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Editors Selection IGR 15-4

Intraocular Pressure: Metabolic syndrome and IOP

Comment by Pradeep Ramulu on:

25341 Metabolic syndrome as a risk factor for high-ocular tension, Imai K; Hamaguchi M; Mori K et al., International Journal of Obesity, 2010;

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Metabolic syndrome predisposes patients to numerous diseases including diabetes, heart disease and stroke. Definitions of metabolic syndrome typically require that three or more of the following be present: high blood pressure, elevated serum triglycerides, low HDL cholesterol, elevated fasting glucose, and large waist circumference. Imai et al. (337) evaluated nearly 17,000 Japanese adults for metabolic syndrome, and measured their IOP using non-contact tonometry. Males with metabolic syndrome were roughly twice as likely to have OHTN and females with metabolic syndrome were over five times as likely to have OHTN. This affect persisted after adjusting for age. Elevated fasting glucose, high blood pressure, and elevated triglycerides were each independently associated with OHTN, while no association was found with either low HDL cholesterol or increased abdominal circumference.

The authors' work suggests that while individual components of metabolic syndrome may not confer much risk, the presence of the full syndrome may have a significant effect on IOP. Subjects with metabolic syndrome receiving treatment for either elevated triglycerides or hypertension also had lower rates of OHTN than subjects with untreated metabolic syndrome, suggesting that treatment of metabolic syndrome may benefit IOP.

The presence of metabolic syndrome(MS) may have a significant effect on IOP, and treatment of MS may lower IOP

A major limitation of the study is that IOP, not glaucoma, is studied as the outcome. Previous studies, for example the Baltimore Eye Survey, found that variables such as hypertension can increase IOP without increasing the risk of glaucoma itself. It also cannot be assumed that the findings can be generalized to other racial and ethnic backgrounds. Finally, the magnitude of IOP changes noted was small. Subjects who met criteria for three elements of metabolic syndrome had an IOP only 1.4 mmHg higher than those who met no criteria. Prospective studies are warranted to determine if treating components of metabolic syndrome can produce meaningful reductions in IOP and protect against disease progression

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