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Editors Selection IGR 16-4
Risk Factors: Is lead a risk factor?
Comment by Robert Ritch & Anzhelika Vaccaro on:
24562 Lead Accumulation as Possible Risk Factor for Primary Open-Angle Glaucoma, Yuki K; Dogru M; Imamura Y et al., Biological Trace Element Research, 2009; 132: 1-8
Metals, such as copper, magnesium, zinc, iron, manganese, molybdenum, selenium, and nickel, acting primarily through their activity as enzymatic cofactors, function to control metabolic and signaling functions, making them essential for cellular activity. However, heavy metals (lead, cadmium, mercury and thallium) can be toxic at very low concentrations. The melanin-containing tissues of the eye have high affinity for lead.1 Lead is a neurotoxin that has been linked to visual deterioration,1 cataract formation in men,2 and development of age-related macular degeneration.3 Lead may be an important nonpressure dependent factor contributing to progression of glaucomatous optic neuropathy. Yuki et al. (1756) evaluated the association between hair lead concentration and POAG. They found a higher lead level associated with glaucoma in women, especially in normal-tension glaucoma. Sex-related differences in relation to lead accumulation might be explained by its efflux from bone in women that occurs with age, pregnancy, lactation and menopause.4 The rate of progression of optic nerve damage has been reported to be faster in women than in men with normal-tension glaucoma.5 Lead may induce retinal ganglion cell death by activation of the N-methyl- D-aspartate receptor, leading to Ca2+ influx and excitotoxic damage.6 Higher lead levels in women may be an independent factor for nonpressure dependent progression of glaucomatous optic neuropathy.
References
- Erie JC, Butz JA, Good JA, et al. Heavy metal concentrations in human eyes. Am J Ophthalmol 2004; 139: 888-893.
- Schaumberg DA, Mendes F, Balaram M, et al. Accumulated lead exposure and risk of age-related cataract in men. JAMA 2004; 292: 2750-2754.
- Erie JC, Butz J, Good JA. Excess lead in the neural retina in age-related macular degeneration. Am J Ophthalmol 2009; 148: 890-894.
- Vahter M, Akesson A, Liden C, et al. Gender differences in the disposition and toxicity of metals. Environmental Research 2007; 104: 85-95.
- Drance S, Anderson D, Schulzer M, et al. Risk factors for progression of visual field abnormalities in normal-tension glaucoma. Am J Ophthalmol 2001; 131: 699-708.
- Sucher NJ, Lipton SA, Dreyer EB. Molecular basis of glutamate toxicity in retinal ganglion cells. Vision Res 1997; 37: 3483-3494.
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