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Editors Selection IGR 24-3

General Aspects: A sick eye in a sick body

Comment by Anja Tuulonen on:

27191 Comparison of comorbid conditions between open-angle glaucoma patients and a control cohort: A case-control study, Lin H-C; Chien C-W; Hu C-C et al., Ophthalmology, 2010; 117: 2088-2095

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The study of Lin et al. (2065) reports de-identified registry data of a single-payer health care system in Taiwan in 2005 with a 99% representatives of the population of 23 million inhabitants.

Of the 97.177 patients with a diagnosis of OAG the authors included 79% (n = 76.673), i.e., those ≥ 40 years of age (mean age of 63 years, 36% over 70 years of age) who had been treated and tested for glaucoma. For every glaucoma patient they selected three age, gender, income and urbanization matched controls who had visited ophthalmologists during the observation period. The authors compared the diagnosis of 31 co-morbidities between the two groups and found a higher prevalence in OAG patients in 28 (93%). Half of OAG patients had systemic hypertension and one third hyperlipidemia and diabetes. The adjusted odds ratio was more than 1.50 also for depression, psychosis, hypothyroidism, fluid and electrolyte disorders and systemic lupus erythematosus. In addition, they found an association between peptic ulcer and liver disease, the latter possibly due to the fact that Taiwan is an endemic area of hepatitis B and hepatocellular carcinoma. Alcohol abuse, obesity, weight loss and coagulapathy were not tested because of very low prevalence in Taiwan.

OAG patients have a sick eye in a sick body

Comprehensive registry data are able to give valuable systemic metalevel overview of eye care in large numbers of subjects and allow country-wise comparisons. The prevalence of treated OAG (0.4%) was one fourth e.g. compared to 1.6% in Finland. The results of the study basically tell that the OAG patients have sick eye in a sick body but are, of course, not able to indicate possible direction of causality. The systemic co morbidities are, however, significant and need to be considered when evaluating health related quality of life in economic evaluations.

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