Exploring ethnic and racial differences in intraocular pressure and glaucoma: The Canadian Longitudinal Study on aging.

Purpose: To determine whether self-reported race/ethnicity is associated with intraocular pressure (IOP) and glaucoma and to explore whether any associations are due to social, behavioral, genetic, or health differences. Design: Cross-sectional analysis of population-based data. Methods: We used the Canadian Longitudinal Study on Aging Comprehensive Cohort, which consists of 30,097 adults aged 45-85 years. Race/ethnicity was self-reported. Corneal-compensated intraocular pressure (IOP) was measured in mmHg using the Reichert Ocular Response Analyzer. Participants were asked to report if they have ever had a diagnosis of glaucoma and whether they used eye care in the past year. A glaucoma polygenic risk score (PRS) was calculated. Logistic and linear regression models were used. Results: Black individuals had higher mean IOP levels (beta coefficient (ß) = 1.46; 95% confidence interval [CI], 0.62, 2.30) while Chinese, Japanese and Korean (ß = -1.00; 95% CI, -1.63, -0.38) and Southeast Asian and Filipino individuals (ß = -1.56; 95% CI, -2.68, -0.43) had lower mean IOP levels as compared to White individuals after adjustment for sociodemographic, behavioral, genetic, and health-related variables. Black people were more likely to report glaucoma as compared to White people after adjustment (odds ratio [OR] = 2.43; 95% CI, 1.27, 4.64). Conclusion: Racial and ethnic differences in IOP and glaucoma were identified. Adjusting for sociodemographic, behavioral, genetic, and health-related variables did not fully explain these differences. Longitudinal research is needed to further explore the reasons for these differences and to understand their relevance to disease pathogenesis and progression.

Alcohol Consumption, Genetic Risk, and Intraocular Pressure and Glaucoma: The Canadian Longitudinal Study on Aging.

Purpose: The purpose of this study was to examine the association of alcohol consumption with intraocular pressure (IOP) and glaucoma and to assess whether any associations are modified by a glaucoma polygenic risk score (PRS). Methods: Cross-sectional analysis of data from the Canadian Longitudinal Study on Aging Comprehensive Cohort, consisting of 30,097 adults ages 45 to 85 years, was done. Data were collected from 2012 to 2015. Alcohol consumption frequency (never, occasional, weekly, and daily) and type (red wine, white wine, beer, liquor, and other) were measured by an interviewer-administered questionnaire. Total alcohol intake (grams/week) was estimated. IOP was measured in mm Hg using the Reichert Ocular Response Analyzer. Participants reported a diagnosis of glaucoma from a doctor. Logistic and linear regression models were used to adjust for demographic, behavioral, and health variables. Results: Daily drinkers had higher IOP compared to those who never drank (ß = 0.45, 95% confidence interval (CI) = 0.05, 0.86). An increase in total weekly alcohol intake (per 5 drinks) was also associated with higher IOP (ß = 0.20, 95% CI = 0.15, 0.26). The association between total alcohol intake and IOP was stronger in those with a higher genetic risk of glaucoma (P for interaction term = 0.041). There were 1525 people who reported being diagnosed with glaucoma. Alcohol consumption frequency and total alcohol intake were not associated with glaucoma. Conclusions: Alcohol frequency and total alcohol intake were associated with elevated IOP but not with glaucoma. The PRS modified the association between total alcohol intake and IOP. Findings should be confirmed in longitudinal analyses.

A Systematic Review and Meta-analysis of Systemic Antihypertensive Medications With Intraocular Pressure and Glaucoma.

PURPOSE: We synthesized the literature on the association between systemic antihypertensive medications with intraocular pressure (IOP) and glaucoma. Antihypertensive medications included ß-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. DESIGN: Systematic review and meta-analysis. METHODS: Databases were searched for relevant articles until December 5, 2022. Studies were eligible if they examined (1) the association between systemic antihypertensive medications with glaucoma or (2) the association between systemic antihypertensive medications with IOP in those without glaucoma or ocular hypertension. The protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews; registration ID: CRD42022352028). RESULTS: A total of 11 studies were included in the review and 10 studies in the meta-analysis. The 3 studies on IOP were cross-sectional, whereas the 8 studies on glaucoma were primarily longitudinal. In the meta-analysis, ß-blockers were associated with a lower odds of glaucoma (odds ratio: 0.83, 95% CI: 0.75-0.92, 7 studies, n = 219,535) and lower IOP (ß: -0.53, 95% CI: -1.05 to -0.02, 3 studies, n = 28,683). Calcium channel blockers were associated with a higher odds of glaucoma (odds ratio: 1.13, 95% CI: 1.03-1.24, 7 studies, n = 219,535) but not with IOP (ß: -0.11, 95% CI: -0.25 to 0.03, 2 studies, n = 20,620). There were no consistent associations between angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or diuretics with glaucoma or IOP. CONCLUSIONS: Systemic antihypertensive medications have heterogeneous effects on glaucoma and IOP. Clinicians should be aware that systemic antihypertensive medications may mask elevated IOP or positively or negatively affect the risk of glaucoma.

Inverse Association of APOE ε4 and Glaucoma Modified by Systemic Hypertension: The Canadian Longitudinal Study on Aging.

Purpose: Studies examining the apolipoprotein E (APOE) ε4 allele and glaucoma are inconsistent, which could be due to interactions with other factors. We examined the relationship between the APOE ε4 allele and glaucoma and intraocular pressure in a large, population-based random sample and explored whether the APOE ε4 allele interacted with systemic hypertension. Methods: Data came from the Canadian Longitudinal Study on Aging, a population-based study that included 24,655 adults ages 45 to 85 years old in the European ancestry cohort. APOE genotypes were derived from single-nucleotide polymorphisms rs429358 and rs7412. Participants were asked about a prior diagnosis of glaucoma from a doctor. Corneal compensated intraocular pressure (IOP) was measured using the Reichart Ocular Response Analyzer. Results: Having an APOE ε4 allele was associated with a lower odds of glaucoma after adjusting for age, sex, IOP, and the top 10 population structure principal components (odds ratio [OR] = 0.83; 95% confidence interval [CI], 0.69-0.98; P = 0.033). A novel statistically significant interaction was found in that having an APOE ε4 allele was only associated with glaucoma in those without systemic hypertension (OR = 0.62; 95% CI, 0.46-0.85) although it was not associated in those with it (OR = 0.97; 95% CI, 0.79-1.21) (interaction term P value = 0.017). APOE ε4 was not associated with IOP (ß = -0.01; 95% CI, -0.13 to 0.10). Conclusions: Evidence increasingly points to the APOE ε4 allele having protective benefits against glaucoma, but this association was limited to those without systemic hypertension. Further research is needed to understand the biological mechanisms for these findings and the treatment potential they hold.

Visual Impairment, Eye Disease, and 3-Year Cognitive Decline: The Canadian Longitudinal Study on Aging.

PURPOSE: To examine the longitudinal association between vision-related variables and the 3-year change in cognitive test scores in a community-dwelling sample of adults and to explore whether sex, education, or hearing loss act as effect modifiers. METHODS: Data came from two waves of a 3-year population-based prospective cohort study (Canadian Longitudinal Study on Aging), which consisted of 30,097 randomly selected people aged 45-85 years from 7 Canadian provinces. Visual impairment (VI) was defined as binocular presenting visual acuity worse than 20/40. Participants were asked if they had ever had a diagnosis of age-related macular degeneration (AMD), glaucoma, or cataract. Cognitive change over 3 years was examined by calculating the difference between baseline and follow-up scores for the Rey Auditory Verbal Learning Test (RAVLT) and the RAVLT delayed test (memory tests), the Controlled Oral Word Association Test (COWAT) and the Animal Naming Test (ANT) (verbal fluency tests), and the Mental Alternation Test (MAT) (processing speed test). Multiple linear regression was used. RESULTS: VI, AMD, and cataract were not associated with 3-year changes on any of the 5 cognitive tests after adjusting for age, sex, ethnicity, education, income, smoking, diabetes, stroke, heart disease, and province. A report of glaucoma was associated with greater declines in MAT scores (ß = -0.60, 95% CI -1.03, -0.18). No effect modification was detected. CONCLUSIONS: Glaucoma was associated with worsening processing speed. Further research to confirm this finding and to understand the possible reason is necessary.

Fine Particulate Matter and Age-Related Eye Disease: The Canadian Longitudinal Study on Aging.

Purpose: To determine the relationship between fine particulate matter (PM2.5) and ocular outcomes such as visual impairment and age-related eye disease. Methods: Baseline data were used from the Canadian Longitudinal Study on Aging. The Comprehensive Cohort consisted of 30,097 adults ages 45 to 85 years. Annual mean PM2.5 levels (µg/m3) for each participant's postal code were estimated from satellite data. Ozone, sulfur dioxide, and nitrogen dioxide levels were also estimated. Binocular presenting visual acuity was measured using a visual acuity chart. Intraocular pressure (IOP) was measured in millimeters of mercury using the Reichart Ocular Response Analyzer. Participants were asked about a diagnosis of glaucoma, macular degeneration, or cataract. Logistic and linear regression models were used. Results: The overall mean PM2.5 level was 6.5 µg/m3 (SD = 1.8). In the single pollutant models, increased PM2.5 levels (per interquartile range) were associated with visual impairment (odds ratio [OR] = 1.12; 95% confidence interval [CI], 1.02-1.24), glaucoma (OR = 1.14; 95% CI, 1.01-1.29), and visually impairing age-related macular degeneration (OR = 1.52; 95% CI, 1.10-2.09) after adjustment for sociodemographics and disease. PM2.5 had a borderline adjusted association with cataract (OR = 1.06; 95% CI, 0.99-1.14). In the multi-pollutant models, increased PM2.5 was associated with glaucoma and IOP only after adjustment for sociodemographics and disease (OR = 1.24; 95% CI, 1.05-1.46 and ß = 0.24; 95% CI, 0.12-0.37). Conclusions: Increased PM2.5 is associated with glaucoma and IOP. These associations should be confirmed using longitudinal data and potential mechanisms should be explored. If confirmed, this work may have relevance for revision of World Health Organization thresholds to protect human health.

Age-Related Eye Disease and Cognitive Function: The Search for Mediators.

PURPOSE: Age-related eye disease may be associated with cognitive decline, but the scientific literature has not been consistent. Furthermore, no studies have been able to explain the relationship. Our objective was to assess whether older adults with age-related macular degeneration (AMD) or glaucoma performed worse on 6 cognitive tests compared with older adults with normal vision and, if so, to understand why. DESIGN: Cross-sectional analysis of hospital-based study (Maisonneuve-Rosemont Hospital Ophthalmology Clinics, Montréal, Canada). PARTICIPANTS: Three hundred thirty-six adults 65 years of age or older with either AMD, glaucoma, or normal vision. METHODS: Cognition was measured with 6 cognitive tests administered orally. Activity levels were measured using the Victoria Longitudinal Study Activity Lifestyle Questionnaire. Visual acuity and visual field were measured. Multiple linear regression was used. Mediation was assessed using structural equation modeling. MAIN OUTCOME MEASURES: Results of the verbal fluency test (animal and letter versions), the digit span test (forward and backward versions), and the logical memory test (immediate and delayed recall). RESULTS: People with glaucoma showed lower scores on 3 cognitive tests than the group with normal vision: the digit span forward and backward tests (ß = -0.8 [95% confidence interval (CI), -1.5 to -0.2] and ß = -0.7 [95% CI, -1.3 to -0.1], respectively) and the logical memory test with immediate recall (ß = -1.3 [95% CI, -2.4 to -0.2]). Activity levels statistically significantly mediated the relationship between glaucoma and the digit span forward test (P = 0.043; percentage of the total effect mediated, 17%). CONCLUSIONS: People with glaucoma showed lower scores on cognitive tests that may depend on verbal working memory and encoding. If confirmed in longitudinal studies, interventions should be developed that are appropriate for a visually impaired population to slow this cognitive decline.

Age-Related Eye Disease and Participation in Cognitive Activities.

Studies have found a benefit to living a cognitively active life in older age. Our goal was to quantify participation in cognitively stimulating activities in adults with and without age-related eye disease. We conducted a cross-sectional hospital-based study in Montreal, Canada of older adults (n = 303) having either age-related macular degeneration (AMD) (n = 96), glaucoma (n = 93), or normal vision (n = 114). To be eligible, the AMD group had to have bilateral late stage AMD with a better eye visual acuity of 20/30 or worse. The glaucoma group had to have a diagnosis of bilateral primary open-angle glaucoma with visual field mean deviation < = -4 dB in their better eye. Further inclusion criteria included age ≥ 65 and a Mini-Mental State Exam Blind score ≥ 10. Cognitive activities were measured using the Victoria Longitudinal Study Activity Questionnaire. Linear regression was used. Patients with AMD (ß = -4.2, 95% confidence interval (CI) -6.0, -2.4) and glaucoma (ß = -1.8, 95% CI -3.3, -0.3) participated in fewer cognitive activities per month compared to those with normal vision after adjusting for age, sex, education, diabetes, number of comorbidities, cognition, and cataract. People with AMD and glaucoma participated in fewer cognitive activities, which could put them at risk for future cognitive impairment.

Maladaptive coping strategies and glaucoma progression.

The identification of modifiable risk factors for glaucoma progression is needed. Our objective was to determine whether maladaptive coping styles are associated with recent glaucoma progression or worse visual field mean deviation.A hospital-based case-control study was conducted in the Glaucoma Service of Maisonneuve-Rosemont Hospital in Montreal, Canada. Patients with primary open angle glaucoma or normal tension glaucoma with ≥4 years of follow-up and ≥5 Humphrey visual fields were included. Cases had recent visual field progression as defined according to the Early Manifest Glaucoma Trial pattern change probability maps. Controls had stable visual fields. The Brief Cope questionnaire, a 28-item questionnaire about 14 different ways of coping with the stress of a chronic disease, was asked. Questions were also asked about demographic and medical factors, and the medical chart was examined. Outcomes included glaucoma progression (yes, no) and visual field mean deviation. Logistic and linear regressions were used.A total of 180 patients were included (82 progressors and 98 nonprogressors). Although none of the 14 coping scales were associated with glaucoma progression (P > 0.05), higher denial was correlated with worse visual field mean deviation (r = -0.173, P = 0.024). In a linear regression model including age, sex, education, depression, intraocular pressure, and family history of glaucoma, greater levels of denial (ß = -1.37, 95% confidence interval [CI] -2.32, -0.41), Haitian ethnicity (ß = -7.78, 95% CI -12.52, -3.04), and the number of glaucoma medications (ß = -1.20, 95% CI -2.00, -0.38) were statistically significantly associated with visual field mean deviation.The maladaptive coping mechanism of denial was a risk factor for worse visual field mean deviation. Further prospective research will be required to verify the pathways by which denial may exert an effect on glaucomatous visual field loss.

Screening for glaucoma using GDx-VCC in a population with ≥1 risk factors.

OBJECTIVE: To estimate the diagnostic accuracy of the GDx-VCC for glaucoma screening in a population with ≥1 risk factors for glaucoma. DESIGN: Cross-sectional evaluation of a diagnostic test for screening. PARTICIPANTS: Two hundred forty-seven community-based volunteer participants with risk factors for glaucoma. METHODS: The peripapillary retinal nerve fibre layers (RNFL) of participants' eyes were scanned using the GDx-VCC. Based on an ophthalmologic examination and frequency doubling perimetry, eyes were classified into 4 categories: normal, possible glaucoma, probable glaucoma, and definitive glaucoma. The sensitivities, specificities, positive and negative predictive values, and positive and negative likelihood ratios of the RNFL parameters were calculated. RESULTS: The right eyes were retained for analyses. After excluding 5 eyes because of missing data and 23 eyes because of poor scan quality, the data of 219 right eyes were analyzed. Four eyes had definitive glaucoma. The best performing parameter was the nerve fibre indicator using a cutoff of 35 with a sensitivity of 75% (95% CI 19.4-99.4) at a specificity of 95% (95% CI 91.3-97.3), a positive predictive value of 25 (95% CI 4.3-48.1), a negative predictive value of 99 (95% CI 97.5-100.0), a positive likelihood ratio of 16 (95% CI 6.69-32.5), and a negative likelihood ratio of 0.20 (95% CI 0.05-1.44). CONCLUSIONS: The GDx-VCC has inadequate sensitivity for screening of definitive glaucoma.

Estimation of ocular rigidity in glaucoma using ocular pulse amplitude and pulsatile choroidal blood flow.

PURPOSE: Theoretical models and animal studies have suggested that scleral rigidity plays an important role in the pathogenesis of glaucoma. The aim of this study was to present a noninvasive technique for estimating ocular rigidity (E) in vivo, and to compare the estimated rigidity between patients with open-angle glaucoma (OAG); ocular hypertension (OHT); suspect glaucomatous disc (GS); and normal subjects (N). We hypothesized that OHT patients would have higher rigidity. METHODS: All patients underwent measurements of ocular pulse amplitude (OPA) using dynamic contour tonometry, pulsatile choroidal blood flow (ChBFP) using laser Doppler flowmetry; axial length (AL); and assessment of automated visual field mean deviation (MD). The ratio between OPA and ChBFP was calculated according to the Friedenwald's equation of ocular rigidity. The calculated ratio is denoted as (ER). The average ER values of the four diagnostic groups were compared using nonparametric tests. The relationship between ER and other ocular and systemic factors was examined using correlation and regression analysis. RESULTS: A total of 257 subjects were included in the study (56 N, 108 OAG, 48 GS, and 45 OHT). ER correlated negatively with AL and positively with MD, signifying that a lower rigidity was associated with a longer eye and a worse (more negative) MD. ER was also found to be highest in OHT (0.235 ± 0.16) and lowest in OAG (0.188 ± 0.14; P = 0.01). CONCLUSIONS: Estimated coefficient of ocular rigidity by OPA and ChBFP suggested that glaucoma patients had the lowest rigidity and OHT the highest. It supports the idea that a more compliant ocular shell may predispose the optic nerve head to intraocular pressure (IOP)-related damage.

Transconjunctival drainage of serous and hemorrhagic choroidal detachment.

PURPOSE: To describe a novel surgical technique for drainage of bullous serous and hemorrhagic choroidal detachments. METHODS: A prospective, consecutive case series of 6 eyes with serous and/or hemorrhagic choroidal detachments secondary to intraocular surgery was documented to evaluate the feasibility of using the 25-gauge and 20-gauge transconjunctival trocar/cannula systems to drain choroidal detachments. Two eyes had expulsive hemorrhagic choroidal detachments and 4 eyes had serous choroidal detachments after glaucoma surgeries. A 25-gauge infusion line was placed in the anterior chamber. A 20-gauge (in eyes with hemorrhagic choroidal detachments) or a 25-gauge (in eyes with serous detachments) trocar/cannula system was inserted into the suprachoroidal space 7.0 mm from limbus. After drainage, the cannulas were removed and no sutures were placed. Pars plana vitrectomy was performed only in eyes with concomitant pathology that demanded the additional procedure. The primary outcome measure was presence of choroidal detachment at 1 week, 2 weeks, and 1 month postoperatively. Secondary outcome measures were visual acuity at 6 months and intraocular pressure at 1 week and 1, 3, and 6 months postoperatively. RESULTS: Drainage of hemorrhagic choroidal detachments resulted in resolution of the detachments by 1 month postoperatively. In eyes with serous detachments, resolution was achieved by 1 week postdrainage. In both groups, intraocular pressure increased to at least 10 mmHg by postoperative Week 1. The visual acuity improved in all eyes. No complications related to the transconjunctival technique were noted. CONCLUSION: Transconjunctival drainage of serous and hemorrhagic choroidal detachments seems to be a feasible and simple surgical option with minimal scleral and conjunctival damage. Pars plana vitrectomy may not be necessary when draining choroidal detachments in this manner.

The validity of screening for open-angle glaucoma in high-risk populations with single-test screening mode frequency doubling technology perimetry (FDT).

PURPOSE: To evaluate whether a single frequency doubling perimetry (FDT) test is a valid screening tool to detect open-angle glaucoma (OAG) in high-risk populations. PATIENTS AND METHODS: All participants underwent frequency doubling Technology perimetry (FDT C-20-5 algorithm, Carl Zeiss Meditec Inc, Dublin, CA) and complete ophthalmic examination. FDT printouts were classified according to Iwasaki and Patel protocols. Gold-standard was clinical diagnosis of glaucomatous optic nerve damage. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, negative predictive value, positive, and negative likelihood ratios of a single-test screening FDT. RESULTS: Data of 445 right eyes and 408 left eyes of participants were analyzed. On the basis of clinical diagnosis, 19 right eyes (4.3%) and 20 left eyes (4.9%) had glaucoma. Depending on the gold standard used, the range of sensitivity was between 40.7% and 78.9%, 66% and 70% for specificity, 7.7% and 25.2% for positive predictive value, 82.3% and 98.6% for negative predictive value, 1.25 and 2.37 for positive likelihood ratio, and 0.32 and 0.87 for negative likelihood ratio. The κ coefficient of agreement between the FDT classifications as described by Iwasaki et al and Patel et al was 0.936 in right eyes and 0.935 in left eyes. CONCLUSIONS: The sensitivity and specificity of a single reliable screening FDT test were low. Thus, a single screening FDT test in even a high-risk population has poor validity and steps should be taken to better define the target population before testing, and enhance the FDT screening strategy.

Assessment of factors affecting the difference in intraocular pressure measurements between dynamic contour tonometry and goldmann applanation tonometry.

PURPOSE: To determine if the difference in intraocular pressure (IOP) measurements between dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) is correlated with axial length (AL), and to assess the possible influence of age, sex, central corneal thickness (CCT), corneal hysteresis (CH), ocular pulse amplitude (OPA), and glaucoma status on the difference in IOP measurements between the 2 instruments (ΔIOP=DCTIOP- GATIOP). METHODS: Two hundred sixty-oneparticipants (509 eyes) in these 4 groups were included: 53 normal individuals (N; 106 eyes), 112 glaucoma patients (OAG; 212 eyes), 52 glaucoma suspects (GS; 103 eyes), and 44 patients with ocular hypertension (OHT; 88 eyes). The patients who had had an incisional ocular surgery were excluded. All participants underwent IOP evaluation with DCT and GAT and AL, CCT, and CH measurements. The influence of age, sex, AL, CCT, CH, OPA, and glaucoma diagnostic status on ΔIOP was evaluated using correlation analysis and analysis of variance (ANOVA). Right (OD) and left eyes (OS) were analyzed separately. RESULTS: ΔIOP was higher in eyes with longer axial lengths (OD: r=0.142, P=0.02; OS: r=0.233, P<0.001). ΔIOP also correlated with CH (OD: r=-0. 127, P=0.04; OS: r=-0.169, P=0.01), in which the ΔIOP increased as CH decreased (corresponding to less rigid corneas). OPA also correlated negatively with ΔIOP, but the correlation was only statistically significant in left eye (OD: r=-0.112, P=0.08; OS: r=-0.124, P=0.05). Age, CCT, sex, and diagnostic status did not influence ΔIOP significantly. CONCLUSIONS: GAT underestimated IOP more compared with DCT in patients with longer axial length and in patients with lower corneal hysteresis.

Risk of glaucoma in elderly patients treated with inhaled corticosteroids for chronic airflow obstruction.

BACKGROUND: Topical and systemic corticosteroids are well known to raise intra-ocular pressure while the effect of inhaled corticosteroids (ICS) on the risk of glaucoma remains uncertain. We sought to determine the risk of new onset ocular hypertension or glaucoma requiring treatment, associated with the use of ICS in elderly patients treated for airways disease. METHODS: We carried out a nested case-control study using the databases from the Québec provincial health insurance plan. A cohort of patients receiving respiratory medications was formed among all subjects 66 years of age and older. Cases were subjects in whom treatment for glaucoma was initiated between January 1, 1988 and December 31, 2003 after a first ever visit to an ophthalmologist within the preceding 90 days. Age-matched controls were selected among individuals who also visited an ophthalmologist for the first time within 90 days of the case's treatment date and did not receive a treatment for glaucoma. RESULTS: A total of 2291 cases were identified. For comparison, a total of 13,445 age-matched controls were selected. The mean age was (75+/-4.2 years). The adjusted rate ratio for glaucoma was 1.05 (95% CI 0.91-1.20) with ICS use in the preceding 30 days. There was no dose-related effect of ICS on the risk of glaucoma or raised intra-ocular pressure requiring treatment. Continuous use of high-dose ICS for 3 of more months was not associated with an increased risk of glaucoma. CONCLUSION: In a large cohort of elderly patients treated for airways disease, we found that current use and continuous use of high-dose ICS did not result in an increased risk of glaucoma or raised intra-ocular pressure requiring treatment.