This article is more than 5 years old. Information may no longer be current.
Study links elevated IOP with systemic disease, obesity, hypertension
Click Here to Manage Email Alerts
Systemic diseases such as diabetes, obesity and systolic hypertension significantly influence IOP and IOP variability in nonglaucomatous subjects, according to a study.
The authors started from the observation that IOP is a dynamic entity, continuously influenced by physiological and environmental changes. In the study, they assessed the long-term effect of diabetes, hypertension, body mass index and smoking status on IOP and IOP changes.
IOP data were collected from the Age-Related Eye Disease Study (AREDS), which included 4,757 participants between 55 and 80 years old from 11 retina clinics in the U.S. and followed between 1992 and 1998, with further data collection in 2005. The IOP measurements taken during the study were analyzed to assess the effect of the chosen factors on IOP. A total of 3,909 participants without glaucoma were included.
Univariate analysis showed a highly statistically significant correlation between IOP elevation and both diabetes and obesity. Systolic and diastolic hypertension were also correlated with elevated IOP, while an inverse correlation was found with systemic beta-blockers use. Systemic diseases also influenced IOP peak and variability.
The authors hypothesized that systemic disease may alter aqueous production and the efficiency of the filtration system in the eye. Similarly, systemic hypertension may lead to increased ciliary pressure, ultrafiltration and episcleral venous pressure. Finally, obesity can damage the trabecular meshwork through increased oxidative load and increased episcleral venous pressure by retro-orbital adipose tissue and elevated intra-abdominal and intrathoracic pressure. Obesity also induces hormonal changes that might affect IOP and is often associated with metabolic syndrome and insulin resistance.
“These findings reveal important population-level trends for potentially modifiable factors in IOP control and are particularly important in the context of elevated obesity and increasing diabetes prevalence rates in adults of all ages,” the authors wrote. – by Michela Cimberle
Disclosure: The author declares no conflict of interest.
Perspective
Back to Top
David Sendrowski, OD, FAAO
Over the years of treating open angle glaucoma, you come to wonder why, no matter how hard you try, some patients fail to respond to your best treatment efforts. Perhaps it is because we fail to consider the overall disease status of the patient and concentrate more on the ocular disease condition. Sir William Osler once stated, “The good physician treats the disease; the great physician treats the patient who has the disease.”
The paper by Dikopf and colleagues, “Systemic disease and long-term intraocular pressure mean, peak and variability in nonglaucomatous eyes,” was thought provoking. It utilized secondary analysis of patients enrolled in the AREDs study for both systemic disease and IOP.
It showed some interesting insights into concurrent disease states of the patient and the mean, peak and variability of IOP. The paper concluded that patients with diabetes, obesity and systolic hypertension all showed increased IOP for all three pressure parameters.
Next time you are with “that” patient who doesn’t seem to respond to your best glaucoma treatment the way you expected them to, it might be a good time to step back and look at the overall disease status of your patient and consider other modifiable factors.
Click Here to Manage Email Alerts