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Rohit Chandramohan Khanna, Murthy V S Gudlavalleti, Pyda Giridhar, Srinivas Marmamula, Hira B Pant, Ghanshyam Palamaner Subash Shantha, Subhabrata Chakrabarti, Clare Gilbert, Gullapalli N Rao; Glaucoma-Associated Long-term Mortality in a Rural Cohort from India: The Andhra Pradesh Eye Disease Study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2684.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate glaucoma-associated mortality in a longitudinal cohort in rural India.
Between 1996-2000, 10,293 participants of all ages from three rural and one urban location were examined in the Andhra Pradesh Eye Diseases Study (APEDS1). About a decade later (June 2009-Jan 2010), participants in the three rural areas were traced (APEDS2): the urban sample no longer existed. History of death or migration were recorded for those not available. All underwent detailed examination, including measurement of intraocular pressure (IOP), cup:disc ratio and visual field testing. Glaucoma was defined using International Society of Geographic and Epidemiologic Ophthalmology criteria. Hyperopia and myopia were defined as spherical equivalent of >+/- 0.5D Sph. Mortality hazard ratio (HR) analysis was performed using Cox proportional hazard regression for those ≥40 years at APEDS1, adjusting for age, sex, diabetes, hypertension, body mass index, smoking, education, visual impairment, cataract and age related macular degeneration.
At APEDS1, there were 2790 participants aged >40 years in the three rural areas. 1322 (47.4%) were male. Overall, 739 (26.5%) had died and 172 (6.2%) had migrated. Migration was higher (52.3%) in females. At baseline, 45 participants had primary open angle glaucoma (POAG) and 66 had primary angle closure disease (PACD). At follow-up, 22/45 (48.8%) with POAG and 22/66 (33.3%) with PACD had died. Univariate analysis indicated increased hazard of mortality in those with POAG (HR=1.9 [95% CI: 1.23-2.94]), pseudoexfoliation (HR=2.79 [95% CI: 2.0-3.89]), myopia (HR=1.78 [95% CI: 1.54-2.06]) and unit increase in cup:disc ratio (HR=4.49 [95% CI: 2.64-7.64]). Hyperopia was protective (HR=0.85 [95% CI: 0.71-1.0]). There was no association with PACD, IOP or family history of glaucoma. In multivariable analysis, cup:disc ratio remained independently associated with mortality with a HR of 2.5 [95% CI: 1.3-5.1] for each unit increase in cup:disc ratio. The association remained significant when other ocular parameters were included in the model (HR=2.1 [95% CI: 1.03-4.2]).
To the best of our knowledge, ours is the first longitudinal study to assess mortality and its association with glaucoma in a longitudinal rural cohort from India. Increased cup:disc ratio could be a marker for aging and needs further validation in elderly cohorts in other populations.
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