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Editors Selection IGR 20-4

Glaucoma and Systemic Diseases: POAG and Glucose metabolism disorders

Comment by Minguang He on:

59521 Diabetes, glucose metabolism, and glaucoma: the 2005-2008 national health and nutrition examination survey, Zhao D; Cho J; Kim MH et al., PLoS ONE, 2014; 9: e112460

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There is some evidence suggesting an association of diabetes and open-angle glaucoma (OAG). Zhao and his colleagues confirmed this association (odds ratio = 2.12, 95%CI: 1.23~3.67) whereas they also reported that diabetes with five years or longer duration had much higher odds (OR=3.90, 95%CI: 1.63~9.32) to be associated with OAG, based on the sample from NHANES study. In this study, diabetes and pre-diabetes were ascertained by a robust definition based on fasting plasma glucose, Hb1Ac and medical history. The potential problem is on the diagnosis of glaucoma where all cases were ascertained by self-reported questionnaire. Given the fact that over 50% of glaucoma might be undiagnosed in the community even in the US population, this definition on glaucoma would probably lead to substantial misclassification. Interestingly, the analysis also suggested a somehow dose-response effect on the association of glaucoma and fasting glucose and metabolism markers. This further supports the biological association between diabetes and OAG. The study is able to deliver an important public health message: in the routine annual eye check-up for diabetic patients, physicians should not only look for diabetic retinopathy but also pay attention to glaucoma, people with longer duration of diabetes would have even greater risk of developing glaucoma.

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