Associations of smoking and alcohol consumption with the development of open angle glaucoma: a retrospective cohort study

Abstract

Objectives: To investigate the associations of alcohol consumption and smoking with the development of perimetric glaucoma in patients with suspected glaucoma.

Design: A retrospective cohort study of patients suspected to have glaucoma enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES).

Setting: Three tertiary glaucoma centres in the USA.

Participants: 825 eyes of 610 patients with glaucoma suspect eyes with normal visual fields (VF) at baseline were followed over an average of 9 years from the DIGS and ADAGES studies.

Outcome measures: Development of glaucoma was defined as occurrence of three consecutive abnormal VF tests during follow-up. Univariable and multivariable Cox regression models were used to investigate lifestyle-related factors associated with development of VF loss over time.

Results: VF tests were abnormal three times in a row in 235 (28.5%) eyes. Alcohol consumption was associated with a higher risk of developing glaucoma (HR 1.57, 95% CI 1.03 to 2.38, p=0.037). In men, the risk of developing glaucoma in alcohol drinkers (HR 1.92, 95% CI 1.00 to 3.68, p=0.048) was greater than non-alcohol drinkers. In individuals of African descent, the risk of developing glaucoma in alcohol drinkers (HR 1.79, 95% CI 1.02 to 3.15, p=0.043) was greater than non-alcohol drinkers. Age was a modifier of the relationship between smoking and glaucomatous VF defects (p=0.048). The risk of developing glaucoma in smokers (HR 1.73, 95% CI 1.10 to 2.72, p=0.019) was greater than never smokers after adjustment for confounding factors in older patients (age >61 years).

Conclusion: Alcohol consumption was associated with an increased risk of developing glaucoma, particularly in men and individuals of African descent. The risk of developing glaucoma among smokers suspected of having glaucoma was influenced by age, with older individuals having a higher risk than younger people.

Trial registration number: NCT00221897 and NCT00221923.

Keywords: epidemiology; glaucoma; medical ophthalmology.

Figure 1

Cumulative probability of glaucoma development in glaucoma suspect eyes between smokers and never smokers at different levels of age (≤61 years in panel A vs >61 in panel B). In panel A, 34 (23.8%) and 50 (18.5%) of eyes developed glaucoma in smokers versus never smokers, respectively. In panel B, 79 (40.9%) versus 72 (32.8%) of eyes developed glaucoma in smokers versus never smokers, respectively.

Figure 2

The cumulative probability of glaucoma development in glaucoma suspect eyes between alcohol drinkers and non-alcohol drinkers by sex (men in panel A vs women in panel B). In panel A, 58 (43.3%) versus 16 (27.6%) of eyes developed glaucoma in alcohol drinkers versus non-alcohol drinkers. In panel B, 27 (37.0%) versus 57 (32.1%) of eyes developed glaucoma in alcohol drinkers versus non-alcohol drinkers.

Figure 3

The cumulative probability of glaucoma development in glaucoma suspect eyes between alcohol drinkers and non-alcohol drinkers by ethnicity (non-African descent in panel A versus African descent in panel B). In panel A, 77 (37.6%) versus 24 (31.2%) of eyes developed glaucoma in alcohol drinker versus non-alcohol drinkers. In panel B, 38 (45.8%) versus 19 (29.2%) of eyes developed glaucoma in alcohol drinker versus non-alcohol drinkers.