Researchers have found a significant association between alcohol consumption and an increased risk of primary open-angle glaucoma. Individuals who consumed four or more alcoholic drinks per week faced a significantly higher risk of developing primary open-angle glaucoma.
Lead study author Leo L.T. Meller, BS, and colleagues at the University of California San Diego utilized a retrospective cohort analysis of electronic health records and survey data from the All of Us Research Program, a U.S. National Institutes of Health initiative designed to include diverse populations historically underrepresented in biomedical research. They analyzed 3,876 patients with primary open-angle glaucoma (POAG) and 15,504 control participants (4:1 ratio). Among patients with POAG, 52% were female, 50% were White, 30% were Black, 3% were Asian, and 15% were Hispanic. Alcohol consumption data were self-reported and categorized into frequency groups: never, monthly or less, two to four times per month, two to three times per week, and four or more times per week. Bivariate and multivariable logistic regression models controlled for age, sex, race, ethnicity, family history of glaucoma, diabetes, hypertension, hyperlipidemia, myopia, migraine, atherosclerosis, substance use, and nicotine dependence.
The researchers found that patients with POAG were more likely to consume four or more drinks per week (15%) compared with controls (12%) (P < .001), they noted in their recent study published in Journal of Glaucoma. Study participants who consumed four or more drinks per week had a 22% increased risk of POAG (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.03–1.44, P = .023), and a dose-response relationship was observed: higher alcohol consumption was associated with a higher risk of glaucoma.
The association was more pronounced in female participants. Even those who drank monthly or less had an increased risk of POAG (OR = 1.21, 95% CI = 1.002–1.46, P = .048), and women who consumed four or more drinks per week had a 52% increased risk of POAG (OR = 1.52, 95% CI = 1.17–1.97, P < .01). No statistically significant association was found in male participants.
Other risk factors included first-degree family history of glaucoma (79% increased risk, OR = 1.79, P < .001), race (Black participants had a 260% higher risk, OR = 3.60, P < .001; and Asian participants had a 207% increased risk, OR = 3.07, P < .001), and co-occurring myopia—which showed the strongest association with POAG (OR = 6.66, P < .001)—hypertension (OR = 1.88, P < .001), and hyperlipidemia (OR = 2.33, P < .001).
The researchers noted prior studies on alcohol and glaucoma risk that have yielded conflicting results. They described a UK Biobank study of mostly White participants that found habitual alcohol consumption was linked to higher intraocular pressure (IOP) and thinner macular ganglion cell layers, as well as a Japanese registry study that reported a positive correlation between alcohol use and POAG prevalence.
Previous research has also hypothesized that chronic alcohol use “can contribute to peripheral neuropathy and that similar mechanisms may be responsible for glaucomatous optic neuropathy,” the study authors described. “[A]lcohol toxicity may result in free radical damage to neuronal tissue, nutritional deficiencies (especially thiamine), as well as direct toxic and proin ammatory effects. Furthermore, alcohol may indirectly increase POAG risk by causing neurodegenerative, cardiovascular diseases, and endocrine disorders, negatively affecting optic nerve perfusion. Therefore, a combination of factors may be responsible for the associations rather than a single factor. In addition, increased oxidative stress and DNA damage associated with chronic alcohol use may exacerbate and/or accelerate age-related changes of the trabecular meshwork. Chronic alcohol consumption is also associated with increased IOP, which may increase POAG risk,” they added.
Current U.S. Dietary Guidelines recommend limiting alcohol intake to up to two drinks per day for men and up to one drink per day for women. Targeted screening for POAG may be beneficial for individuals who have high alcohol intake.
Limitations of the study included self-reported alcohol consumption that may have been subject to recall and social desirability bias. The researchers also noted that observational study design cannot establish causality, and they did not assess alcohol type or duration of use, which could influence glaucoma risk. Further, they explained that the All of Us database does not currently include IOP data, optical coherence tomography data, data on caffeine or sodium intake, or images or clinical notes on patient eye examinations. The researchers suggested that future research should explore substratified data on alcohol type and duration. Additional data in All of Us in the future could also spark reevaluation of the data presented in this study.
“As the global burden of glaucoma is increasing, the identification of modifiable risk factors such as alcohol use may provide an opportunity to improve our understanding of the pathogenesis of glaucoma. Moreover, it can potentially lead to the introduction of preventative measures and treatment strategies beyond IOP reduction,” the study authors concluded.
A full list of disclosures can be found in the published research.