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Editors Selection IGR 18-3

Glaucoma and Mortality

Comment by Anja Tuulonen on:

22567 The association of primary open-angle glaucoma with mortality: a meta-analysis of observational studies, Akbari M; Akbari S; Pasquale LR, Archives of Ophthalmology, 2009; 127: 204-210

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Akbari et al. (481) completed a systematic search of literature for articles related to mortality in patients with glaucoma without date restrictions, performed a meta-analysis of nine studies and concluded that mortality in patients with POAG is similar to the general population. The search of literature with inclusion and exclusion criteria are clearly and literally reported. One study was a population- based, cross-sectional study while others were 5- to 16-year follow-up studies. The sample size was 146,848 with 2811 classified as having POAG. In 8 studies, glaucoma was assessed with optic disc and/or visual field changes, while the largest study (n = 1289) had self-reported glaucoma. As the latter exposes a reporting bias, is some analyses the effects of excluding this study was reported. Although several studies sampled from predominantly ethnically uniform populations, only one of the remaining studies adjusted for ethnicity which is an important risk factor for glaucoma. A pooled analysis demonstrated a marginally statistically significant association between POAG and cardiovascular mortality which may be owing to side effects of glaucoma medications (timolol in Blue Mountain Eye Study and Barbados Study) or the adverse effects of systemic medications used to treat cardiovascular disease. The authors discussed also disease misclassification bias, which is relevant in glaucoma diagnostics. No publication bias could be demonstrated. Overall, the meta-analysis could not demonstrate an association between POAG and all-cause or cardiovascular mortality. This is an excellent example of well-done and well-reported secondary research. Hopefully, the number of such publications will increase in glaucoma literature. A systematic review of the published literature should be the starting point of all clinical studies. This would eliminate the phrase 'everybody writes, nobody reads'.

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