JOURNAL OF GLAUCOMA

IS Diabetes Mellitus a Blessing in Disguise for Primary Open Angle Glaucoma?

Huiyuan Hou, MD, PhD, Sasan Moghimi, MD, Sally L. Baxter, MD, MSc, and Robrt N. Weinreb, MD

Abstract:

Although numbers of studies have addressed this question, the relationship between diabetes mellitus (DM) and primary open angle glaucoma (POAG) is still unclear. This article discusses progress in understanding the complex relationship between these two entities and recent shifts in perspective that challenge the traditional dogma regarding DM and POAG. There are still many unanswered questions.Although numbers of studies have addressed this question, the relationship between diabetes mellitus (DM) and primary open angle glaucoma (POAG) is still unclear. This article discusses progress in understanding the complex relationship between these two entities and recent shifts in perspective that challenge the traditional dogma regarding DM and POAG. There are still many unanswered questions.

The Association of Intraocular Pressure With Obesity and Cardiometabolic Risk in a Young Farmworker Population

Reddy, Aditya ; Halenda, Kevin ; Cromer, Pamela ; Chen, Li ; Butler, Julian ; Raed, Anas; Bhagatwala, Jigar; Sponseller, Tracie ; Bollinger, Kathryn ; Zhu, Haidong ; Young, Lufei ; Layman, Debbie; Dong, Yanbin.

Abstract

Purpose:

Elevated IOP is a known risk factor for glaucomatous optic neuropathy and is believed to be associated with obesity and cardiometabolic diseases. The high prevalence of these conditions in the United States necessitates an evaluation of the relationship among obesity, cardiometabolic risks, and IOP among understudied younger populations.

Materials and Methods:

Farmworker data were collected from the annual Costa-Layman Health Fair between 2013 and 2017. Correlations of IOP with demographic factors, obesity, and cardiometabolic risks were analyzed using analysis of covariance, partial Pearson correlations, and linear regressions.

Results:

In the farmworker population (n=346), the mean IOP was 15.5 mm Hg and the prevalence of ocular hypertension (IOP>21 mm Hg) was 5.5%. BMI, waist circumference, and DBP were significantly correlated (r=0.192, P=0.001; r=0.128, P=0.017; r=0.142, P=0.007, respectively) with IOP when adjusted for age, sex, and ethnicity. Each 10 mm Hg increase in DBP corresponded with a 0.51 mm Hg increase in IOP. With adjustment for age, sex, ethnicity, systolic blood pressure, and DBP, BMI remained significantly correlated with IOP (r=0.166, P=0.002).

Conclusions:

Higher IOP is associated with obesity measures including BMI and waist circumference and is correlated with DBP. These findings suggest that BMI is an independent risk factor for elevated IOP.

Assessment of Corneal Epithelium Thickness in Glaucomatous Patients Undergoing Medical Treatment

Halkiadakis, Ioannis; Vernikou, Anna; Tzimis, Vasilis; Markopoulos, Ioannis; Popeskou, Korina; Konstadinidou, Vasiliki

Purpose:

To evaluate CET parameters by means of anterior segment optical coherence tomography in glaucomatous patients undergoing medical treatment and compare them with CET parameters of controls.

Methods:

This was a cross-sectional study of 62 patients with primary open-angle or pseudoexfoliative glaucoma (study group) and 62 age-matched controls. Fourier-domain optical coherence tomography (RTVue) with a corneal adaptor module was used in the present study. Τhe pachymetry scan pattern was used to map the cornea and the software generated corneal thickness parameters were recorded. Simple comparisons between groups were performed and the correlations of CET parameters with parameters associated with medication use (treatment duration, number of medications and number of instillations) were assessed.

Results:

Mean age of the patients was 68±۱۱.۹ years in the glaucoma group and 65.5±۸.۵, years in the control group (P=0.17). Median number of instillations of medication was 2 (range, 1 to 6) for the glaucoma group. Central corneal thickness was 537.6±۳۳.۳ in the glaucoma group and 550.8±۳۳.۷ in the control group, respectively (P=0.028). The central CET was 48.8.±۳.۷ μm in the glaucoma group and 53.5±۳.۷ μm in the control group (P<0.001). Similarly, the average superior (2 to 7 mm) CET and the average inferior (2 to 7 mm) CET were almost equally reduced in the glaucoma group (45±۴ vs. 49.6±۳.۳ μm, P<0.001 and 49±۳.۹ vs 53.5±۳.۷, P<0.001, respectively). No CET parameter was correlated with any of the treatment parameters.

Conclusions:

Patients treated for glaucoma have uniformly reduced corneal epithelial thickness.

Changes in Intraocular Pressure and Anterior Chamber Angle After Congenital Cataract Extraction

Gouda, Jylan; Tomairek, Reham H.; Elhusseiny, Abdelrahman M.; El-Fayoumi, Dina; Awadein, Ahmed; Gawdat, Ghada; Elhilali, Hala

Purpose:

The purpose of this study was to study the changes in IOP and in the ACA during the first 2 years after pediatric cataract surgery and to determine risk factors for such changes.

Patients and Methods:

A retrospective observational study was done on infants who underwent pediatric cataract surgery in Cairo University Hospitals and completed a 1-year follow-up. Demographic and clinical characteristics were recorded including age at surgery, sex, corneal diameter, CCT pupil diameter, IOP, gonioscopic findings, presence of persistent hyperplastic primary vitreous, surgical approach, primary intraocular lens implantation, and perioperative subconjunctival steroid injection. Changes in IOP and in the ACA were recorded, and the risk factors for such changes were analyzed.

Results:

Postoperative IOP elevation >18 mm Hg occurred in 23 eyes of 206 eyes (11%), who completed Year 1 and in 9 (13%) of 86 eyes who completed Year 2. Risk factors for IOP elevation were larger preoperative CCT (P=0.01) in Year 1, and younger age at surgery (P=0.01), and aphakia (P=0.05) in Year 2. In multivariate analysis only younger age at surgery was a risk factor for IOP elevation in Year 2. ACA narrowing occurred in 49% and in 21% of the examined eyes in Years 1 and 2, respectively. Aphakia was not a significant risk factor of angle narrowing in Years 1 and 2 (P=0.17 and 0.42, respectively).

Conclusions:

Higher preoperative CCT was a risk factor for early-onset IOP elevation. Surgery at >2 months was associated with lower susceptibility to late-onset IOP elevation.

How Does Cataract Surgery Rate Affect Angle-closure Prevalence

Jin, Guangming ; Wang, Lanhua ; Scheetz, Jane ; Zhang, Jian; He, Mingguang

Purpose:

The purpose of this study was to estimate the effects of cataract surgical rates (CSR) on the prevalence of primary angle-closure glaucoma in the Chinese population.

Methods:

Participants aged 50 years and older from the Liwan Eye Study were included as the study sample. Occludable angle (OA) as a surrogate of primary angle-closure glaucoma was evaluated using static gonioscopy and anterior chamber depth was measured before dilation using A-mode ultrasound. Random sampling was used to generate 50 cohorts with a sample size of 200 for each predefined CSR at 2000, 4000, 6000, 8000, 10,000, 12,000, according to the multinomial distribution. The mean anterior chamber depth and OA rates of each cohort were calculated. Logistic function models of nonlinear least-squares estimation were used to predict the prevalence of OA.

Results:

Data of the right eye from 1280 participants were included. The prevalence of cataract surgery and OA was 2.27% and 11.3%, respectively. The projected prevalence of OA in the cohorts with CSR of 2000, 4000, 6000, 8000, 10,000 and 12,000 was 11.4% [95% confidence interval (CI), 10.8%-12.0%], 11.2% (95% CI, 10.6%-11.9%), 10.9% (95% CI, 10.3%-11.6%), 11.4% (95% CI, 10.8%-12.1%), 10.8% (95% CI, 10.2-11.4%), and 10.1% (95% CI, 9.46-10.7%), respectively. The OA rates decreased remarkably as CSR increased for those aged 70 years and older.

Conclusions:

Our study indicated that with CSR increased, the OA prevalence could decrease remarkably especially in the older population. It is advisable to perform cataract surgery at an appropriate time for patients in their late 60s to 70s with significant cataracts.