Burden of Glaucoma: Adjunct Eye Disease

PURPOSE: The purpose of this study was to better understand the broad impact of primary open-angle glaucoma (POAG) by identifying eye conditions commonly associated with this multifactorial disease. METHODS: An IRB-approved retrospective chart study was conducted at a major academic institution. A total of 713 ethnically diverse patients met the inclusion criteria: 411 were diagnosed with POAG and 302 were controls with no glaucoma diagnosis. Information was collected on: demographics, refractive errors, and ocular ailments. Cochran-Mantel-Haenszel tests were used to compare eye disease prevalence between the two groups. RESULTS: The POAG group (mean age: 64.3, SD=13.3) was 44% female and the control group (mean age: 64.8, SD=12.3) was 47% female. The POAG group showed a higher prevalence of astigmatism (80% vs 60%,p<0.0001), myopia (66% vs 54%,p=0.0004), legal blindness (4.6% vs 1%,p= 0.004), pseudophakia (43% vs 35%,p=0.01), blepharitis (18% vs 12%,p=0.006), retinal detachment (4.1% vs 1.3%, p=0.03), central retinal vein occlusion (CRVO) (3.4% vs 0%,p=0.001), ptosis (12% v 4%,p=0.0001), and uveitis (2.4% vs 0.3%,p=0.02). DISCUSSION: The POAG group had an increased prevalence of astigmatism, myopia, legal blindness, pseudophakia, blepharitis, retinal detachment, CRVO, ptosis, and uveitis. Some of these results are explainable and expected. Glaucoma is the second leading cause of legal blindness in the United States. In addition, myopes have an increased risk of POAG and retinal detachment compared to emmetropes. The increased prevalence of blepharitis is likely due to side-effects of glaucoma medications. Another side effect is an increased risk of cataracts, which may explain the increased prevalence of pseudophakia. Lastly, glaucoma is a known risk factor for CRVO. The results involving uveitis and ptosis are more difficult to explain. CONCLUSIONS: This study has shown that patients with POAG have a host of other ocular diseases that may affect their quality of life. Awareness of these associations and their causes would be invaluable to clinicians as they screen for and treat ocular diseases. Future work to replicate the findings of this study and the elucidation of potential mechanisms underlying these associations are indicated.