Researchers identify factors that may increase primary angle-closure glaucoma risk
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Key takeaways:
- IOP, anterior chamber depth, axial length, lens thickness and spherical equivalent are risk factors for PACG.
- Several others included body weight, RNFL, cataract and short-term antidepressant exposure.
Factors including IOP, anterior chamber depth, cataract and short-term antidepressant exposure may increase primary angle-closure glaucoma risk, according to a review published in Optometry and Vision Science.
“Our analyses further confirmed the association of primary angle-closure glaucoma with previously reported factors including IOP, anterior chamber depth, axial length, lens thickness and spherical equivalent,” Ying Wang, MSc, and colleagues from Suzhou Medical College of Soochow University wrote. “In addition, primary angle-closure glaucoma was also found to be significantly associated with body weight, retinal nerve fiber layer (RNFL) thickness, cataract, hyperlipidemia, total cholesterol, triglyceride, malondialdehyde and short-term antidepressant exposure, which may help in understanding the causes of primary angle-closure glaucoma.”
The researchers reviewed 45 studies to systemically summarize the associated risk factors for primary angle-closure glaucoma (PACG) across seven general morphological, physiological and lifestyle indicators, the most frequently investigated of which were diabetes and hypertension.
Cataract, hyperlipidemia, headache, liver diseases, peptic ulcers, sensorineural hearing loss, personal history of venous thromboembolism and constipation were significantly associated with PACG, but no significant association was found with hypertension, cardiovascular disease, migraine and ischemic heart disease.
Antidepressant exposure, current topiramate or bupropion use and short-term exposure to benzodiazepine also were associated with increased risk for PACG.
“This meta-analysis identified 10 primary angle-closure glaucoma–related factors from five different dimensions,” Wang and colleagues wrote. “Screening for relevant factors can help identify high-risk populations of primary angle-closed glaucoma. However, identifying causal evidence between these factors and primary angle-closed glaucoma and applying these potential factors to clinical diagnosis and treatment remain a great challenge for us.”
Perspective
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It is reassuring that the clinical features we associate with PACG were supported in this meta-analysis. Axial length, anterior chamber depth, hyperopic refractive errors and cataracts are known morphometric features of PACG, and these associations were consistent across many of the studies evaluated.
A critical next step would be developing a risk model that would provide the predictive value of each characteristic with respect to PACG. For narrow-angle patients, obtaining serial measurements could be of value diagnostically in conjunction with repeated gonioscopy evaluation.
The meta-analysis also found IOP and RNFL thickness to have associations with PACG, which aligns with our understanding of PACG from a pathophysiological perspective. Antidepressant use was another associated factor, and the pharmacological effects of many medications have been well-documented in terms of risk for PACG. These are vital components in any PACG evaluation.
The association between elevated triglycerides and other serological factors with PACG is intriguing but should be interpreted with caution. The meta-analysis included only a limited number of studies that evaluated serological characteristics and it is premature to incorporate these into clinical testing for PACG management based on this analysis. The relationship between these characteristics and PACG will require further investigation.
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