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Editors Selection IGR 19-2

Risk factors: Intake of fruits and vegetables

Comment by Augusto Azuara Blanco on:

21309 Glaucoma risk and the consumption of fruits and vegetables among older women in the study of osteoporotic fractures, Coleman AL; Stone KL; Kodjebacheva G et al., American Journal of Ophthalmology, 2008; 145: 1081-1089

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This cross-sectional cohort study by Coleman et al. (906) found that a higher intake of certain fruits and vegetables (green collards and kale, carrots, peaches) in older women may be associated with a decreased risk of glaucoma. This positive association is very exciting. Some questions regarding this paper may be appropriate: the reported prevalence of glaucoma (8.2%) appears to be higher than most reported population-based studies, and I wonder whether the methods to diagnose glaucoma were highly specific, mainly the requirement of only one missing location in a 76-point supra-threshold test.

A higher intake of certain fruits and vegetables in older women may be associated with a decreased risk of glaucoma

The authors did not report the agreement among examiners in the diagnosis of glaucoma, which may be relevant. I would also like to know about the severity of glaucoma in the 95 patients diagnosed with the disease. Does the relationship persist if the patients with 'mild glaucoma' (some of whom may be false positives) are excluded? Could the associations found in this study be explained by chance? Fruits and vegetables are certainly good for the overall health of glaucoma patients, but whether they reduce the incidence of glaucoma needs to be confirmed in other cohorts, including men and younger patients. Ultimately, a causal relationship needs to be proven. I would like to congratulate the authors for their novel finding and encourage them to pursue this interesting line of investigation.

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