were risk factors associated with a large vertical cup-to-disk ratio (vCDR). Purpose: To identify risk factors for a large vCDR using data from the Korea National Health and Nutritional Examination Survey (2008–2012). Materials and Methods: Out of the total 29,322 participants aged 20 or older who participated in Korea National Health and Nutrition Survey (KHANES) from the year 2008 to 2012, this study was conducted on 21,780 participants, excluding 1449 of them without fundus photographs and 6093 of them with missing values. To identify the risk factors associated with a large vCDR, the participants were divided into 2 groups: ≥0.6 and <0.6. Results: Of the 21,780 subjects, 2357 of them had a vCDR ≥0.6 and 19,423 had a vCDR <0.6. There were significant differences in age, sex, and educational levels between the 2 groups. After adjusting age, sex, education level, and survey year by propensity score matching, in the group having vCDR ≥0.6, intraocular pressure (IOP) was high, systolic blood pressure (SBP) was high, and serum aspartate transaminase to alanine aminotransaminase level (AST/ALT ratio) was high (P<0.001, P<0.001, and P<0.001). The results of multiple logistic regression analyses revealed that high IOP, high SBP, high myopia, and high AST/ALT ratio were risk factors for vCDR ≥0.6 (P<0.001, P=0.006, P=0.005, P<0.001). Conclusions: In this study, risk factors associated with large vCDR were analyzed. Higher IOP, higher SBP, and higher AST/ALT ratio were related to vCDR ≥0.6.

Independent Effects of Blood Pressure on Intraocular Pressure and Retinal Ganglion Cell Degeneration: A Mendelian Randomization Study

“… 58 Similarly, both low 20 , 59 and high blood pressure. 21 , 60 , 61 have been reported to associate with increased VCDR, although to our knowledge no studies have directly investigated the association of blood pressure with VCDR using nonlinear models. Although methods for nonlinear MR have been developed, 62 large-scale individual participant data in a one-sample setting is required, and such data are not currently available for POAG or VCDR.…”

Factors Associated with Large Cup-to-Disc Ratio and Blindness in the Primary Open-Angle African American Glaucoma Genetics (POAAGG) Study

“…In fact, studies have found optic discs to be significantly smaller in White and Hispanic populations compared to Asian and African-ancestry ones [ 28 , 29 ]. In studies on Asian populations, the risk factors for LCDR were found to be higher IOP, lower diastolic and higher systolic blood pressure, higher AST/ALT ratio, longer axial length, lower BMI, older age, male sex, and previous cataract surgery [ 30 , 31 ]. Notably, higher IOP emerged as the most significant determinant of a LCDR, similar to our findings in an African ancestry population [ 31 ].…”

“…In our study, eyes with LCDR were more likely to experience elevated IOP, which is a major risk factor for POAG [ 32 , 33 ]. Studies have consistently found a significant correlation between higher IOP and LCDR, an indication of more severe glaucomatous damage [ 6 , 30 , 34 ]. Furthermore, research has shown that both IOP and VCDR have significant heritability and are genetically correlated with each other, as well as with the risk of POAG [ 6 , 34 , 35 ].…”