Autoimmunity may be involved in the pathogenesis of glaucoma. Image courtesy of Getty Images.
Several studies have suggested an underlying antibody-mediated mechanism involved in the pathogenesis of glaucoma. To further explore a possible relationship, researchers investigated specifically whether primary open-angle glaucoma (POAG) is associated with autoimmune disease (AiD) in ophthalmic surgery patients. They found a higher prevalence of AiD in POAG patients, confirming that an association between the two does exist.
The retrospective, cross-sectional study included 172 POAG patients undergoing ophthalmic surgery and 179 controls undergoing cataract surgery at Massachusetts Eye and Ear. A thorough chart review was done for each patient, and diagnoses were determined to be autoimmune or autoimmune-related based on the American Autoimmune-related Diseases Association disease list.
The analysis revealed the overall prevalence of autoimmune disease to be 17.4% in the POAG group and 10.1% in the control group. A higher number of POAG patients had more than one AiD compared with controls (6.4% vs. 3.4%).
“The most prevalent AiD in the POAG group was rheumatoid arthritis (4.6%), followed by psoriasis (4.1%), non-infectious anterior uveitis (2.9%) and Graves’ disease (1.7%),” the researchers wrote in their study. “In control subjects, psoriasis and rheumatoid arthritis were the most prevalent (2.8% for each), followed by Raynaud’s syndrome, Sjogren syndrome and Hashimoto’s thyroiditis (1.7% for each).”
The researchers concluded, “Having an AiD was associated with 2.62-fold increased odds of POAG relative to controls.” Additional risk factors associated with POAG included older age, diabetes and non-White ethnicity. Systemic steroid use (either intravenous or oral) for longer than four weeks was also more significantly associated with POAG patients with AiD than without (16.7% vs. 2.8%).
The findings from this study demonstrated that “the presence of [T-cell mediated] AiD was associated with increased risk for POAG after adjusting for covariates. Autoimmunity should be explored further in the pathogenesis of POAG.”
Lorenzo MM, Devlin J, Saini C, et al. The prevalence of autoimmune diseases in primary open angle glaucoma patients undergoing ophthalmic surgeries. Ophthalmology. August 3, 2021. [Epub ahead of print].