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Editors Selection IGR 12-2

Progression: Influence of smoking on progression

Comment by Rohit Varma on:

25856 Smoking, an additional risk factor in elder women with primary open-angle glaucoma, Zanon-Moreno V; Garcia-Medina JJ; Zanon-Viguer V et al., Molecular Vision, 2009; 15: 2953-2959

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USA In this paper, Zanon-Moreno et al. (765) state that their aim is to "determine whether smoking influences the progression of primary open angle glaucoma in women." In this crosssectional, clinic-based study, the authors sampled the aqueous humor and plasma of 120 consecutive women with POAG who were undergoing trabeculectomy. These women were equally divided into current smokers, ex-smokers and non-smokers (n = 40 for each group). Biomarkers of inflammation (interleukin-6 ‐ IL-6) and apoptosis (caspase-3 and poly[ADP-ribose] polymerase 1 ‐ PARP-1) were studied by enzyme immunoassay and western blot. The authors found that IL-6, caspase-3 and PARP-1 levels in aqueous humor and plasma were higher in current smokers than in ex-smokers and non-smokers. Based on these results the authors conclude that "smoking could be an additional important risk factor for glaucoma progression in elderly women." While it is important to study the role of modifiable risk factors for glaucoma, this study does not provide any meaningful information regarding the role of smoking in glaucoma. There are numerous methodological and study design issues that need to be considered when assessing the validity of these data and their conclusions. These issues relate to potential biases in sample selection, lack of data characterizing the severity of glaucomatous damage, lack of data on progression of glaucomatous damage, lack of data relating the plasma and aqueous biomarkers to glaucomatous damage and finally a misinterpretation of the significance of the data that has been collected. Given that there is no data on the severity and progression of glaucomatous damage it is difficult to interpret the relationship of these biomarkers to the presence of glaucomatous damage or progression of primary openangle glaucoma in women. These data do suggest that there may be a relationship between smoking and elevated inflammatory and apoptotic biomarkers ‐ a finding that has been reported previously.^1,2 Studies correlating biomarkers to glaucomatous damage are critical to providing further insight into the glaucomatous disease process. However, these studies need to correlate these biomarkers to the disease process both in cross-sectional and longitudinal studies. Furthermore, the nature of the relationship (linear or polynomial) between glaucomatous damage and the putative biomarkers should be explored and potential confounders excluded.

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