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Published on: May 25, 2020
Incidence and Risk Factors of Glaucoma in a Health Screening Cohort: Findings Over 10 Years from the Gangnam Eye
Eunoo Bak1, Jin-Soo Kim2, Dae Joong Ma3
1From the Department of Ophthalmology, Uijeongbu Eulji Medical Center (E.B.), Eulji University School of Medicine, Uijeongbu, Republic of Korea; Department of Ophthalmology (E.B., J.S.K., D.J.M., J.L., B.L.O., H.J.C.), Seoul National University College of Medicine, Seoul, Republic of Korea.
Purpose:
To investigate the long-term incidence of structural glaucoma conversion and associated ocular and systemic risk factors in a large Korean health screening cohort.
Design:
Retrospective cohort study.
Participants:
A total of 17 212 Korean adults with no evidence of glaucomatous structural change at baseline who underwent health screening at the Seoul National University Hospital Healthcare System Gangnam Center and had follow-up fundus photographs 10 years or more after baseline.
Methods:
Serial fundus photographs were reviewed to identify incident reproducible glaucomatous structural change. Glaucoma conversion was defined as the development of definite structural glaucomatous change in eyes with normal baseline findings. Incidence was estimated using Kaplan-Meier analysis, and associated risk factors were evaluated using Cox proportional hazards models.
Main Outcome Measures:
Incidence of structural glaucoma conversion and ocular and systemic risk factors associated with conversion.
Results:
During a mean follow-up of 13.0 ± 2.0 years, structural glaucoma conversion occurred in 399 participants (2.3%), with an incidence rate of 180.2 cases per 100 000 person-years. In multivariable Cox models, glaucoma conversion was independently associated with older age (per 1-year increase; hazard ratio [HR], 1.017; 95% CI, 1.006-1.028), higher intraocular pressure (per 1-mmHg increase; HR, 1.158; 95% CI, 1.117-1.199), retinal arteriosclerosis (HR, 1.459; 95% CI, 1.247-1.708), higher serum uric acid (per 1-mg/dL increase; HR, 1.080; 95% CI, 1.002-1.164), and total cholesterol (per 10-mg/dL increase; HR, 1.096; 95% CI, 1.003-1.199).
Conclusions:
In this large Korean health screening cohort, retinal arteriosclerosis detected on routine fundus photographs was associated with structural glaucoma conversion. These findings suggest that microvascular changes, together with intraocular pressure and systemic metabolic factors, may help refine glaucoma risk stratification in preventive eye screening settings.
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