The prevalence of diabetes among male glaucoma patients

Nataliya Antonova; Inci Irak Dersu; Eitan Burstein; Lance Lyons; Wei Hou

doi:10.4103/PAJO.PAJO_31_20

ORIGINAL ARTICLE

Year : 2020 | Volume : 2 | Issue : 1 | Page : 31

The prevalence of diabetes among male glaucoma patients

Nataliya Antonova¹, Inci Irak Dersu¹, Eitan Burstein¹, Lance Lyons¹, Wei Hou²
¹ Department of Ophthalmology, SUNY Downstate Medical Center, New York, USA
² Stony Brook Medical Center, Stony Brook, New York, USA

Date of Submission	25-Jun-2020
Date of Decision	08-Jul-2020
Date of Acceptance	27-Jul-2020
Date of Web Publication	20-Oct-2020

Correspondence Address:
Dr. Nataliya Antonova
450 Clarkson Avenue Brooklyn, NY 11203
USA

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/PAJO.PAJO_31_20

Abstract

Introduction: The purpose of this study was to examine the relationship between diabetes and glaucoma.
Methods: Consecutive 143 subjects with primary angle-closure glaucoma and 127 subjects with primary open-angle glaucoma (control) were studied retrospectively at an urban Veterans Administration Hospital. In addition to ocular examination findings, body mass index (BMI) and diabetes mellitus (DM) status were recorded.
Results: All subjects in this study were male. The mean age was 72.3 years old in primary open angle versus 71.1 in primary angle-closure subjects. Half of the subjects with angle closure and 70% of open-angle subjects were self-identified as African–American. BMI was not significantly different between the two groups (28.2 in open angle vs. 28.7 in angle closure; P = 0.45). The percentage of DM was higher in subjects with primary angle closure than in those with primary open-angle glaucoma (43% vs. 29%, P = 0.001; Chi-square test). The odds of having DM were nearly two times higher in angle-closure subjects than open-angle subjects (Logistic regression, P = 0.01, 95% confidence interval: 1.17–3.30).
Conclusion: In this retrospective study, diabetes was found to be associated with higher risk for primary angle-closure glaucoma.

Keywords: Angle-closure glaucoma, diabetes, open-angle glaucoma

How to cite this article:
Antonova N, Dersu II, Burstein E, Lyons L, Hou W. The prevalence of diabetes among male glaucoma patients. Pan Am J Ophthalmol 2020;2:31

How to cite this URL:
Antonova N, Dersu II, Burstein E, Lyons L, Hou W. The prevalence of diabetes among male glaucoma patients. Pan Am J Ophthalmol [serial online] 2020 [cited 2021 Jun 23];2:31. Available from: https://www.thepajo.org/text.asp?2020/2/1/31/298636

Introduction

More than 60 million people worldwide were estimated to have glaucoma in 2014 with the projection of reaching 111.8 million by 2040.^[1] The numbers among Asian and African descent are particularly on the rise.^[1] Many risk factors have been contributed to the glaucoma. In Rotterdam study, positive family history and high intraocular pressure (IOP) appeared to be risk factors for developing open-angle glaucoma during the two decades of observational study, while body mass index (BMI), gender, or myopia did not seem correlated.^[2] Systemic conditions including obesity and diabetes were reported in various studies as contributing factors for open-angle glaucoma.^{[3],[4],[5],[6]} The relationship between diabetes and angle-closure glaucoma is lesser known. In one large population study conducted in Asia where angle-closure glaucoma is more common than open angle, diabetes along with increasing age and female gender is described as risk factor.^[7]

This study was undertaken to investigate the role of diabetes among male subjects with known glaucoma.

Methods

This study was approved by the Veterans Administration New York Harbor Institutional Review Board and the ethical guidelines were followed. Subjects were chosen from a convenience sample from laser procedure records in the eye clinic. Subjects who underwent laser trabeculoplasty formed open-angle group (control) versus subjects who received laser iridotomy included in angle-closure group. The absence of visualization of 180° or more of pigmented trabecular meshwork with or without synechia qualified the subject for prophylactic laser iridotomy. Subjects who had mixed mechanism glaucoma or previous cataract surgery were excluded.

Data including BMI and the presence of diabetes were collected from the electronic health record. BMI was automatically calculated by the electronic medical records system using the last available data points for height and weight. Only Type II diabetes mellitus (DM) patients were included in this study.

Results

Of 269 subjects, 127 had primary open-angle glaucoma and 142 had primary angle-closure glaucoma. Angle-closure subjects consisted of 80 African–American, 57 Caucasians, and 5 other races. There were 86 African–American, 39 Caucasians, and 2 other races in open-angle group. The mean age was 71.1 (35–92) for primary angle-closure group and 72.3 (41–93) was primary open-angle glaucoma group.

BMI was found to be similar in both the groups (28.2 in open angle vs. 28.7 in angle closure, P = 0.45). Percentage of diabetes was higher in primary angle-closure group than in primary open-angle group (43% vs. 29%, P = 0.001, Chi-square test). Based on the logistic regression, the odds of having diabetes were 1.97 times more likely in primary angle closure than the odds in open angle, 95% confidence interval [CI]: 1.17–3.30, P = 0.01 [Table 1]. Diabetic retinopathy was observed in 20% of diabetic patients in both glaucoma groups.

Table 1: Frequency and percentage of diabetes mellitus by glaucoma type

Click here to view

Discussion

Glaucoma is an optic neuropathy with two studied major mechanisms, one mechanical stress from increased IOP and second being reduced ocular perfusion pressure from variety of local and systemic conditions. The interaction between systemic comorbidities such as obesity, diabetes, hyperlipidemia, hypertension, and glaucoma has been area of interest to researchers in search of reducing the burden of the disease by risk modifications and alternative treatments. Obesity has been previously associated with increased IOP due to elevated episcleral venous pressure and consequently reduction in the outflow.^[8] Diabetes is reported as a risk factor for angle closure in a Taiwanese population-based study, but interestingly, this finding was statistically significant only among males but not females.^[9] In agreement with previous study, there was higher percentage of diabetes in the primary angle-closure subjects compared to primary open-angle subjects (43% vs. 29%, P = 0.001; odds ratio [OR] of 1.97) in this study. In addition, this study is also consistent with the outcome of research conducted in the Indian population where the presence of diabetes was reported significantly associated with increased angle-closure risk (OR: 3.18, 95% CI: 1.34–7.58, P = 0.001).^[7] Furthermore, Saw et al.'s study among Singapore Chinese population (n = 943) found that subjects with self-claimed diabetes had increased risk of angle closure because of thicker lenses and shorter anterior chamber measured by A-mode ultrasound.^[10] In addition to the aforementioned biometric changes, in postmortem eyes, age-related stiffening of scleral matrix has been reported to be accelerated in diabetic eyes.^[11] Another factor to consider in angle-closure glaucoma patients is the choroidal thickness. There is mounting evidence that anterior choroid is thicker in primary angle-closure glaucoma than control subjects.^[12],[13]

Subjects with diabetes usually require pharmacologically dilated eye examinations more often than ones without diabetes. Although the studies point to very low incidence of acute angle-closure glaucoma attack upon dilating diabetic patients, it may be important to identify subjects with angle closure because the condition may cause a detrimental effect on eye pressure and optic nerve health in long term.^[14] Therefore, based on our finding of a higher prevalence of angle closure among diabetic subjects, it is recommended that eye examination in diabetic subjects should be used for the opportunity to screen for angle closure in addition to diabetic retinopathy.

Limitations of this study include, first, the study population included only males, second, subjects were part of a convenience sample who underwent laser, and third, subjects had access to comprehensive health care; therefore, the diagnosis of diabetes may have been understated in a different population.

The strength of the study is diabetes diagnosis which was instituted by a health-care provider rather than being self-claimed; second, as angle-closure glaucoma is more common in females, less information is known in the male population and this study sheds the light on male population.

Conclusion

Diabetes appears to be an independent risk factor for primary angle-closure glaucoma.

It may be advisable to utilize gonioscopic examination more often to assess the angle during the diabetic eye examination.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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