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Editors Selection IGR 24-3
Clinical Forms of Glaucoma: Lifestyle-related risk factors
Comment by Pradeep Ramulu on:
27664 Lifestyle and Risk of Developing Open-Angle Glaucoma: The Rotterdam Study, Ramdas WD; Wolfs RC; Hofman A et al., Archives of Ophthalmology, 2011; 129:767-772
A frequent and important question from glaucoma suspects is what, besides IOP-lowering treatment, can be done to prevent the onset of glaucoma? The current study by Ramdas et al. (240) examines this question using longitudinal, population-based data from the Rotterdam Eye Study. The authors focus on whether the rate of incidence glaucoma is related to potentially modifiable lifestyle-related risk factors such as smoking, alcohol, socioeconomic status, or obesity.
The authors used interview-administered questionnaires to quantify socioeconomic status, smoking, and alcohol consumption at baseline. None of these factors influenced the rate of incident OAG or intraocular pressure. These conclusions are limited by the inherent difficulty in accurately assessing smoking status and alcohol intake, but suggest that neither is a major risk factor with regards to developing glaucoma.
Obese women were less likely to develop glaucoma compared to non-obese women with a similar baseline IOP
Obesity, on the other hand, was associated with a 6% relative reduction in the rate of incident OAG. After stratifying their analysis by gender, the authors found that this effect was specific to females. Surprisingly, obesity was also associated with increased IOP in women. It is important to note that the impact of obesity on incident OAG was evaluated in models containing baseline IOP as a covariate. As such, the correct conclusion is that obese women were less likely to develop glaucoma compared to non-obese women with a similar baseline IOP.
The authors suggest a plausible explanation for this finding. Previous work has suggested that Goldmann applanation may overestimate IOP in obese women. If true, one would expect higher IOPs in obese women, and also a lower rate of incident glaucoma at a specific IOP (because the true IOP would be lower). Further prospective work evaluating IOP by methods other than Goldmann applanation will be necessary to confirm whether the authors' findings reflect a true biological effect or an artifact reflecting errors in IOP measurement.
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