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J.-P. G. Renard, J. Rouland, E. Sellem, A. Bron, J. Nordmann, C. Baudouin, P. Denis, S. Pinchinat, F. Levrat, C. DelCourt; Risk Factors Associated With Primary Open-Angle Glaucoma and Ocular Hypertension: French Epidemiological Case Control Study. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3991.
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Many risk factors (RF) may be related to the onset and development of primary open-angle glaucoma (POAG) development. The aim of the photoGRAF study was to evaluate known and potential risk factors (RF), including nutritional and environmental factors, differentiating patients with POAG from control subjects with isolated ocular hypertension (OHT).
This French multicentric, cross-sectional case-control study include 769 patients: 339 pairs of POAG cases and OHT age matched controls (± 5 years). Ophthalmologists had to include 1 to 4 patients with POAG and a corresponding number of age-matched control OHT. The comparisons were performed by a stratified conditional logistic regression for matched sets.
The mean age of patients was 63.6 years (± 10.5) with a mean duration of disease of 6 years. After adjusting for age, gender and duration of disease, the following ocular RF were identified: IOP ≥ 24 mmHg at diagnosis (OR=3.04 [1.46 - 6.35]), central corneal thickness (CCT) <510 µm (OR=4.92 [1.26 - 19.24]) and βperipapillary atrophy (β-PPA) (OR=17.90 [5.14 - 62.29]). Among systemic factors, hypercholesterolemia was associated with a higher risk of POAG (OR=1.75 [1.12 - 2.72]), hypothyroidism with a decreased risk (OR=0.33 [0.11 - 0.96]). A positive association with POAG was found in case of low consumption of wallnuts (<8 times/year)(OR=2.02 [1.18 - 3.47]), oily fish (OR=2.14 [1.10 - 4.17]) and in case of exposure to pesticides (OR=2.65 [1.04 - 6.78]).
This study confirm the main known ocular RF for POAG (IOP, CCT, b-PPA) and reveal some associations still under debate in the literature: hypercholesterolemia, hypothyroidism. The results also suggest a protective effect of omega-3 fatty acids (wallnuts and oily fish) and raised the deleterious effect of exposure to pesticides. The possible neuroprotective action of omega-3 fatty acids and neurotoxic impact of exposure to pesticides, which need further confirmation, open up new perspectives in the management of glaucoma
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