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Editors Selection IGR 22-1

Glaucoma and Systemic Diseases: Systemic Levels of Trace Metals

Comment by Louis Pasquale on:

Lin et al. performed a cross-sectional study using the Korean National Health and Nutritional Exam Survey to assess the relation between body levels of trace metals (manganese, mercury, lead, cadmium and arsenic) and glaucoma. These metals might effect a variety of physiologic processes but a compelling prior hypothesis specific to glaucoma cannot be articulated based on prior literature. All included patients (n = 2680) had a standardized eye exam although not every participant completed all aspect of that exam. Nonetheless, a standard definition of glaucoma was employed and 36 cases were identified. The specific type of glaucoma was not determined. The authors found a robust, inverse and concentration dependent relation between serum manganese levels and glaucoma in multivariable analysis. If other investigators confirm this result, it is intriguing to consider that manganese could be a therapeutic target for glaucoma. A relation between elevated mercury levels and glaucoma was also found but this result was not concentration dependent. Lin and coworkers did not confirm a prior report of the relation between higher lead levels and primary open-angle glaucoma.¹ No other trace metal was found to be associated with glaucoma but the number of cases was low and power may have been inadequate to see any relations. As there is scant prior data on trace metal exposure and glaucoma, more research is needed, particularly analyses performed on specific glaucoma subtypes.

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