Abstract
PurposeWe aim to assess the longitudinal association between baseline estimated cerebrospinal fluid pressure (CSFP) and 5-year incident primary open angle glaucoma (POAG) in a population-based sample of Bai Chinese living in rural China.MethodsAmong the 2133 Bai Chinese aged 50 years or older who had participated in the baseline examination of the Yunnan Minority Eye Study, 1520 (71.3%) attended the follow-up examination after five years and 1485 were at risk of developing POAG. Participants underwent comprehensive ophthalmic examinations at both baseline and follow-up surveys. CSFP in mmHg was estimated as 0.55 × body mass index (kg/m2) + 0.16 × diastolic blood pressure (mmHg)-0.18 × age (years)-1.91. Glaucoma was defined using the International Society of Geographical and Epidemiological Ophthalmology Classification criteria. Multivariate logistic regression models were established to determine the association between baseline CSFP and incident POAG.ResultsAfter a mean follow-up time of 5 years, 19 new cases of POAG were detected, with an incidence rate of 1.3% (95% confidence interval, 0.7–1.9%). In multivariate logistic regression analysis, after adjusting for age, gender, education, intraocular pressure, central corneal thickness, hypertension and diabetes, no significant associations, nor any trends, were evident between baseline estimated CSFP and incident POAG. The association between estimated CSFP per mmHg increase in baseline and 5-year incidence of POAG was also non-significant, with adjusted relative risk of 0.96 (P = 0.11) in multivariate analysis.ConclusionsThis longitudinal cohort study does not support previously observed cross-sectional association between estimated CSFP and POAG in population-based studies.
Highlights
Glaucoma is the leading cause of irreversible blindness throughout the world, which affects more than 60 million people currently and will affect more 100 million by the year 2040.[1]
The association between estimated cerebrospinal fluid pressure (CSFP) per mmHg increase in baseline and 5-year incidence of Primary open angle glaucoma (POAG) was nonsignificant, with adjusted relative risk of 0.96 (P = 0.11) in multivariate analysis
Recent studies indicated that cerebrospinal fluid pressure (CSFP) or trans-lamina cribrosa pressure difference may be involved in the pathogenesis of glaucomatous optic neuropathy.[7,8,9,10]
Summary
Glaucoma is the leading cause of irreversible blindness throughout the world, which affects more than 60 million people currently and will affect more 100 million by the year 2040.[1]. Most of the studies were retrospective or cross-sectional in nature, from which the evidence is far from conclusive. Selection bias inherent to the casecontrol design and the lack of temporal information provided by the cross-sectional nature of population-based surveys has made the findings less convincing. Population-based longitudinal assessment would reduce the selection bias of the studied population and be important for clarifying the potential causal association by providing temporal information. To the best of our knowledge, there have been no population-based longitudinal studies reporting the association between CSFP and incident POAG
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