Study examines risk of open angle glaucoma in young adults with allergic diseases

(Image Credit: AdobeStock/Sandor Jackal)

A team of researchers has investigated possible links between allergic diseases and the development of primary open-angle glaucoma.

According to the study, researchers authorized data from the Korean National Health Information Database (KNHID), which provides comprehensive medical claims data and information from the National Health Screening Program.¹

Co-lead authors are Kyungdo Han, PhD, and Jin-Hyung Jung, PhD, both professors at the Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea. Younhea Jung, MD, PhD, Kyoung Ohn, MD, and Jung Il Moon, MD, all with the Department of Ophthalmology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, contributed to the study.

“We compared the baseline characteristics of subjects with and without allergic diseases and calculated the incidence and risk of glaucoma development,” they wrote. “Cox proportional hazard regression analysis was used to determine the risk of glaucoma development in subjects with allergic diseases.”

According to the news release, glaucoma is the leading cause of irreversible blindness globally and is expected to increase from 76.5 million patients in 2020 to 111.8 million in 2040.

In the study, a total of 171,129 subjects aged 20 to 39 with or without allergic diseases who underwent a general health examination between 2009 and 2015 were included.

Subjects with allergic diseases showed a higher rate of glaucoma compared to the control group. The hazard ratio (HR) of glaucoma onset was 1.49 and 1.39 in subjects with at least 1 allergic disease prior to and after adjusting for possible contributing factors, respectively. Among allergic diseases, atopic dermatitis (eczema) demonstrated the greatest risk for glaucoma development (aHR 1.73) after adjusting for confounders. Allergic rhinitis demonstrated an increased risk for incident glaucoma after adjustment (aHR 1.38).¹

Asthma showed the lowest incidence, but still an increased risk for glaucoma (aHR 1.22). The links were consistent in all subgroup analyses stratified by smoking, drinking, exercise, sex, diabetes, hypertension, dyslipidemia, or history of steroid use. Allergic diseases are also associated with an increased risk of glaucoma development. Among allergic diseases, atopic dermatitis showed the highest risk for glaucoma development followed by allergic rhinitis and asthma.¹

Although the prevalence of glaucoma increases with age, the prevalence of primary open-angle glaucoma in those aged 19 to 29 and 30 to 39 has been reported to be 1.2% and 2.4%, respectively, in a study using the Korea National Health and Nutrition Examination Survey.²

“Identifying risk factors for early detection and treatment is important, especially in these young adults,” the researchers wrote. “Glaucoma is a progressive neurodegenerative disease, and neuroinflammation has emerged as an increasingly important risk factor for the development and progression of glaucoma.”

Methodology

According to the news release, the nationwide population-based cohort study was approved by the Institutional Review Board of the Yeouido St. Mary’s Hospital, the Catholic University of Korea.

“We included a total of 587,319 subjects who had undergone a general health examination at least once between 2009 and 2015,” the researchers wrote. “The date of the NHSP was regarded as the index date.”

The researchers noted that only people aged 20 to 39 were included in the study (n = 179,501). Those with missing data (n = 4552) and those with previously diagnosed glaucoma (n = 3820) were excluded. Previously diagnosed glaucoma was defined as diagnosis of glaucoma between January 1, 2002, and index date. In total, 171,129 subjects were included in the study and were followed using their medical records until December 31, 2018.¹

“We found significantly increased risk of glaucoma development in allergic diseases in general and in each of the three most common allergic diseases per se,” the researchers wrote. “Among allergic diseases, AD showed the greatest risk of subsequent glaucoma onset, followed by AR and asthma.”

Moreover, the researchers noted the association was significant before and after adjusting for potential confounding factors including a history of steroid use.

“The association between allergic diseases and subsequent glaucoma onset was robustly significant in all subgroups stratified by gender, lifestyle factors including smoking, drinking, and exercise, and systemic diseases including diabetes, hypertension, dyslipidemia, and history of steroid use,” they wrote.

Limitations

Researchers noted more detailed clinical information, such as subtype or severity of diseases, which could lead to further understanding of the possible link between the 2 diseases, could not be assessed.

Additionally, the possibility of detection bias cannot be ruled out. Patients with allergic diseases may visit hospitals more often, resulting in the increased possibility of detecting glaucoma. In addition, our results were robust in all subgroups stratified by gender, lifestyle factors including smoking, drinking, and exercise, and systemic diseases including diabetes, hypertension, dyslipidemia, and history of steroid use.¹

Conclusion

“In conclusion, allergic diseases including AD, AR, and asthma were significantly associated with increased risk of glaucoma development in young adults,” the researchers wrote. “Our findings have clinical implications: because glaucoma is an irreversible progressive disease, screening for glaucoma in those with allergic diseases can be an effective strategy for early glaucoma diagnosis.”

References:

1. Han, K., Jung, JH., Jung, Y. et al. The risk of open angle glaucoma in young adults with allergic diseases: a Nationwide cohort study. Sci Rep 14, 10694 (2024). https://doi.org/10.1038/s41598-024-57619-5

2. Shim, S. H. et al. The prevalence of open-angle glaucoma by age in myopia: The Korea national health and nutrition examination survey. Curr. Eye Res. 42, 65–71 (2017).