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Ebrahimi M, Ebrahimi M, Vergroesen JE, Aschner M, Sillanpää M. Environmental exposures to cadmium and lead as potential causes of eye diseases. J Trace Elem Med Biol 2024; 82:127358. [PMID: 38113800 DOI: 10.1016/j.jtemb.2023.127358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
Humans are exposed to cadmium and lead in various regions of the world daily due to industrial development and climate change. Increasing numbers of preclinical and clinical studies indicate that heavy metals, such as cadmium and lead, play a role in the pathogenesis of eye diseases. Excessive exposure to heavy metals such as cadmium and lead can increase the risk of impaired vision. Therefore, it is essential to better characterize the role of these non-essential metals in disease etiology and progression. This article discusses the potential role of cadmium and lead in the development of age-related eye diseases, including age-related macular degeneration, cataracts, and glaucoma. Furthermore, we discuss how cadmium and lead affect ocular cells and provide an overview of putative pathological mechanisms associated with their propensity to damage the eye.
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Affiliation(s)
- Moein Ebrahimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity, Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Maryam Ebrahimi
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Joëlle E Vergroesen
- Department of Ophthalmology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Mika Sillanpää
- Department of Chemical Engineering, School of Mining, Metallurgy and Chemical Engineering, University of Johannesburg, P. O. Box 17011, Doornfontein 2028, South Africa; International Research Centre of Nanotechnology for Himalayan Sustainability (IRCNHS), Shoolini University, Solan 173212, Himachal Pradesh, India; Zhejiang Rongsheng Environmental Protection Paper Co. LTD, NO.588 East Zhennan Road, Pinghu Economic Development Zone, Zhejiang 314213, PR China; Department of Civil Engineering, University Centre for Research & Development, Chandigarh University, Gharuan, Mohali, Punjab, India
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Vergroesen JE, Jarrar ZA, Weiss S, Frost F, Ansari AS, Nguyen P, Kraaij R, Medina-Gomez C, Völzke H, Tost F, Amin N, van Duijn CM, Klaver CCW, Jürgens C, Hammond CJ, Ramdas WD. Glaucoma Patients Have a Lower Abundance of Butyrate-Producing Taxa in the Gut. Invest Ophthalmol Vis Sci 2024; 65:7. [PMID: 38315494 PMCID: PMC10851784 DOI: 10.1167/iovs.65.2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose Glaucoma is an eye disease that is the most common cause of irreversible blindness worldwide. It has been suggested that gut microbiota can produce reactive oxygen species and pro-inflammatory cytokines that may travel from the gastric mucosa to distal sites, for example, the optic nerve head or trabecular meshwork. There is evidence for a gut-eye axis, as microbial dysbiosis has been associated with retinal diseases. We investigated the microbial composition in patients with glaucoma and healthy controls. Moreover, we analyzed the association of the gut microbiome with intraocular pressure (IOP; risk factor of glaucoma) and vertical cup-to-disc ratio (VCDR; quantifying glaucoma severity). Methods The discovery analyses included participants of the Rotterdam Study and the Erasmus Glaucoma Cohort. A total of 225 patients with glaucoma and 1247 age- and sex-matched participants without glaucoma were included in our analyses. Stool samples were used to generate 16S rRNA gene profiles. We assessed associations with 233 genera and species. We used data from the TwinsUK and the Study of Health in Pomerania (SHIP) to replicate our findings. Results Several butyrate-producing taxa (e.g. Butyrivibrio, Caproiciproducens, Clostridium sensu stricto 1, Coprococcus 1, Ruminococcaceae UCG 007, and Shuttleworthia) were less abundant in people with glaucoma compared to healthy controls. The same taxa were also associated with lower IOP and smaller VCDR. The replication analyses confirmed the findings from the discovery analyses. Conclusions Large human studies exploring the link between the gut microbiome and glaucoma are lacking. Our results suggest that microbial dysbiosis plays a role in the pathophysiology of glaucoma.
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Affiliation(s)
- Joëlle E. Vergroesen
- Department of Ophthalmology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Zakariya A. Jarrar
- Department of Ophthalmology, King's College London, London, United Kingdom
- Department of Twins Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Stefan Weiss
- Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Fabian Frost
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Abdus S. Ansari
- Department of Ophthalmology, King's College London, London, United Kingdom
- Department of Twins Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Picard Nguyen
- Department of Ophthalmology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Robert Kraaij
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Carolina Medina-Gomez
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Frank Tost
- Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany
| | - Najaf Amin
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Cornelia M. van Duijn
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Caroline C. W. Klaver
- Department of Ophthalmology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, University of Basel, Basel, Switzerland
| | - Clemens Jürgens
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Chris J. Hammond
- Department of Ophthalmology, King's College London, London, United Kingdom
- Department of Twins Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Wishal D. Ramdas
- Department of Ophthalmology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Vergroesen JE, Thee EF, de Crom TOE, Kiefte-de Jong JC, Meester-Smoor MA, Voortman T, Klaver CCW, Ramdas WD. The inflammatory potential of diet is associated with the risk of age-related eye diseases. Clin Nutr 2023; 42:2404-2413. [PMID: 37865012 DOI: 10.1016/j.clnu.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/26/2023] [Accepted: 10/09/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND & AIMS Inflammation is involved in the pathogenesis of cataract, age-related macular degeneration (AMD), and possibly open-angle glaucoma (OAG). We assessed whether the inflammatory potential of diet (quantified using the dietary inflammatory index; DII) affects the incidence of these common blinding age-related eye diseases. Serum inflammation markers were investigated as possible mediators. METHODS Participants aged >45 years were selected from the prospective, population-based Rotterdam Study. From 1991 onwards, every 4-5 years, participants underwent extensive eye examinations. At baseline, blood samples and dietary data (using food frequency questionnaires) were collected. The DII was adapted based on the data available. Of the 7436 participants free of eye diseases at baseline, 4036 developed incident eye diseases during follow-up (cataract = 2895, early-intermediate AMD = 891, late AMD = 81, OAG = 169). RESULTS The adapted DII (aDII) ranged from -4.26 (i.e., anti-inflammatory) to 4.53 (i.e., pro-inflammatory). A higher aDII was significantly associated with increased inflammation. A higher neutrophil-lymphocyte ratio (NLR) was associated with an increased risk of cataract and AMD. Additionally, complement component 3c (C3c) and systemic immune-inflammation index (SII) were associated with increased risks of cataract and late AMD, respectively. Every point increase in the aDII was associated with a 9% increased risk of cataract (Odds ratio [95% confidence interval]: 1.09 [1.04-1.14]). The NLR and C3c partly mediated this association. We also identified associations of the aDII with risk of AMD (early-intermediate AMD, OR [95% CI]: 1.11 [1.03-1.19]; late AMD, OR [95% CI]: 1.24 [1.02-1.53]). The NLR partly mediated these associations. The aDII was not associated with OAG. CONCLUSIONS A pro-inflammatory diet was associated with increased risks of cataract and AMD. Particularly the NLR, a marker of subclinical inflammation, appears to be implicated. These findings are relevant for patients with AMD and substantiate the current recommendations to strive for a healthy lifestyle to prevent blindness.
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Affiliation(s)
- Joëlle E Vergroesen
- Department of Ophthalmology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Eric F Thee
- Department of Ophthalmology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; EyeNED Reading Center, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Tosca O E de Crom
- Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Jessica C Kiefte-de Jong
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands.
| | - Magda A Meester-Smoor
- Department of Ophthalmology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, P.O. Box 17 6700 AA Wageningen, the Netherlands.
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; EyeNED Reading Center, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Ophthalmology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands; Institute of Molecular and Clinical Ophthalmology, University of Basel, CH-4031 Basel, Switzerland.
| | - Wishal D Ramdas
- Department of Ophthalmology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
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Vergroesen JE, Schuster AK, Stuart KV, Asefa NG, Cougnard-Grégoire A, Delcourt C, Schweitzer C, Barreto P, Coimbra R, Foster PJ, Luben RN, Pfeiffer N, Stingl JV, Kirsten T, Rauscher FG, Wirkner K, Jansonius NM, Arnould L, Creuzot-Garcher CP, Stricker BH, Keskini C, Topouzis F, Bertelsen G, Eggen AE, Bikbov MM, Jonas JB, Klaver CCW, Ramdas WD, Khawaja AP. Association of Systemic Medication Use with Glaucoma and Intraocular Pressure: The European Eye Epidemiology Consortium. Ophthalmology 2023; 130:893-906. [PMID: 37150298 DOI: 10.1016/j.ophtha.2023.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023] Open
Abstract
PURPOSE To investigate the association of commonly used systemic medications with glaucoma and intraocular pressure (IOP) in the European population. DESIGN Meta-analysis of 11 population-based cohort studies of the European Eye Epidemiology Consortium. PARTICIPANTS The glaucoma analyses included 143 240 participants and the IOP analyses included 47 177 participants. METHODS We examined associations of 4 categories of systemic medications-antihypertensive medications (β-blockers, diuretics, calcium channel blockers [CCBs], α-agonists, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers), lipid-lowering medications, antidepressants, and antidiabetic medications-with glaucoma prevalence and IOP. Glaucoma ascertainment and IOP measurement method were according to individual study protocols. Results of multivariable regression analyses of each study were pooled using random effects meta-analyses. Associations with antidiabetic medications were examined in participants with diabetes only. MAIN OUTCOME MEASURES Glaucoma prevalence and IOP. RESULTS In the meta-analyses of our maximally adjusted multivariable models, use of CCBs was associated with a higher prevalence of glaucoma (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.08 to 1.39). This association was stronger for monotherapy of CCBs with direct cardiac effects (OR, 1.96; 95% CI, 1.23 to 3.12). No other antihypertensive medications, lipid-lowering medications, antidepressants, or antidiabetic medications were associated with glaucoma. Use of systemic β-blockers was associated with a lower IOP (β coefficient, -0.33 mmHg; 95% CI, -0.57 to -0.08 mmHg). Monotherapy of both selective systemic β-blockers (β coefficient, -0.45 mmHg; 95% CI -0.74 to -0.16 mmHg) and nonselective systemic β-blockers (β coefficient, -0.54 mmHg; 95% CI, -0.94 to -0.15 mmHg) was associated with lower IOP. A suggestive association was found between use of high-ceiling diuretics and lower IOP (β coefficient, -0.30 mmHg; 95% CI, -0.47 to -0.14 mmHg) but not when used as monotherapy. No other antihypertensive medications, lipid-lowering medications, antidepressants, or antidiabetic medications were associated with IOP. CONCLUSIONS We identified a potentially harmful association between use of CCBs and glaucoma prevalence. Additionally, we observed and quantified the association of lower IOP with systemic β-blocker use. Both findings potentially are important, given that patients with glaucoma frequently use systemic antihypertensive medications. Determining causality of the CCB association should be a research priority. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Joëlle E Vergroesen
- Department of Ophthalmology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Alexander K Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Kelsey V Stuart
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - Nigus G Asefa
- Department of Ophthalmology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Cécile Delcourt
- INSERM, BPH, U1219, Université de Bordeaux, Bordeaux, France
| | - Cédric Schweitzer
- INSERM, BPH, U1219, Université de Bordeaux, Bordeaux, France; Department of Ophthalmology, CHU de Bordeaux, Bordeaux, France
| | - Patrícia Barreto
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; University of Coimbra, Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine (iCBR- FMUC), Coimbra, Portugal
| | - Rita Coimbra
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal; Department of Mathematics, University of Aveiro, Aveiro, Portugal
| | - Paul J Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - Robert N Luben
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom; MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Julia V Stingl
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Toralf Kirsten
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany; Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany; Medical Informatics Center, Department of Medical Data Science, Leipzig University Medical Center, Leipzig, Germany
| | - Franziska G Rauscher
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany; Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
| | - Kerstin Wirkner
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany; Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
| | - Nomdo M Jansonius
- Department of Ophthalmology, University Medical Center Groningen, Groningen, The Netherlands
| | - Louis Arnould
- Department of Ophthalmology, University Hospital, Dijon, France
| | | | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Christina Keskini
- First Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotis Topouzis
- First Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Geir Bertelsen
- Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Anne E Eggen
- Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | | | - Jost B Jonas
- Ufa Eye Research Institute, Ufa, Russia; Institute of Molecular and Clinical Ophthalmology, University of Basel, Basel, Switzerland; Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Institute of Molecular and Clinical Ophthalmology, University of Basel, Basel, Switzerland; Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wishal D Ramdas
- Department of Ophthalmology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anthony P Khawaja
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom; MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
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Vergroesen JE, Kaynak A, Aribas E, Kavousi M, van Meurs JBJ, Klaver CCW, Ramdas WD. Higher testosterone is associated with open-angle glaucoma in women: a genetic predisposition? Biol Sex Differ 2023; 14:27. [PMID: 37161452 PMCID: PMC10170716 DOI: 10.1186/s13293-023-00512-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/02/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Testosterone may be a possible modifiable risk factor for open-angle glaucoma (OAG) and intraocular pressure (IOP), but evidence has been scarce and conflicting. In this study we evaluated the association of testosterone and its genetic predisposition with incident (i) OAG, IOP, retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GCL +). METHODS Participants aged 45-100 years were derived from the prospective, population-based Rotterdam Study. Ophthalmic examinations and serum testosterone measurements (including bioavailable and free testosterone) were performed from 1991 onwards. Follow-up took place every 4-5 years. A total of 187 out of 7898 participants were diagnosed with incident (i) OAG during follow-up. Genotyping was performed in 165 glaucoma cases and 6708 controls. We calculated sex-specific weighted genetic risk scores (GRS) for total and bioavailable testosterone. Associations with iOAG were analyzed using multivariable logistic regression. Associations with IOP, RNFL, and GCL + were analyzed with multivariable linear regression. Analyses were stratified on sex and adjusted for at least age, body mass index, and follow-up duration. RESULTS In men, testosterone was not associated with iOAG. However, the GRS for higher total testosterone was associated with an increased iOAG risk (odds ratio [OR] with 95% confidence interval [95% CI]: 2.48 [1.18; 5.22], per unit). In women, higher values of bioavailable testosterone (2.05 [1.00; 4.18] per nmol/L) and free testosterone (1.79 [1.00; 3.20] per ng/dL) were significantly associated with increased risk of iOAG. Moreover, the GRS for higher bioavailable testosterone was associated with an increased iOAG risk (2.48 [1.09; 5.65], per unit). Higher bioavailable and free testosterone were adversely associated with IOP (0.58 [0.05; 1.10] per nmol/L and 0.47 [0.04; 0.90] per ng/dL). Higher total testosterone was inversely associated with peripapillary RNFL and GCL + (Beta [95% CI]: - 3.54 [- 7.02; - 0.06] per nmol/L and - 2.18 [- 4.11; - 0.25] per nmol/L, respectively). CONCLUSIONS In women, higher testosterone levels increased the risk of iOAG. Both IOP-dependent and IOP-independent mechanisms may underlie this association. Managing testosterone levels may be particularly relevant for the prevention of neurodegeneration in the eye. Future research should confirm these findings.
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Affiliation(s)
- Joëlle E Vergroesen
- Department of Ophthalmology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Adem Kaynak
- Department of Ophthalmology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Elif Aribas
- Department of Epidemiology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Joyce B J van Meurs
- Department of Epidemiology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Ophthalmology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, University of Basel, CH-4031, Basel, Switzerland
| | - Wishal D Ramdas
- Department of Ophthalmology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Vergroesen JE, Klaver CCW, Ramdas WD. Diabetes Medication to Reduce Age-Related Eye Disorders Beyond Glucose Control-Reply. JAMA Ophthalmol 2023; 141:405-406. [PMID: 36795385 DOI: 10.1001/jamaophthalmol.2022.6317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Joëlle E Vergroesen
- Department of Ophthalmology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,EyeNED Reading Center, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands.,Institute of Molecular and Clinical Ophthalmology, University of Basel, Basel, Switzerland
| | - Wishal D Ramdas
- Department of Ophthalmology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Tran JH, Stuart KV, de Vries V, Vergroesen JE, Cousins CC, Hysi PG, Do R, Rocheleau G, Kang JH, Wiggs JL, MacGregor S, Khawaja AP, Mackey DA, Klaver CCW, Ramdas WD, Pasquale LR. Genetic Associations Between Smoking- and Glaucoma-Related Traits. Transl Vis Sci Technol 2023; 12:20. [PMID: 36786746 PMCID: PMC9932549 DOI: 10.1167/tvst.12.2.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Purpose The purpose of this study was to describe the genetic relationship between smoking and glaucoma. Methods We used summary-level genetic data for smoking initiation, smoking intensity (cigarettes per day [CPD]), intraocular pressure (IOP), vertical cup-disc ratio, and open-angle glaucoma (OAG) to estimate global genetic correlations (rg) and perform two-sample Mendelian randomization (MR) experiments that explored relations between traits. Finally, we examined associations between smoking genetic risk scores (GRS) and smoking traits with measured IOP and OAG in Rotterdam Study participants. Results We identified weak inverse rg between smoking- and glaucoma-related traits that were insignificant after Bonferroni correction. However, MR analysis revealed that genetically predicted smoking initiation was associated with lower IOP (-0.18 mm Hg per SD, 95% confidence interval [CI] = -0.30 to -0.06, P = 0.003). Furthermore, genetically predicted smoking intensity was associated with decreased OAG risk (odds ratio [OR] = 0.74 per SD, 95% CI = 0.61 to 0.90, P = 0.002). In the Rotterdam Study, the smoking initiation GRS was associated with lower IOP (-0.09 mm Hg per SD, 95% CI = -0.17 to -0.01, P = 0.04) and lower odds of OAG (OR = 0.84 per SD, 95% CI = 0.73 to 0.98, P = 0.02) in multivariable-adjusted analyses. In contrast, neither smoking history nor CPD was associated with IOP (P ≥ 0.38) or OAG (P ≥ 0.54). Associations between the smoking intensity GRS and glaucoma traits were null (P ≥ 0.13). Conclusions MR experiments and GRS generated from Rotterdam Study participants support an inverse relationship between smoking and glaucoma. Translational Relevance Understanding the genetic drivers of the inverse relationship between smoking and glaucoma could yield new insights into glaucoma pathophysiology.
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Affiliation(s)
- Jessica H. Tran
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kelsey V. Stuart
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
| | - Victor de Vries
- Departments of Ophthalmology and Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joëlle E. Vergroesen
- Departments of Ophthalmology and Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Clara C. Cousins
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Pirro G. Hysi
- Department of Ophthalmology, King's College London, St. Thomas’ Hospital, London, UK
- Department of Twin Research & Genetic Epidemiology, King's College London, St. Thomas’ Hospital, London, UK
| | - Ron Do
- Charles Bronfman Institute for Personalized Medicine, Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ghislain Rocheleau
- Charles Bronfman Institute for Personalized Medicine, Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jae H. Kang
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Janey L. Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Stuart MacGregor
- Department of Statistical Genetics, QIMR Bergohofer Medical Research Institute, Brisbane, Australia
| | - Anthony P. Khawaja
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
| | - David A. Mackey
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Western Australia, Australia
| | - Caroline C. W. Klaver
- Departments of Ophthalmology and Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Radboudumc, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, University of Basel, Basel, Switzerland
| | - Wishal D. Ramdas
- Departments of Ophthalmology and Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Louis R. Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Vergroesen JE, Thee EF, Ahmadizar F, van Duijn CM, Stricker BH, Kavousi M, Klaver CCW, Ramdas WD. Association of Diabetes Medication With Open-Angle Glaucoma, Age-Related Macular Degeneration, and Cataract in the Rotterdam Study. JAMA Ophthalmol 2022; 140:674-681. [PMID: 35587864 DOI: 10.1001/jamaophthalmol.2022.1435] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Recent studies suggest that the diabetes drug metformin has a protective effect on open-angle glaucoma (OAG) and age-related macular degeneration (AMD). However, studies have not addressed the critical issue of confounding by indication, and associations have not been evaluated in a large prospective cohort. Objective To determine the association between diabetes medication and the common eye diseases OAG, AMD, and cataract and to evaluate their cumulative lifetime risks in a large cohort study. Design, Setting, and Participants This cohort study included participants from 3 independent cohorts from the prospective, population-based Rotterdam Study between April 23, 1990, and June 25, 2014. Participants were monitored for incident eye diseases (OAG, AMD, cataract) and had baseline measurements of serum glucose. Data on diabetes medication use and data from ophthalmologic examinations were gathered. Exposures Type 2 diabetes (T2D) and the diabetes medications metformin, insulin, and sulfonylurea derivatives. Main Outcomes and Measures Diagnosis and cumulative lifetime risk of OAG, AMD, and cataract. Results This study included 11 260 participants (mean [SD] age, 65.1 [9.8]; 6610 women [58.7%]). T2D was diagnosed in 2406 participants (28.4%), OAG was diagnosed in 324 of 7394 participants (4.4%), AMD was diagnosed in 1935 of 10 993 participants (17.6%), and cataract was diagnosed in 4203 of 11 260 participants (37.3%). Untreated T2D was associated with a higher risk of OAG (odds ratio [OR], 1.50; 95% CI, 1.06-2.13; P = .02), AMD (OR, 1.35; 95% CI, 1.11-1.64; P = .003), and cataract (OR, 1.63; 95% CI, 1.39-1.92; P < .001). T2D treated with metformin was associated with a lower risk of OAG (OR, 0.18; 95% CI, 0.08-0.41; P < .001). Other diabetes medication (ie, insulin, sulfonylurea derivates) was associated with a lower risk of AMD (combined OR, 0.32; 95% CI, 0.18 to 0.55; P < .001). The cumulative lifetime risk of OAG was lower for individuals taking metformin (1.5%; 95% CI, 0.01%-3.1%) than for individuals without T2D (7.2%; 95% CI, 5.7%-8.7%); the lifetime risk of AMD was lower for individuals taking other diabetes medication (17.0%; 95% CI, 5.8%-26.8% vs 33.1%; 95% CI, 30.6%-35.6%). Conclusions and Relevance Results of this cohort study suggest that, although diabetes was clearly associated with cataract, diabetes medication was not. Treatment with metformin was associated with a lower risk of OAG, and other diabetes medication was associated with a lower risk of AMD. Proof of benefit would require interventional clinical trials.
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Affiliation(s)
- Joëlle E Vergroesen
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eric F Thee
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,EyeNED Reading Center, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fariba Ahmadizar
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Cornelia M van Duijn
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,EyeNED Reading Center, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands.,Institute of Molecular and Clinical Ophthalmology, University of Basel, Basel, Switzerland
| | - Wishal D Ramdas
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
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