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Risk factors for incident open-angle glaucoma: the Barbados Eye Studies.

Abstract

PURPOSE

To evaluate risk factors for definite open-angle glaucoma (OAG), based on African-descent participants of the Barbados Eye Studies.

DESIGN

Cohort study with 81% to 85% participation over 9 years' follow-up.

PARTICIPANTS

We evaluated 3222 persons at risk, 40 to 84 years old, who did not have definite OAG at baseline.

METHODS

Participants had standardized study visits at baseline and after 4 and 9 years, with structured interviews, blood pressure (BP), and other measurements. The ophthalmic protocol included automated perimetry, applanation tonometry, fundus photography, and comprehensive ophthalmologic examinations for those referred. Central corneal thickness (CCT) was measured in a subset at the 9-year examination. Incidence was estimated by the product-limit approach; relative risk ratios (RRs) with 95% confidence intervals (CIs) were based on Cox regression models with discrete time.

MAIN OUTCOME MEASURE

Nine-year incidence of definite OAG.

RESULTS

Over 9 years, 125 persons developed definite OAG (incidence, 4.4%; 95% CI, 3.7-5.2). Baseline factors influencing risk were age (RR, 1.04; 95% CI, 1.02-1.05 per year); family history of glaucoma (RR, 2.4; 95% CI, 1.3-4.6); higher intraocular pressure (IOP) (RR, 1.12; 95% CI, 1.08-1.16 per mmHg); lower systolic BP (RR, 0.91; 95% CI, 0.84-1.00 per 10 mmHg); and lower ocular systolic, diastolic, and mean perfusion pressures (RR, 0.66; 95% CI, 0.54-0.80 per 10 mmHg higher mean perfusion pressure) (RR, 2.6; 95% CI, 1.4-4.6 for low mean perfusion pressure [<40 mmHg]). Thinner CCT was also associated with OAG incidence (odds ratio, 1.41; 95% CI, 1.01-1.96 per 40 mum lower).

CONCLUSIONS

This is the first report of risk factors for long-term OAG incidence; it is also based on a sizable number of new cases. Incidence was high in this African-descent population, where the established factors of older age, higher IOP, and family history contributed to risk. Additional predictors were vascular factors, including lower systolic BP, and particularly lower ocular perfusion pressures, which more than doubled risk. Thinner CCT was also a factor. These findings indicate a multifactorial etiology of OAG and suggest that similar risk factors apply across populations. Results are relevant for understanding OAG causation and identifying groups at high risk.

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  • Authors+Show Affiliations

    ,

    Department of Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, New York 11794-8036, USA. cleske@notes.cc.sunysb.edu

    , , , ,

    Source

    Ophthalmology 115:1 2008 Jan pg 85-93

    MeSH

    Adult
    African Continental Ancestry Group
    Aged
    Aged, 80 and over
    Barbados
    Cohort Studies
    Female
    Follow-Up Studies
    Glaucoma, Open-Angle
    Humans
    Incidence
    Intraocular Pressure
    Male
    Middle Aged
    Optic Disk
    Optic Nerve Diseases
    Risk Factors
    Visual Fields

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    17629563

    Citation

    Leske, M Cristina, et al. "Risk Factors for Incident Open-angle Glaucoma: the Barbados Eye Studies." Ophthalmology, vol. 115, no. 1, 2008, pp. 85-93.
    Leske MC, Wu SY, Hennis A, et al. Risk factors for incident open-angle glaucoma: the Barbados Eye Studies. Ophthalmology. 2008;115(1):85-93.
    Leske, M. C., Wu, S. Y., Hennis, A., Honkanen, R., & Nemesure, B. (2008). Risk factors for incident open-angle glaucoma: the Barbados Eye Studies. Ophthalmology, 115(1), pp. 85-93.
    Leske MC, et al. Risk Factors for Incident Open-angle Glaucoma: the Barbados Eye Studies. Ophthalmology. 2008;115(1):85-93. PubMed PMID: 17629563.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Risk factors for incident open-angle glaucoma: the Barbados Eye Studies. AU - Leske,M Cristina, AU - Wu,Suh-Yuh, AU - Hennis,Anselm, AU - Honkanen,Robert, AU - Nemesure,Barbara, AU - ,, Y1 - 2007/07/16/ PY - 2006/10/19/received PY - 2007/03/09/revised PY - 2007/03/09/accepted PY - 2007/7/17/pubmed PY - 2008/1/15/medline PY - 2007/7/17/entrez SP - 85 EP - 93 JF - Ophthalmology JO - Ophthalmology VL - 115 IS - 1 N2 - PURPOSE: To evaluate risk factors for definite open-angle glaucoma (OAG), based on African-descent participants of the Barbados Eye Studies. DESIGN: Cohort study with 81% to 85% participation over 9 years' follow-up. PARTICIPANTS: We evaluated 3222 persons at risk, 40 to 84 years old, who did not have definite OAG at baseline. METHODS: Participants had standardized study visits at baseline and after 4 and 9 years, with structured interviews, blood pressure (BP), and other measurements. The ophthalmic protocol included automated perimetry, applanation tonometry, fundus photography, and comprehensive ophthalmologic examinations for those referred. Central corneal thickness (CCT) was measured in a subset at the 9-year examination. Incidence was estimated by the product-limit approach; relative risk ratios (RRs) with 95% confidence intervals (CIs) were based on Cox regression models with discrete time. MAIN OUTCOME MEASURE: Nine-year incidence of definite OAG. RESULTS: Over 9 years, 125 persons developed definite OAG (incidence, 4.4%; 95% CI, 3.7-5.2). Baseline factors influencing risk were age (RR, 1.04; 95% CI, 1.02-1.05 per year); family history of glaucoma (RR, 2.4; 95% CI, 1.3-4.6); higher intraocular pressure (IOP) (RR, 1.12; 95% CI, 1.08-1.16 per mmHg); lower systolic BP (RR, 0.91; 95% CI, 0.84-1.00 per 10 mmHg); and lower ocular systolic, diastolic, and mean perfusion pressures (RR, 0.66; 95% CI, 0.54-0.80 per 10 mmHg higher mean perfusion pressure) (RR, 2.6; 95% CI, 1.4-4.6 for low mean perfusion pressure [<40 mmHg]). Thinner CCT was also associated with OAG incidence (odds ratio, 1.41; 95% CI, 1.01-1.96 per 40 mum lower). CONCLUSIONS: This is the first report of risk factors for long-term OAG incidence; it is also based on a sizable number of new cases. Incidence was high in this African-descent population, where the established factors of older age, higher IOP, and family history contributed to risk. Additional predictors were vascular factors, including lower systolic BP, and particularly lower ocular perfusion pressures, which more than doubled risk. Thinner CCT was also a factor. These findings indicate a multifactorial etiology of OAG and suggest that similar risk factors apply across populations. Results are relevant for understanding OAG causation and identifying groups at high risk. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/17629563/Risk_factors_for_incident_open_angle_glaucoma:_the_Barbados_Eye_Studies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(07)00242-4 DB - PRIME DP - Unbound Medicine ER -