Association between Metabolic Dysfunction-Associated Steatotic Liver Disease and Intraocular pressure-related...

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is increasingly recognized as a systemic metabolic disorder with potential ocular manifestations. Emerging evidence suggests a relationship between MASLD and glaucoma; however, findings remain inconsistent. We conducted a systematic review to evaluate the association between MASLD and intraocular pressure (IOP) related outcomes.

We retrieved relevant articles from four databases (PubMed, Embase, Scopus, and Cochrane) and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcomes were the proportion with glaucoma and the mean IOP among individuals with MASLD compared with those without fatty liver disease. A meta-analysis was performed to estimate the pooled mean difference (MD) with 95% confidence interval (CI) in IOP between the fatty liver and non-fatty liver groups, using a random-effects model.

Five observational studies involving more than 370,000 participants were included, with four retrospective and one prospective cohort. Across studies, individuals with fatty liver consistently demonstrated higher IOP and a greater risk of glaucoma-related outcomes compared with those without fatty liver disease. Increasing severity of fatty liver was associated with higher IOP in three studies. A meta-analysis comprising 23,625 participants (7,409 with fatty liver and 16,216 healthy) demonstrated a significantly higher mean IOP in patients with fatty liver (MD: 0.81 mmHg; 95% CI: 0.51-1.10; p=0.007).

Current evidence suggests that patients with MASLD have higher intraocular pressure. Individuals with MASLD may represent a high-risk population warranting ophthalmic screening and closer metabolic risk assessment.