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Editors Selection IGR 9-3

Risk Factors: Is Low Serum Vitamin D related to Higher IOP?

Comment by Ramin Talebi & Anne Coleman on:

107559 Inverse Relationship between Serum 25-Hydroxyvitamin D and Elevated Intraocular Pressure, Lee JH; Kwon YJ; Lee HS et al., Nutrients, 2023; 15:

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This cross-sectional study by Lee et al. examined the association between vitamin D levels and elevated intraocular pressure (EIOP) using health examination data from a single center. There is a known inverse relationship between serum 25(OH)D levels and glaucoma risk, which has been attributed to the role of vitamin D in reducing oxidative stress on the optic nerve and trabecular meshwork. The authors of the present study extend this association to intraocular pressure by hypothesizing that serum vitamin D levels are inversely related to EIOP. EIOP was determined using a threshold of ≥ 22 mmHg measured by an air puff tonometer. Serum 25(OH)D levels were determined through laboratory measurements of blood samples and categorized into 25(OH)D deficiency (< 20 ng/mL), insufficiency (20-29 ng/mL), and sufficiency (≥ 30 ng/mL). The association between 25(OH) D levels and risk of EIOP was determined using cubic spline analysis and logistic regression modeling, adjusting for several demographic characteristics, social factors, and physical and laboratory measurements.

A total of 15,388 participants ages 19 years and older with IOP and serum 25(OH)D data were included. Spline analysis demonstrated an inverse non-linear dose-response relationship between serum 25(OH)D and EIOP risk (p < 0.001). This dose-response relationship was also observed in regression analysis. In fully adjusted models, the 25(OH)D insufficiency (odds ratio [OR]: 0.72, 95% 95% confidence interval [CI]: 0.56- 0.92) and 25(OH)D sufficiency (OR: 0.51, 95% CI: 0.34-0.78) groups had significantly lower odds of EIOP compared to the 25(OH)D deficiency group.

The study findings significantly lack generalizability as the population was ethnically homogenous and the data lacked information about glaucomatous status or past exposure to IOP lowering pharmacotherapy

The study results suggest an inverse dose-dependent association between serum 25(OH) D levels and EIOP. The use of two distinct statistical methods and several covariates on a large sample provides a robust analysis to support the inverse association. The application of both spline analysis and logistic regression allows readers to examine the relationship continuously and provides useful thresholds to consider for clinical screening. Importantly, the study findings significantly lack generalizability as the population was ethnically homogenous and the data lacked information about glaucomatous status or past exposure to IOP lowering pharmacotherapy. Further studies are needed to examine the effects of serum 25(OH)D and Vitamin D supplementation on IOP, especially among treatment-naive patients and patients at risk of glaucoma. We congratulate the authors on studying this very important relationship.

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