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Association Between Systemic Comorbidity Burden and Glaucoma Progression: A 5-Year Cohort Study

Melody Y Zhou1, Hayden Reed2, Rishi P Singh3,4,5

  • 1Case Western Reserve University School of Medicine.

Journal of Glaucoma
|June 1, 2026
PubMed

Insights

Higher comorbidity burden, measured by the age-adjusted Charlson Comorbidity Index (age-CCI), increases glaucoma progression risk. This finding supports integrating systemic health assessments into glaucoma management strategies for better risk stratification.

Area of Science:

  • Ophthalmology
  • Public Health
  • Geriatrics

Background:

  • Glaucoma progression is a leading cause of irreversible blindness worldwide.
  • Systemic health comorbidities are increasingly recognized as potential risk factors influencing ocular disease outcomes.
  • The age-adjusted Charlson Comorbidity Index (age-CCI) is a validated measure of overall health burden.

Purpose of the Study:

  • To investigate the association between higher comorbidity burden, quantified by the age-CCI, and the odds of glaucoma progression over a five-year period.
  • To determine if the age-CCI can serve as a tool for stratifying glaucoma progression risk.
  • To explore potential differential effects of comorbidity burden on glaucoma progression based on disease severity.

Main Methods:

  • Retrospective cohort study of 11,863 adult patients with primary open-angle glaucoma, preglaucoma, or ocular hypertension.
  • Age-CCI scores were calculated using ICD-10 diagnoses.
  • Multivariate logistic regression analyzed the association between age-CCI and glaucoma progression, adjusting for covariates, with stratification by disease stage and comorbidity tertiles.

Main Results:

  • Each one-point increase in age-CCI correlated with a 6% increased odds of progression from early to moderate-stage glaucoma (OR=1.06) and a 9% increase in odds of progression to severe-stage (OR=1.09).
  • Associations between age-CCI and progression varied by disease stage and comorbidity burden tertile.
  • Male sex, Black race, public insurance, ophthalmic procedure history, and increased medication use were also linked to higher progression odds.

Conclusions:

  • Elevated age-adjusted Charlson Comorbidity Index scores are significantly associated with increased glaucoma progression.
  • The impact of comorbidity burden on glaucoma progression differs based on the disease's current stage and the patient's overall health status.
  • The age-CCI demonstrates utility as a practical tool for enhancing glaucoma risk stratification and guiding management decisions.
Abstract

Keywords:
Charlson comorbidity indexglaucoma progressionmultimorbidityrisk stratification

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