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Editors Selection IGR 16-4
Clinical Forms of Glaucoma: Exfoliation glaucoma
Comment by David Friedman on:
51155 The Relationship between caffeine and coffee consumption and exfoliation glaucoma or glaucoma suspect: a prospective study in two cohorts, Pasquale LR; Wiggs JL; Willett WC et al., Investigative Ophthalmology and Visual Science, 2012; 53: 6427-6433
Pasquale et al. studied the association of exfoliation suspect (ES) and exfoliation glaucoma (EG) with caffeine consumption in the Nurse's Health Study and the Health Professionals Follow-up Study (total studied: over 100,000 individuals). They specifically looked at this potentially modifiable risk factor because coffee consumption is highest in Scandinavian countries and ES and EG are more common there. The authors propose possible mechanisms for why increased caffeine consumption might lead to greater exfoliation material production, but these are mostly speculative.
The exposure (caffeine and specifically coffee consumption) was measured every two years, using questionnaires. Each report of caffeine intake was averaged for the preceding two years and then the average of these two-year periods was used as the summary measure of caffeine intake. Nearly 10% of subjects were excluded from this analysis for implausible data on the initial food frequency questionnaire, and another 10% were excluded who lacked an eye exam over the follow-up period. The authors used either complete chart data or a form completed by the ophthalmologist for all subjects who reported diagnosed glaucoma. Over a third of self-reported glaucoma diagnoses could not be confirmed. In the end, 300 women and 60 men were confirmed to have ES/EG.
Drinking three or more cups of coffee, however, had a higher risk [for exfoliation] than those drinking no cups (OR = 1.66)
The authors used incidence rates of EG/ES as the main outcome. Despite the large sample size studied, the association was not statistically significant for total caffeine consumption and EG/ES (OR = 1.43 comparing lowest daily consumption to highest, 95% CI = 0.98-2.08). Those drinking three or more cups of coffee, however, had a higher risk than those drinking no cups (OR = 1.66). The association with high intake of coffee and ES/EG found here is intriguing and should lead to additional research on possible mechanisms. The finding cannot support clinical recommendations since the absolute increased risk is small, the underlying biology is not known and the association seen here may be due to confounding by other factors associated with coffee consumption that are not known or were not measured.
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