Alcohol consumption associated with glaucoma, related traits
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Regular alcohol intake was adversely associated with glaucoma and multiple related traits, even at levels below current United Kingdom and United States drinking guidelines, according to data reported in Ophthalmology Glaucoma.
“Although it would be important for these results to be replicated in independent cohorts and ethnically diverse populations, in the absence of viable alternative study designs, our findings may be of particular interest to people with or at risk of glaucoma and their advising physicians,” Kelsey V. Stuart, MBBCh, MSc, of Moorfields Eye Hospital at NHS Foundation Trust and UCL Institute of Ophthalmology, and colleagues wrote.
In a cross-sectional observational and gene-environment interaction analysis of UK Biobank participants (mean age, 56-57 years; 52%-53% women; 90%-92% white) with data on IOP (n = 109,097), OCT-derived macular inner retinal layer thickness measure (n = 46,236) and glaucoma status (n = 173,407), Stuart and colleagues examined the association of alcohol intake with glaucoma and related traits.
Participants were grouped into categories based on their alcohol consumption habits, which included never drinkers, infrequent drinkers (special occasions), regular drinkers (at least one-three times/month) and former drinkers. Alcohol consumption data were obtained from baseline questionnaires completed from 2006 to 2010.
In addition, researchers tested the potential modification of the alcohol-glaucoma association by utilizing genetic data to calculate a glaucoma polygenic risk score. Mendelian randomization experiments were utilized to determine causal effects.
Stuart and colleagues reported that regular drinkers had higher IOP (+ 0.17 mm Hg; P < .001) and thinner macular ganglion cell-inner plexiform layer (–0.17 µm; P = .049) compared with infrequent drinkers, while former drinkers had higher prevalence of glaucoma (OR = 1.53; P = .002) compared with infrequent drinkers.
Alcohol intake in regular drinkers had a dose-dependent adverse association with all outcomes, including higher IOP, thinner macular retinal nerve fiber layer (RNFL), thinner macular ganglion cell-inner plexiform layer and higher prevalence of glaucoma (P < .001).
Researchers also reported a nonlinear association with alcohol intake of 50 grams/week — below current U.K. and U.S. guidelines — for macular RNFL and macular ganglion cell-inner plexiform layer thickness.
In addition, participants with a higher genetic susceptibility to glaucoma had significantly stronger associations of alcohol intake with IOP (P for interaction < .001).
“This study also adds to the growing body of literature implicating gene-environment interactions in glaucoma, raising the possibility of precision nutrition and dietary recommendations based on genomic data in the future,” Stuart and colleagues wrote. “This may be of particular importance as a preventive strategy in healthy individuals identified to be at high genetic risk of glaucoma but before the development of disease.”
Perspective
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Sometimes the evidence-based science takes time to catch up to common sense. A recent World Health Organization declaration that no amount of alcohol is “safe” was not all that surprising. While researchers acknowledged that drinking may provide some “small” health benefits, those benefits did not seem to outweigh the risks. It was also thought that alcohol (at least temporarily) decreased eye pressure, but it is a misconception that it benefits glaucoma patients, as alcohol has neurotoxic properties that have been associated with neurodegenerative conditions.
In this latest study by Stuart and colleagues, alcohol consumption in regular drinkers had a dose-dependent negative association with all outcomes, including higher IOP, thinner macular retinal nerve fiber layer, thinner macular ganglion cell-inner plexiform layer and elevated prevalence of glaucoma. Those with a genetic predisposition for glaucoma were even more vulnerable.
The positive, clinically applicable news is that such risk can be mitigated. In the not-too-distant future, genomic data will allow nutrition and dietary recommendations for glaucoma suspects (before they get the disease). In the meantime, a healthy diet and exercise along with stress reduction and limiting alcohol as much as possible seems like sensible clinical advice for those at risk.
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