Age at Time of Type 2 Diabetes or Hypertension Diagnosis Linked to Glaucoma Risk

The earlier individuals develop type 2 diabetes or hypertension in life, the earlier they are likely to develop primary open-angle glaucoma (POAG), according to a new study.

The findings, published in Clinical Ophthalmology¹ could lead to better screening protocols for POAG, which accounts for up to 90% of all cases of glaucoma, the University of Texas Southwestern (UTSW) Medical Center said in a news release.²

Because POAG has few symptoms in its earliest stages, patients are frequently diagnosed in its later stages when vision has already been permanently damaged, said Karanjit Kooner, M.D., Ph.D., associate professor of ophthalmology at UTSW.

Although researchers have identified several risk factors for POAG – including type 2 diabetes (T2D), hypertension (HTN), migraines, and obstructive sleep apnea (OSA) – how they might influence the onset of POAG is not well understood. “Diabetes and hypertension have both been associated with glaucoma, but our study focused on whether the age of onset of DM or HTN was associated with the age of POAG diagnosis,” Kooner told Drug Topics.

Kooner and his colleagues collected data from the medical records of 389 POAG patients, all seen by Kooner between June 2019 and December 2019.

They found that the diagnosis of T2D and HTN at an earlier age is associated with the early onset of POAG. Although the association between age at HTN diagnosis and age at POAG diagnosis (1.3% change) was significant, it was noticeably weaker than age at T2D diagnosis and age at POAG diagnosis (8.6% and 6.9% change respectively, the researchers wrote.

The Asian race/ethnicity was associated with earlier development of POAG for patients with T2D with or without HTN.

“Our study has unearthed an extremely important link between T2D, HTN, and glaucoma and this information should be disseminated widely for the benefit of patients and reigning in health care costs,” Kooner said. “Our data provides sufficient evidence to encourage ophthalmological examinations for patients who are diagnosed with T2D or HTN to detect early glaucoma and prevent blindness. This would be especially true for patients with a family history of glaucoma, Black race, and myopia.”

However, the researchers did not find significant contributions in predicting age at POAG diagnosis from gender, race/ethnicity, or BMI [body mass index], Kooner told Drug Topics.

They also did not find significant differences for age at POAG diagnosis based on a history of migraine or OSA. “We were surprised that the age of sleep apnea or migraine diagnosis did not influence the age of POAG diagnosis,” Kooner said.

“The history of migraine has been addressed previously as a possible POAG risk factor, though the relationship is still controversial,” Kooner wrote.

If the connections hold up in future research, type 2 diabetes and hypertension could be added to the list of factors that can trigger POAG screening – including a family history of POAG, elevated intraocular pressure, and Black race – and lead to earlier diagnosis of POAG, preserving patients’ vision and quality of life’, Kooner said.

Kooner and colleagues plan to expand the study further in collaboration with diabetic and hypertensive clinics.

References

1. Wooliscroft J, Akram R, Zuberi H, et al. Predictors of early onset glaucoma. Clin Ophthalmol. 2022 Jun 10;16:1925-1932. doi: 10.2147/OPTH.S360719

2. Early onset of diabetes, hypertension can predict early glaucoma, UTSW ophthalmologists report. News release. University of Texas Southwestern Medical Center. August 29, 2022. Accessed September 6, 2022. https://www.eurekalert.org/news-releases/963150