Socioeconomic status, systolic blood pressure and intraocular pressure: the Tanjong Pagar Study

Low cardiorespiratory fitness is associated with elevated intraocular pressure among apparently healthy adults

PURPOSE

To evaluate the association of cardiorespiratory fitness with elevated intraocular pressure (IOP) in healthy adults.

METHODS

In this cross-sectional study, we evaluated 17,990 asymptomatic self-referred adults free of diabetes or cardiovascular disease who were screened in a preventive healthcare setting. All subjects underwent measurement of IOP and completed a maximal exercise stress test according to the Bruce protocol. Fitness was categorized into age and sex-specific quintiles according to the treadmill time and dichotomized to low (lowest quintile) and non-low fitness groups. Elevated IOP was defined as ≥ 21 mmHg.

RESULTS

Median age was 45 (IQR 39-52) years and 12,073 (67%) were men. There were 3,351 (19%) subjects in the low fitness group. Median IOP was 14 mmHg (IQR 12-16) with elevated IOP documented in 188 (1%) subjects. Univariate binary logistic regression model demonstrated that compared with non-low fitness group, subjects in the low fitness group were 2.2 times more likely to have elevated IOP (95% CI 1.598-2.95, p<0.001). Multivariate binary logistic regression with adjustment to known cardiovascular risk factors (age, sex, hypertension, smoking, overweight, regular physical activity, low HDL cholesterol, high triglycerides, and fasting glucose levels) successfully demonstrated that lower fitness was independently and significantly associated with a 90% increased likelihood of elevated IOP (95% CI 1.37-2.61, p<0.001). Subgroup analysis revealed that the association was more pronounced among women compared with men (OR 3.8 vs. 1.6, p for interaction = 0.069).

CONCLUSIONS

Low cardiorespiratory fitness is independently associated with increased IOP among apparently healthy adults.

Migraine headache and other risk factors associated with glaucoma among the adult population living in Armenia: a case-control study

PURPOSE

This study aimed to assess the association between migraine headache and glaucoma among the adult population living in Armenia.

METHODS

This case-control study recruited 145 cases with glaucoma and 250 controls without glaucoma and other ocular disorders except refractive error from Optomed Canada Diagnostic Eye Center in Armenia. A structured questionnaire contained questions on socio-demographics, family history of glaucoma and stroke, ocular health, smoking, migraine, and obstructive sleep apnea. The Migraine Screening Questionnaire assessed possible migraine and the Berlin Questionnaire measured obstructive sleep apnea.

RESULTS

The mean ages of cases and controls were 63.3 (SD = 12.3) and 39.5 (SD = 13.5), respectively. Females comprised 62.8% of cases and 69.1% of controls. A total of 17.8% of cases and 19.0% of controls had possible migraine. In the adjusted analysis older age (OR 1.17; 95% CI 1.12; 1.23), average/lower than average socio-economic status (OR 5.27; 95% CI 1.30; 21.3), and family history of glaucoma (OR 4.25; 95% CI 1.51; 11.9) were associated with high-tension glaucoma.

CONCLUSION

Timely case detection of glaucoma among those with average/low socio-economic status and those with family history of glaucoma could prevent further progression of the disease. Further studies to explore the relationship between migraine headache and specific types of glaucoma may be worthwhile.

Risk factors associated with elevated intraocular pressure: a population-based study in a rural community of Bangladesh

OBJECTIVE

High intraocular pressure (IOP) is one of the major modifiable risk factors for glaucoma. The objective was to examine socio-demographic and clinical factors related to IOP.

METHODS AND ANALYSIS

This study was conducted among 3097 adults residing in a rural area of Bangladesh, with all participants undergoing clinical and ophthalmological evaluations. The measurement of IOP was carried out using of a rebound Tonometer called Icare pro. Multiple logistic regression analysis was employed to identify variables associated to IOP levels of 21 mm Hg or above. Adjusted OR (aOR) and 95% CI were reported.

RESULTS

This study found that, in total, 9% of the study population had high IOP in one or both eyes. Elevated IOP was significantly associated with respondents who were service holders (aOR 2.52; 95% CI 1.48 to 4.31), had a lower education level (aOR 1.55, 95% CI 1.07 to 2.23), used biomass fuel (aOR 2.00; 95% CI 1.09 to 3.67), belonged to a higher socioeconomic position (aOR 1.55, 95% CI 1.07 to 2.23) and had obesity (aOR 2.00; 95% CI 1.07 to 3.73), hypertension (aOR 1.32; 95% CI 1.01 to 1.73) or history of diabetes (aOR 2.44; 95% CI 1.67 to 3.55), after adjusting for covariates including age, sex, marital status, light source and tobacco consumption, in a multiple regression analysis.

CONCLUSION

Chronic diseases, such as hypertension and diabetes, obesity and sociodemographic characteristics such as high socioeconomic status and use of biomass fuels, have all been linked to elevated IOP. Patients with chronic diseases should undergo for IOP testing regularly.

A review of risk factors for retinal vein occlusions

INTRODUCTION

Risk factors for retinal vein occlusion have been extensively studied, with varying population sizes. Smaller populations result in less certain measures of associations. The present review included studies with a relevant population size to identify clinically relevant risk factors for retinal vein occlusion. Understanding the risk factors of retinal vein occlusion is important for the management of these patients.

AREAS COVERED

A comprehensive literature review was conducted through a systematic literature search in PubMed and Embase. Additional studies were selected from cross references in the assessed studies. Weighted effect measures were calculated for all included risk factors.Risk factors associated with retinal vein occlusion included cardiovascular diseases, eye diseases, systemic diseases, medical interventions, and sociodemographic factors.

EXPERT OPINION

This review provided an extensive overview of a wide variety of risk factors increasing the risk of developing retinal vein occlusion. The severity of the identified risk factors indicated that these patients have been in contact with the health care system before their retinal vein occlusion event. Therefore, the clinical course for patients with retinal vein occlusion may benefit from a multidisciplinary collaboration between ophthalmologists and especially cardiologists.

Clinical risk factors for retinal artery occlusions: a nationwide case-control study

PURPOSE

This study seeks to examine potential risk factors for the development of retinal artery occlusions (RAO).

METHODS

We used data obtained from Danish nationwide registries to evaluate potential risk factors for RAO present up to 5 years prior to the RAO diagnosis. The study included 5312 patients diagnosed with RAO registered in the Danish National Patient Register and 26,560 controls assessed from the general population matched on sex and age at index date. Adjusted conditional logistic regression was used to estimate the odds ratio of included risk factors for RAO diagnosis. We conducted supplementary analyses stratified on sex and age, and on RAO subtype. In addition, interaction analyses were performed between strata in the stratified analyses.

RESULTS

Risk factors associated with the development of RAO included diabetes, arterial hypertension, ischemic heart disease, peripheral artery disease, stroke, renal disease, cataract, and glaucoma, with ORs ranging from 1.33 to 4.94. Atrial fibrillation and sleep apnea yielded effect measures close to equivalence. The presence of a risk factor was generally associated with higher odds of RAO among the population ≤ 55 of age. Arterial hypertension was stronger associated with RAO in male patients than in female patients. The association with arterial hypertension was stronger for CRAO than for BRAO subtype.

CONCLUSION

The investigated risk factors suggest that atherosclerosis and conditions changing the intraocular pressure are involved in the pathophysiology of RAO.

Socioeconomic risk factors and age-related macular degeneration in the UK Biobank study

Objective

There is contrasting evidence on the relationship between socioeconomic status (SES) and age-related macular degeneration (AMD), the most common cause of visual impairment (VI) in developed countries. This study examines the relationship between SES, cardiovascular risk factors and self-reported AMD.

Methods and analysis

Over 500000 people participated in the UK Biobank study from 2006 to 2019, with sociodemographic data and clinical measurements collected using standardised procedures. Visual acuity was measured in 117907 participants with VI defined as LogMAR ≤0.3. We used logistic regression to examine the cross-sectional associations between SES and self-reported AMD.

Results

Self-reported AMD was available for 133339 participants aged 50 and older. People reporting AMD had higher academic qualifications, lower income, were unable to work due to disability, have higher BMI, diabetes and vascular heart disease after adjusting for age and sex. In a multivariable analysis, higher income was protective of AMD and economic inactivity due to disability increased the odds of AMD (2.02, 95% CI 1.13 to 3.61). Both associations were independent of cardiovascular factors, but was no longer significant after adjusting for VI.

Conclusions

The association between education, employment and household income with AMD was independent of cardiovascular risk factors.

Long Anterior Lens Zonules and Intraocular Pressure

Purpose

To investigate the relation between intraocular pressure (IOP) and the idiopathic long anterior zonule (LAZ) trait.

Methods

Patients presenting for primary eye care were examined for LAZ, identified as radially oriented zonular fibers with central extension >1.0 mm beyond the normal anterior lens insertion zone (estimated via slit lamp beam length). Ocular, systemic health, and lifestyle data were collected via comprehensive exam and questionnaire. Multivariate regression was used to assess the relationship between IOP (Goldmann) and LAZ.

Results

There were 2169 non-LAZ and 129 LAZ subjects (mean age: 49.8 ± 15.0 vs. 62.6 ± 10.2 years; 63.6% vs. 76.0% female; 83.2% vs. 91.5% African American). Right eyes with >trace LAZ (n = 59 of 110) had higher unadjusted mean IOP than control eyes (16.4 ± 3.3 vs. 15.0 ± 3.3 mm Hg, P = 0.005), and with control for numerous factors, LAZ eyes had an average IOP of approximately 1.3 ± 0.4 mm Hg higher (P = 0.003) than non-LAZ eyes. Final model covariates included sex (P = 0.001); spherical-equivalent refractive error (D; P < 0.0001); body mass index (kg/m²; P < 0.001); presence of diabetes (P < 0.001); having >high school education (P < 0.001); systolic blood pressure (mm Hg; P < 0.0001); being an ever smoker (P = 0.006); and having history of any site cancer (P = 0.01).

Conclusions

The LAZ trait, with potential prevalence near 2%, was associated with a higher IOP. This observation is consistent with the hypothesis that the trait is a marker for underlying mechanisms that elevate glaucoma risk.

Multiple deprivation, vision loss, and ophthalmic disease in adults: global perspectives

The association between socioeconomic position and morbidity and mortality has long been recognized. We evaluate the evidence for an association between multiple aspects of deprivation and ocular health in a global context. This is a systematic review of studies that evaluated deprivation in the adult population in the context of the major acquired causes of visual loss such as cataract, diabetic eye disease, glaucoma, age-related macular degeneration, and ocular trauma. The search strategy identified relevant studies reported between 1946 and August 2016, with randomized control trials, case-control, cohort, and cross-sectional study designs being selected for inclusion. The studies identified in this review from across the world demonstrate the extent to which the common themes such as low educational attainment and low income may be associated with increased incidence of various sight-threatening conditions and may adversely affect access to specialist assessment and delivery of treatment. Health inequality may always persist, but an increased recognition of the importance of the various impacts of deprivation may empower policy makers to target limited resources to the most vulnerable groups in order to deliver the greatest benefit.

Area deprivation and age related macular degeneration in the EPIC-Norfolk Eye Study

Objectives

To investigate the relationship between area deprivation, individual socio-economic status (SES) and age related macular degeneration (AMD).

Study design

Cross sectional study nested within a longitudinal cohort study.

Methods

Data were collected in the EPIC-Norfolk Eye Study by trained nurses, using standardized protocols and lifestyle questionnaires. The English Index of multiple deprivation 2010 (IMD) was derived from participants' postcodes. AMD was identified from standardized grading of fundus photographs. Logistic regression was used to examine associations between IMD, SES and AMD.

Results

5344 pairs (62.0% of total 8623) of fundus photographs were of sufficient quality for grading of AMD. Of 5182 participants with complete data, AMD was identified in 653 participants (12.60%, 95%CI = 11.7–13.5%). Multivariable logistic regression showed that people living in the most affluent 5% of areas had nearly half the odds of AMD compared to those living in comparatively more deprived areas (OR = 0.56, 95% CI = 0.36–0.89, P = 0.02), after adjusting for age, sex, education, social class and smoking.

Conclusions

The authors found that living in the most affluent areas exerted a protective effect on AMD, independently of education and social class. Further investigation into underlying mechanisms will inform potential interventions to reduce health inequalities relating to AMD.

•

The relationship between area deprivation and AMD diagnosed from fundus photographs was examined.

•

Data from 5182 participants from the EPIC-Norfolk Eye study were analyzed.

•

Predominantly early AMD was identified in 653 participants (12.6%).

•

People living in more affluent areas had nearly half the risk of AMD.

•

Results require interpretation with caution due to the healthy population studied.

The distribution of intraocular pressure and associated systemic factors in a Korean population: the Korea National Health and Nutrition Examination Survey

PURPOSE

To investigate the distribution of intraocular pressure (IOP) and its associated factors in a large Korean population based on the data from the nationwide cross-sectional survey.

METHODS

We obtained 2009-2010 data from the Korea National Health and Nutrition Examination Survey (KNHANES) (n = 17 901). After excluding individuals under 19 years of age, a total of 13 431 subjects were enrolled. All participants completed a comprehensive questionnaire and underwent an ocular examination including measurement of IOP by Goldmann applanation tonometry, as well as a systemic evaluation including blood pressure measurements, anthropometry and blood tests.

RESULTS

The mean IOP in the right eye was 13.99 ± 2.75 mmHg, and in the left eye, 13.99 ± 2.75 mmHg, representing no significant bilateral difference. There was, however, a significant difference between males (14.19 ± 2.78 mmHg) and females (13.79 ± 2.70 mmHg) (p < 0.001). Multiple regression analysis revealed that higher IOP was significantly correlated with male sex, higher myopic refractive error, higher body mass index, higher systolic blood pressure, higher fasting plasma glucose and higher total cholesterol (all p < 0.05). On the other hand, age, histories of smoking or migraine or cold hands/feet were not significantly correlated with IOP (all p > 0.05).

CONCLUSIONS

In the general Korean population, IOP increases with male sex and increasing myopia. Further, IOP is significantly correlated with systemic factors relating to cardiovascular disease and metabolic syndrome.

Vascular considerations in glaucoma patients of African and European descent

Glaucoma is the leading cause of blindness in individuals of African descent (AD). While open-angle glaucoma (OAG) disproportionately affects individuals of AD compared with persons of European descent (ED), the physiological mechanisms behind this disparity are largely unknown. The more rapid progression and greater severity of the disease in persons of AD further raise the concern for identifying these underlying differences in disease pathophysiology between AD and ED glaucoma patients. Ocular structural differences between AD and ED patients, including larger optic disc area, cup:disc ratio and thinner corneas, have been found. AD individuals are also disproportionately affected by systemic vascular diseases, including hypertension, cardiovascular disease, stroke and diabetes mellitus. Abnormal ocular blood flow has been implicated as a risk factor for glaucoma, and pilot research is beginning to identify localized ocular vascular differences between AD and ED OAG patients. Given the known systemic vascular deficits and the relationship between glaucoma and ocular blood flow, exploring these concepts in terms of glaucoma risk factors may have a significant impact in elucidating the mechanisms behind the disease disparity in the AD population.

Area deprivation, individual socioeconomic status and low vision in the EPIC-Norfolk Eye Study

Background

Poor vision is associated with lower socioeconomic status, but less is known about its relationship to area deprivation.

Methods

The European Prospective Investigation into Cancer and Nutrition study Norfolk Eye Study was a cross-sectional study of 8563 participants with completed eye examinations. Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) was measured using standard protocols and low vision (LV) was defined as Snellen equivalent (VA) ≤6/12 in the better eye. Uncorrected refractive error (URE) was defined as improvement of VA by 2 logarithm of the minimum angle of resolution lines with pinhole. The lowest 5% of index of multiple deprivation rank was used to define the most deprived areas. The index of multiple deprivation is a composite measure using routine data from seven domains of deprivation to identify the most disadvantaged areas in England. Logistic regression was used to examine univariable and multivariable associations with LV.

Results

Ninety-six participants with missing data were excluded, leaving 8467 for analysis (98.9%). The mean age of the study group was 68.7 years (SD=8.1, range=48–92), with 55.1% women. LV was present in 263 participants (3.1%, 95% CI 2.7 to 3.5%). LV was associated with deprivation after adjusting for age, sex, education, social class and cataract surgery (OR=1.7, 95% CI 1.1 to 2.6, p=0.03), but this effect was mitigated by additionally adjusting for URE (OR=1.5, 95% CI 1.0 to 2.4, p=0.09).

Conclusions

People with LV are more likely to live in the most deprived areas; this association was independent of socioeconomic status and partly mediated by URE. Targeting URE in deprived areas may reduce health inequalities associated with LV.

Hemodynamic interactions in the eye: a review

The ocular circulation provides readily visible information about the state of the systemic circulation, as well as being potentially of relevance to the pathogenesis of ocular disorders such as glaucoma. The interaction between intraocular pressure, retinal vessels and cerebrospinal fluid pressure located at the retrolaminar portion of the eye has been of great interest for both ophthalmic and neurological clinicians and researchers. Understanding the relationship between these physiological parameters can explain phenomena such as spontaneous retinal venous pulsatility, and characterize the effects of the translaminar pressure gradient. It may be feasible to use measurable changes in venous pulsatility to enhance clinical assessment in different diseases. In this article we review recent findings on ocular hemodynamics and the relevance of these parameters in the diagnosis of ophthalmic and neurological diseases.

Distribution and associations of intraocular pressure in indigenous Australians within central Australia: the Central Australian Ocular Health Study

PURPOSE

To determine the distribution and associations of intraocular pressure (IOP) among the indigenous Australian population living in central Australia.

DESIGN

Clinic-based cross-sectional study.

PARTICIPANTS

1884 individuals living in one of 30 remote communities within the statistical local area of 'Central Australia'. This equated to 36% of those aged ≥20 years and 67% of those aged ≥40 years within this district.

METHODS

Participants aged 20 years or over were recruited as they presented to the eye clinic at each remote community. Of those recruited into the study, 1060 underwent IOP measurement using either a Perkins tonometer (Haag-Streit, Koeniz, Switzerland) or an ICare tonometer (Tiolat Oy, Helsinki, Finland) depending on the availability of equipment. Central corneal thickness (CCT) was also measured using ultrasound pachymetry.

MAIN OUTCOME MEASURES

The distribution and associations of IOP from the right eye of each participant is presented.

RESULTS

Mean IOP was 12.8 mmHg (SD 3.2 mmHg) and CCT was 512 µm (SD 36 µm). IOP was strongly associated with CCT (r(2) = 0.14, t = 3.87; P < 0.0001), showing an increase of 0.4 mmHg with every 10 µm increase in CCT. Furthermore, IOP was strongly associated with age, decreasing by 1.9 mmHg for every decade increase in age, but only for eyes with a CCT above the mean.

CONCLUSION

  IOP of indigenous Australians is lower than any other racial group previously published. This may relate to the low CCT readings found among this population. Clinicians will need to bear this in mind when examining indigenous Australians and make appropriate allowances for the measured IOP.

Central corneal thickness and intraocular pressure in Malay children

Background

To determine the mean values for central corneal thickness (CCT) and intraocular pressure (IOP) and the relationship between these values, in healthy Malay children to serve as reference values in diagnosis and treatment.

Design

A cross-sectional study.

Methodology/Principal Findings

One hundred and eight eyes (54 subjects) of Malay children without diagnosis of ocular abnormality or disease meeting our inclusion and exclusion criteria were selected. The CCT and IOP were measured by specular microscopy and non-contact air-puff tonometry respectively, for analysis and comparison with the values obtained in previous studies. Mean CCT and IOP was found to be 530.87±30.79 µm and 15.65±3.05 mm Hg respectively. CCT was found not to vary with age. A positive relationship was found between CCT and IOP; specifically, with every 100-µm increase in CCT, IOP increased by 3.5 mm Hg.

Conclusions/Significance

CCT and IOP are strongly related in healthy Malay children aged 8 to 16. The mean CCT of Malay children is lower than that of majority children of other ethnic groups, supporting the existence of CCT variation among different populations and that ethnicity should be a key consideration when applying CCT data to the general pediatric population.

Intraocular pressure, central corneal thickness, and glaucoma in chinese adults: the liwan eye study

PURPOSE

To describe the distribution of central corneal thickness (CCT), intraocular pressure (IOP), and their determinants and association with glaucoma in Chinese adults.

DESIGN

Population-based cross-sectional study.

METHODS

Chinese adults aged 50 years and older were identified using cluster random sampling in Liwan District, Guangzhou. CCT (both optical [OCCT] and ultrasound [UCCT]), intraocular pressure (by Tonopen, IOP), refractive error (by autorefractor, RE), radius of corneal curvature (RCC), axial length (AL), and body mass index (BMI) were measured, and history of hypertension and diabetes (DM) was collected by questionnaire. Right eye data were analyzed.

RESULTS

The mean values of OCCT, UCCT, and IOP were 512 ± 29.0 μm, 542 ± 31.4 μm, and 15.2 ± 3.1 mm Hg, respectively. In multiple regression models, CCT declined with age (P < .001) and increased with greater RCC (P < .001) and DM (P = .037). IOP was positively associated with greater CCT (P < .001), BMI (P < .001), and hypertension (P < .001). All 25 persons with open-angle glaucoma had IOP <21 mm Hg. CCT did not differ significantly between persons with and without open- or closed-angle glaucoma. Among 65 persons with ocular hypertension (IOP >97.5th percentile), CCT (555 ± 29 μm) was significantly (P = .01) higher than for normal persons.

CONCLUSIONS

The distributions of CCT and IOP in this study are similar to that for other Chinese populations, though IOP was lower than for European populations, possibly due to lower BMI and blood pressure. Glaucoma with IOP <21 mm Hg is common in this population. We found no association between glaucoma and CCT, though power (0.3) for this analysis was low.

The effect of trabeculectomy on intraocular pressure of the untreated fellow eye in the collaborative initial glaucoma treatment study

PURPOSE

To describe the intraocular pressure (IOP) of the untreated fellow eye after unilateral trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS).

DESIGN

Data collected from a prospective, multicenter, randomized clinical trial.

PARTICIPANTS

Three hundred patients with newly diagnosed open-angle glaucoma enrolled at 14 centers in the United States who were randomized to initial trabeculectomy.

METHODS

After baseline evaluation and randomization to initial trabeculectomy in the study eye, patients were evaluated at 3 and 6 months and at 6-month intervals thereafter. The IOP was measured by Goldmann applanation tonometry. All eyes included in the analysis were untreated fellow eyes, and the data were censored for potential IOP-lowering events in the fellow eye, including trabeculectomy, argon laser trabeculoplasty, or cataract extraction. Predictive factors for IOP response in the fellow eye to initial trabeculectomy in the study eye were analyzed using a linear mixed model.

MAIN OUTCOME MEASURES

Intraocular pressure in the untreated fellow eye during follow-up.

RESULTS

Although the IOP in the fellow eye was lower than baseline at 3, 6, 12, 18, and 24 months after trabeculectomy in the study eye, this decrease was statistically significant only at month 12 (mean decrease from baseline, 0.73 ± 3.37 mmHg; P = 0.0134). Predictive associations with higher IOP in the fellow eye during follow-up included higher baseline IOP (P < 0.0001), lower level of education (P = 0.0129), time (P = 0.0005), and the presence of other vascular disease (P = 0.0069). Patients who ultimately required fellow eye trabeculectomy (P < 0.0001) or argon laser trabeculoplasty (P<0.0001), but not cataract extraction (P = 0.4597) in the fellow eye, had lower IOPs during follow-up after these procedures.

CONCLUSIONS

There was no evidence of a substantial effect of trabeculectomy on the IOP of the untreated fellow eye during follow-up. Trabeculectomy does not seem to decrease the mean IOP of the fellow eye, as suggested by some previous studies.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Level of education associated with ophthalmic diseases. The Beijing Eye Study

OBJECTIVE

To determine associations between educational level and ophthalmic diseases in Chinese.

METHODS

The population-based Beijing Eye Study, performed in 2006, enrolled 3,251 participants (age: 45+ years) out of 4,439 subjects invited to participate (response rate: 73.2%). The participants underwent an interview including questions concerning their educational level, and a detailed ophthalmic examination.

RESULTS

Data on the level of education were available for 3,221 (99.1%) subjects, with 1,484 (46.1%) subjects living in the rural region. The mean age was 60.4 +/- 10.1 years (range: 45-89 years). In a multivariate analysis, a higher level of education was significantly associated with myopic refractive error, higher best-corrected visual acuity, lower degree of nuclear cataract, and lower prevalence of angle-closure glaucoma, and with the systemic parameters of lower age, male gender, urban region, taller body height, and lower body mass index. It was not significantly associated with intraocular pressure, amount of subcapsular cataract and cortical cataract, cataract surgery, and the prevalences of diabetes mellitus, retinal vein occlusions, chronic open-angle glaucoma, and age-related macular degeneration, and with the systemic parameters of fasting serum concentrations of glucose, high-density lipoproteins, low-density lipoproteins, cholesterol and triglycerides, systolic and diastolic blood pressure.

CONCLUSIONS

In the Greater Beijing area, a higher level of education was associated with myopic refractive error, higher best-corrected visual acuity, and lower prevalence of nuclear cataract and angle-closure glaucoma, after adjusting for the systemic parameters of younger age, male gender, urban region, taller body height, lower body mass index less smoking and less alcohol consumption. Educational level was not significantly associated with intraocular pressure, cortical cataract, blood pressure, and frequencies of age-related macular degeneration, retinal vein occlusions and chronic open-angle glaucoma.

Factors associated with intraocular pressure before and during 9 years of treatment in the Collaborative Initial Glaucoma Treatment Study

PURPOSE

To evaluate, both at initial glaucoma diagnosis and during treatment, the role of demographic and clinical factors on intraocular pressure (IOP).

DESIGN

Cohort study of patients enrolled in a randomized clinical trial.

PARTICIPANTS

Six hundred seven patients with newly diagnosed open-angle glaucoma (OAG) were enrolled at 14 centers in the United States.

METHODS

After randomization to initial surgery or medications, patients were followed at 6-month intervals. Intraocular pressure was measured by Goldmann applanation tonometry. Predictive factors for IOP at baseline and during follow-up were analyzed using linear mixed models.

MAIN OUTCOME MEASURE

Intraocular pressure at baseline and during follow-up.

RESULTS

The mean baseline IOP was 27.5 mmHg (standard deviation, 5.6 mmHg). Predictive factors for higher baseline IOP included younger age (0.7 mmHg per 10 years), male gender (2.4 mmHg higher than females), pseudoexfoliative glaucoma (5.4 mmHg higher than primary OAG), and pupillary defect (2.2 mmHg higher than those without a defect). During 9 years of follow-up, both surgery and medications dramatically reduced IOP from baseline levels, but the extent of IOP reduction was consistently greater in the surgery group. Over follow-up years 2 through 9, mean IOP was 15.0 versus 17.2 mmHg for surgery versus medicine, respectively. Predictive associations with higher IOP during follow-up included higher baseline IOP (P<0.0001), worse baseline visual field (mean deviation; P<0.0001), and lower level of education (P = 0.0019). Treatment effect was modified by smoking status: nonsmokers treated surgically had lower IOP than smokers treated surgically (14.6 vs. 16.7 mmHg, respectively; P = 0.0013). Clinical center effects were significant (P<0.0001) in both the baseline and follow-up models.

CONCLUSIONS

In this large cohort of newly diagnosed glaucoma patients, predictors of pretreatment IOP and IOP measurements over 9 years of follow-up were identified. Our findings lend credence to the postulate that sociodemographic, economic, compliance, or other environmental influences play a role in IOP control during treatment.

The socioeconomic impact among Egyptian glaucoma patients

BACKGROUND/AIM

To evaluate the economic burden of intraocular pressure (IOP)-lowering medications on Egyptian patients with glaucoma, in addition to studying the social grounds of glaucoma education.

METHODS

In a cross-sectional observational study, the clinical and socioeconomic data were collected from 68 glaucomatous patients who were attending the outpatient clinics of Cairo University Hospital, through interviews, questionnaires, and clinical examinations.

RESULTS

Patients had a mean IOP of 22.9 mm Hg (SD 11.5). Just under half the patients had an IOP of over 30 mmHg although 88% were on medical treatment; average of 2.1 medications (SD 0.8). Patients had been spending 79.5 LE (SD 95.3) on glaucoma medications a month, which equals 30.1% of their monthly income. Forty per cent of patients did not know that glaucoma causes blindness. The primary source of knowledge about glaucoma for 79.4% of patients was the ophthalmologist.

CONCLUSION

The lack of control of IOP is probably related to the economic burden associated with glaucoma medications. 'Glaucoma education' is an important issue to both the treating ophthalmologist and the patient.