Abstract
Purpose :
The long anterior zonule (LAZ) trait is characterized by zonular fibers extending central to the normal anterior capsular insertion zone. It is frequently accompanied by pigment dispersion signs, and is hypothesized to be associated with glaucoma. Rarely, LAZ may be caused by a S163R mutation in the C1q tumor necrosis factor-related protein 5 gene (C1QTNF5/CTRP5) in association with late-onset macular degeneration, but a more common variety is idiopathic with potential prevalence of 2% or higher. The purpose of this analysis was to investigate the relationship between LAZ and glaucoma.
Methods :
As part of an ongoing investigation, ocular and general health information was collected during 2011-2017 on consecutive patients belonging to several practitioners in an urban academic eye care facility in Chicago, Illinois, USA. All patients were examined for the LAZ trait, and information on ocular, systemic health, lifestyle, and other demographic variables was collected from the medical record as well as from a questionnaire administered at time of exam. Patients were excluded if they were <18 years of age, refused consent, did not have pupil dilation, or if there was history of intraocular surgery, uveitis, or significant ocular trauma. Controlling for numerous factors, multivariate regression was used to explore the relationship between LAZ and presence of glaucoma or ocular hypertension.
Results :
Analysis included 3,057 subjects (mean age=51.0 +/- 15.3 years, 84% African-American, 64.8% female), with 94 of these people having >trace LAZ in the right eye (mean age=64.3 +/- 11.0 years, 94.7% African-American, 78.7% female). Among non-LAZ eyes, 4.1% (N=119) were treated with glaucoma medications, and among LAZ eyes, 14.9% (N=14) were taking glaucoma medications (P<0.0001). Controlling for other significant factors (P<0.05), including age, race, refractive error, BMI, and history of smoking, the association between LAZ and use of glaucoma medications was retained (P<0.05), with LAZ eyes being 2.0x more likely (OR=2.0, 95%CI=1.1 to 3.9) to be treated with glaucoma medications than eyes not having LAZ.
Conclusions :
This investigation supports the hypothesis that eyes with the LAZ trait may have elevated risk of glaucoma. Further study of this association is warranted.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.