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Editors Selection IGR 24-3
Risk Factors for Glaucoma: Glaucoma and sleep-apnea
Comment by Pradeep Ramulu on:
53586 Obstructive Sleep Apnea and Increased Risk of Glaucoma: A Population-Based Matched-Cohort Study, Lin CC; Hu CC; Ho JD et al., Ophthalmology, 2013; 120: 1559-1564
Cross-sectional studies suggest an association between OAG and obstructive sleep apnea (OSA). This study by Lin and colleagues extends on this work using a large Taiwanese longitudinal health insurance database. The authors retrospectively compared individuals newly diagnosed with OSA based on polysomnography to age/gender matched controls. Patients were presumed not to have glaucoma prior to OSA diagnosis based on the presence of a prior eye exam in which glaucoma was not coded. Incident glaucoma rates of 11.3 and 6.8 cases/1,000 person years were found in the OSA and control groups respectively based on a new OAG diagnosis and prescription of an IOP-lowering medicine. After adjusting for several features (including diabetes, obesity, monthly income, and frequency of outpatient visits for ophthalmic care), patients with OSA had a 1.67-fold higher rate of incident OAG as compared to controls.
Because of the retrospective design, details regarding OSA severity are lacking, making it impossible to determine if more severe OSA was particularly associated with a higher rate of glaucoma. Moreover, OAG was diagnosed by treating physicians, and some of these diag- noses may be inaccurate. Finally, OSA treatment and the relationship of treatment to OAG incidence were not considered.
Despite these limitations, this longitudinal study provides the strongest evidence to date linking OSA to a higher risk of OAG. Furthermore, there is a very plausible link between the two conditions (episodic hypoxia causing retinal nerve fiber damage). The practical implications of this possible association are still not clear. The increased risk of OAG in OSA patients is modest, such that these patients may not require routine screening for glaucoma unless very risk subgroups can be identified. Future work must also determine if proper OSA treatment can impact the rate of glaucomatous damage as defined by retinal nerve fiber damage, visual field loss, and/or incident glaucoma.
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