Oral Contraceptive Use and Prevalence of Self-Reported Glaucoma or Ocular Hypertension in the United States.

PURPOSE: To investigate the association between oral contraceptive (OC) use and glaucoma prevalence in the United States. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 3406 female participants, aged 40 years or older, from the 2005 to 2008 National Health and Nutrition Examination Survey, who reported a presence or absence of glaucoma or ocular hypertension completed both the vision and the reproductive health questionnaires and underwent eye examinations. METHODS: Multivariate regression analysis was used to assess the correlation between OC use and self-reported glaucoma or ocular hypertension (n = 231 cases), controlling for potential confounders, including age, ethnicity, systemic comorbidities such as hypertension and stroke, ocular diseases such as cataract and diabetic retinopathy, and reproductive health factors, including age at menopause, age at menarche, history of hormone replacement therapy, and gynecological surgical history. MAIN OUTCOME MEASURES: The outcome variable was self-reported glaucoma or ocular hypertension. RESULTS: After adjusting for confounders, those with ≥3 years of OC use had greater odds (odds ratio, 1.94; 95% confidence interval, 1.22-3.07) of self-reported glaucoma or ocular hypertension. Other factors associated with higher glaucoma or ocular hypertension prevalence included older age, African American race, and later age at menarche. CONCLUSIONS: Oral contraceptive use may be associated with increased risk of self-reported glaucoma or ocular hypertension.

Mediators of Visual Acuity in Descemet Membrane Endothelial Keratoplasty and Ultrathin Descemet Stripping Automated Endothelial Keratoplasty.

PURPOSE: The aim of this study was to investigate mediators of visual acuity in ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) compared with Descemet membrane endothelial keratoplasty (DMEK). METHODS: This was a prespecified secondary analysis of the Descemet Endothelial Thickness Comparison Trial, a prospective, randomized controlled trial comparing UT-DSAEK with DMEK. Subjects with Fuchs endothelial dystrophy or pseudophakic bullous keratopathy presenting to 2 academic centers were enrolled and randomized to either UT-DSAEK (n = 25 eyes) or DMEK (n = 25 eyes). Higher order aberrations (HOAs) and corneal densitometry were measured with Pentacam Scheimpflug imaging at 3, 6, 12, and 24 months. RESULTS: The posterior corneal surface at the 6.0-mm optical zone had significantly less total HOAs (P <0.001) in the DMEK group compared with UT-DSAEK at 24 months. Anterior and posterior corneal densitometry improved from baseline to 24 months for both UT-DSAEK and DMEK, but there was no significant difference between the 2 groups. Corneal densitometry and posterior HOAs were both associated with best-corrected visual acuity (P <0.05). DMEK had 1.3 logarithm of the minimum angle of resolution better visual acuity compared with UT-DSAEK at 24 months. Approximately 64% of this effect was mediated through posterior HOAs, whereas none was mediated through anterior HOAs or densitometry. CONCLUSIONS: Decreased posterior HOAs mediate better visual acuity and account for improved vision after DMEK compared with UT-DSAEK. Corneal light scatter as measured by densitometry is similar between UT-DSAEK and DMEK, indicating that the increased thickness and stromal-stromal interface in UT-DSAEK do not significantly affect visual acuity.

Association between self-reported bupropion use and glaucoma: a population-based study.

PURPOSE: To investigate the relationship between self-reported bupropion use and self-reported glaucoma in a nationally representative sample of the US population. METHODS: This cross-sectional study included 6760 participants in the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2008, age ≥40 years, who responded to a question regarding their glaucoma status. Participants were interviewed regarding the use of prescription medications, and those ascertained as having used bupropion were further divided into groups based on duration of usage. Other relevant information, including demographics, comorbidities and health-related behaviours, was obtained via interview. Multivariate logistic regression was performed to determine the OR and 95% CIs for association between bupropion use and prevalent glaucoma. Covariates in the final multivariate model included parameters associated with glaucoma at p<0.1: age, gender, ethnicity and annual income. RESULTS: 453 participants self-reported a diagnosis of glaucoma, and 108 reported bupropion medication use. Participants who reported using bupropion for more than 1 year had decreased odds of self-reporting a diagnosis of glaucoma (unadjusted OR=0.5, 95% CI 0.01 to 0.52; adjusted OR=0.1, 95% CI 0.01 to 0.81) compared with those not using bupropion or using it for less than a year. CONCLUSIONS: Bupropion use, particularly for an extended period of time, may be associated with a reduced risk of glaucomatous disease.

Hypothyroidism and Glaucoma in The United States.

PURPOSE: To investigate the association between hypothyroidism and glaucomatous disease. METHODS: This cross-sectional study included all subjects above the age of 40 years from two nationwide surveys: the 2008 National Health Interview Survey (NHIS) as well as the 2007 and 2008 National Health and Nutrition Examination Survey (NHANES). The presence or absence of glaucoma, thyroid disease and other demographic and health-related information including comorbidities was ascertained via interview. Blood samples were collected from NHANES subjects and analyzed for thyrotropin (TSH). RESULTS: A total of 13,599 and 3,839 NHIS and NHANES participants respectively were analyzed to assess for a possible relationship between self-reported glaucoma, and self-reported hypothyroidism as well as self-reported thyroid disease. The unadjusted odds ratio (OR) for NHIS showed a significant association between self-reported glaucoma and self-reported hypothyroidism (OR 1.46, 95% confidence interval [CI] 1.07-1.99). Multivariate logistic regression analysis adjusted for age, gender, race, comorbidities, and health-related behavior, however, showed no association between self-reported glaucoma and hypothyroidism or thyroid disease in both surveys (OR 1.60, 95%CI 0.87-2.95 for NHIS; OR 1.05, 95%CI 0.59-1.88 for NHANES). CONCLUSION: A previously reported association between hypothyroidism and glaucomatous disease was not confirmed in two large U.S. health survey populations. While such an association was noted in the univariate analysis for the NHIS survey, such a relationship was not found in the multivariate analysis after adjustment for potential confounding variables.

Self-reported Calcium Supplementation and Age-Related Macular Degeneration.

IMPORTANCE: Despite widespread use of calcium supplementation among elderly people, little is known about the association between such consumption and the prevalence of age-related macular degeneration (AMD) in the United States. OBJECTIVE: To investigate the association between self-reported supplementary calcium consumption and the prevalence of AMD in a representative US sample. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included 3191 participants 40 years and older in the 2007-2008 National Health and Nutrition Examination Survey (NHANES) who were evaluated for the presence or absence of AMD by fundus photography. Participants were interviewed regarding use of dietary supplements and antacids during the 30-day period preceding enrollment. Self-reported supplementary intake of calcium was aggregated and divided into quintiles. Fundus photographs were graded for the presence or absence of AMD. Information regarding demographics, comorbidities, and health-related behaviors was obtained via interview. Multivariable logistic regression models were created to determine the odds of an AMD diagnosis among participants in each quintile of self-reported calcium vs participants not self-reporting supplementary calcium consumption after adjusting for confounders. INTERVENTIONS: Self-reported use of calcium supplements. MAIN OUTCOMES AND MEASURES: Presence or absence of AMD by fundus photography. RESULTS: A total of 248 participants (7.8%) were diagnosed with AMD. Mean ages were 67.2 years for those with AMD and 55.8 for those without AMD. After adjustment for potential confounding variables, study participants who self-reported consumption of more than 800 mg/d of supplementary calcium were found to have higher odds of an AMD diagnosis based on fundus photography evaluation compared with those not self-reporting supplementary calcium consumption (odds ratio, 1.85; 95% CI, 1.25-2.75). The association between self-reported supplementary calcium intake and AMD was stronger in older than younger individuals (odds ratio, 2.63; 95% CI, 1.52-4.54). A clear dose-response association between the quintiles of self-reported supplementary calcium intake and AMD was not established. CONCLUSIONS AND RELEVANCE: Self-reported supplementary calcium consumption is associated with increased prevalence of AMD, with the findings suggesting a threshold rather than a dose-response relationship. The stronger association in older individuals may be due to relatively longer duration of calcium supplementation in older individuals.

Lens Position Parameters as Predictors of Intraocular Pressure Reduction After Cataract Surgery in Nonglaucomatous Patients With Open Angles.

PURPOSE: To evaluate the relationship between lens position parameters and intraocular pressure (IOP) reduction after cataract surgery in nonglaucomatous eyes with open angles. METHODS: The main outcome of the prospective study was percentage of IOP change, which was calculated using the preoperative IOP and the IOP 4 months after cataract surgery in nonglaucomatous eyes with open angles. Lens position (LP), defined as anterior chamber depth (ACD) + 1/2 lens thickness (LT), was assessed preoperatively using parameters from optical biometry. Preoperative IOP, central corneal thickness, ACD, LT, axial length (AXL), and the ratio of preoperative IOP to ACD (PD ratio) were also evaluated as potential predictors of percentage of IOP change. The predictive values of the parameters we found to be associated with the primary outcome were compared. RESULTS: Four months after cataract surgery, the average IOP reduction was 2.03 ± 2.42 mm Hg, a 12.74% reduction from the preoperative mean of 14.5 ± 3.05 mm Hg. Lens position was correlated with IOP reduction percentage after adjusting for confounders (P = 0.002). Higher preoperative IOP, shallower ACD, shorter AXL, and thicker LT were significantly associated with percentage of IOP decrease. Although not statistically significant, LP was a better predictor of percentage of IOP change compared to PD ratio, preoperative IOP, and ACD. CONCLUSIONS: The percentage of IOP reduction after cataract surgery in nonglaucomatous eyes with open angles is greater in more anteriorly positioned lenses. Lens position, which is convenient to compute by basic ocular biometric data, is an accessible predictor with considerable predictive value for postoperative IOP change.