Baseline risk factors that predict the development of open-angle glaucoma in a population: the Los Angeles Latino Eye Study

Abstract

Objective: To determine which baseline sociodemographic, lifestyle, anthropometric, clinical, and ocular risk factors predict the development of open-angle glaucoma (OAG) in an adult population.

Design: A population-based, prospective cohort study.

Participants: A total of 3772 self-identified Latinos aged ≥40 years from Los Angeles, California, who were free of OAG at baseline.

Methods: Participants from the Los Angeles Latino Eye Study had standardized study visits at baseline and 4-year follow-up with structured interviews and a comprehensive ophthalmologic examination. We defined OAG as the presence of an open angle and a glaucomatous visual field abnormality and/or evidence of glaucomatous optic nerve damage in ≥1 eye. Multivariate logistic regression with stepwise selection was performed to determine which potential baseline risk factors independently predict the development of OAG.

Main outcome measures: Odds ratios for various risk factors.

Results: Over the 4-year follow-up, 87 participants developed OAG. The baseline risk factors that predict the development of OAG include older age (odds ratio [OR] per decade, 2.19; 95% confidence interval [CI], 1.74-2.75; P<0.001), higher intraocular pressure (IOP; OR per mmHg, 1.18; 95% CI, 1.10-1.26; P<0.001), longer axial length (OR per mm, 1.48; 95% CI, 1.22-1.80; P<0.001), thinner central cornea (OR per 40 μm thinner, 1.30; 95% CI, 1.00-1.70; P = 0.050), higher waist-to-hip ratio (OR per 0.05 higher, 1.21; 95% CI, 1.05-1.39; P = 0.007) and lack of vision insurance (OR, 2.08; 95% CI, 1.26-3.41; P = 0.004).

Conclusions: Despite a mean baseline IOP of 14 mmHg in Latinos, higher IOP is an important risk factor for developing OAG. Biometric measures suggestive of less structural support such as longer axial length and thin central corneal thickness were identified as important risk factors. Lack of health insurance reduces access to eye care and increases the burden of OAG by reducing the likelihood of early detection and treatment of OAG.

Financial disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

FIGURE 1

LOWESS plot demonstrating the independent relationship between baseline intraocular pressure and the four-year incidence of open-angle glaucoma in the Los Angeles Latino Eye Study. The predicted four-year incidence of open-angle glaucoma was estimated using a locally weighted regression after adjusting for other covariates found to be significant in the final logistic regression model. LOWESS=locally weighted scatterplot smoothing; OAG=open-angle glaucoma; IOP=intraocular pressure.

FIGURE 2

LOWESS plots illustrating the independent relationship between baseline intraocular pressure and the four-year incidence of open-angle glaucoma stratified by central corneal thickness in the Los Angeles Latino Eye Study. The predicted four-year incidence of open-angle glaucoma was estimated using a locally weighted regression after adjusting for other covariates found to be significant in the final logistic regression model. LOWESS=locally weighted scatterplot smoothing; OAG=open-angle glaucoma; IOP=intraocular pressure; CCT=central corneal thickness.

FIGURE 3

LOWESS plots illustrating the independent relationship between baseline axial length and the four-year incidence of open-angle glaucoma in the Los Angeles Latino Eye Study. The predicted four-year incidence of open-angle glaucoma was estimated using a locally weighted regression after adjusting for other covariates found to be significant in the final logistic regression model. LOWESS=locally weighted scatterplot smoothing; OAG=open-angle glaucoma.