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B. B. Markowitz, K. B. Mitchell; The Prevalence and Relative Significance of Auto-Immune Disease Among Patients With NTG, POAG, and Ocular Hypertension. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5844.
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There is a known higher prevalence of auto-immune diseases in patients with normal tension glaucoma (NTG). Recent epidemiologic data and immunologic research suggest dysregulation of auto-immune mechanisms may be contributing factors to the development of both NTG and primary open angle glaucoma (POAG). In this retrospective chart review, the prevalence and relative significance of several auto-immune diseases (specifically systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), hypothyroidism (HoT), and hyperthyroidism (HrT)) was determined for patients with a known diagnosis of POAG, NTG, or ocular hypertension (OH) who were examined over a three year period at an academic referral center.
Retrospective chart review of 306 patients with a known diagnosis of POAG, NTG, or OH seen over a three year period (2005 - 2007) to document the presence of any concurrent known diagnosis or history of SLE, RA, HoT, or HrT.
171/306 (55.88%) were diagnosed with POAG, 81/306 (26.47%) with OH, and 54/306 (17.68%) with NTG. In patients with POAG, the prevalence of SLE was 9/171 (5.26%), RA was 12/171 (7.02%), HoT was 31/171 (18.13%), and HrT 25/171 (14.62%). In patients with NTG, the prevalence of SLE was 4/54 (7.41%), RA was 5/54 (9.26%), HoT was 12/54 (22.22%), and HrT was 10/54 (18.52%). In patients with OH, the prevalence of SLE was 2/81 (2.47%), RA was 7/81 (8.64%), HoT was 11/81 (13.58%), and HrT 10/81 (12.36%). There was a statistically significant higher prevalence of SLE in patients with NTG versus OH (p = 0.0412) but not between NTG vs. POAG (p = 0.0701) or between POAG vs. OH (p = 0.0857). There was no significant difference in the prevalence rates of RA among POAG, NTG, and OH. There was a statistically significant higher prevalence of HoT in patients with NTG vs. OH (p = 0.0399) and POAG vs. OH (p = 0.0417), but not between NTG vs. POAG (p = 0.0611). There was a statistically significant higher prevalence of HrT in patients with NTG vs. OH (p = 0.0427) but not between NTG vs. POAG (p = 0.0693) or POAG vs. OH (p = 0.0706). Four patients with POAG (2.34%) and 4 patients with NTG (7.41%) had more than one auto-immune disease diagnoses.
In the population studied, the overall prevalence of the auto-immune diseases investigated is higher in patients with NTG compared to POAG and OH. HoT is more prevalent in patients with NTG and POAG compared to OH while HrT is more prevalent only in the NTG patients. Similar to HrT, SLE is more prevalent in patients with NTG than either POAG or OH. No statistically significant difference in the prevalence of RA was found among those patients with POAG, NTG, or OH. The most common auto-immune disease among POAG, NTG, and OH patients was HoT.
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