The Multifaceted Non-Genetic Risk Factors for Primary Open-Angle Glaucoma - An Overview of Systematic Reviews

Jens Rovelt; Josefine Freiberg; Augusto Azuara-Blanco; Gianni Virgili; Miriam Kolko

doi:10.1016/j.ogla.2024.10.004

The Multifaceted Non-Genetic Risk Factors for Primary Open-Angle Glaucoma - An Overview of Systematic Reviews

Ophthalmol Glaucoma. 2024 Oct 15:S2589-4196(24)00182-0. doi: 10.1016/j.ogla.2024.10.004. Online ahead of print.

Authors

Jens Rovelt¹, Josefine Freiberg¹, Augusto Azuara-Blanco², Gianni Virgili³, Miriam Kolko⁴

Affiliations

¹ Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
² Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
³ Department of Neurosciences, Psychology Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy.
⁴ Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark. Electronic address: miriamk@sund.ku.dk.

PMID: 39419202
DOI: 10.1016/j.ogla.2024.10.004

Abstract

Topic: A synthesis of the current knowledge on risk factors for primary open-angle glaucoma (POAG).

Method: We conducted a systematic search of PubMed, Embase, Web of Science, and the Cochrane Library to identify relevant systematic reviews (SR) published in English after 2012. The inclusion criteria focused on SRs investigating risk factors for POAG. We registered the study prospectively in the PROSPERO database (CRD42022351372) and used Covidence and the Risk Of Bias In Systematic reviews (ROBIS) tool to manage article selection and assess the risk of bias in the included SRs. Data was extracted independently by two authors.

Results: After removing duplicate SRs, we assessed 2,542 SRs. Of these, 2,396 were determined to be irrelevant, leaving 138 for a full text review. Following this, 78 were excluded with reasons, resulting in 57 SRs. Of these, 30 had a low risk of bias. In our bias assessment, SRs categorized as high risk of bias were characterized by 1) lack of sufficient detail in the bias assessment of the SR and 2) insufficient information or missing calculations of heterogeneity among the included studies. In our study, we identified 22 risk factors associated with POAG. The SRs covered a wide range of risk factors for POAG. Among these, the strongest associations with glaucoma, based on effect size, were observed in two SRs related to obstructive sleep apnea (OSA), with a pooled odds ratio (OR) of 3.66 (95% CI: 1.70-7.90) and an adjusted OR of 2.46 (95% CI: 1.32-4.59). Similarly, two SRs investigating Helicobacter pylori (H. pylori) infections showed significant associations, with pooled ORs of 2.08 (95% CI: 1.48-2.93) and 2.08 (95% CI: 1.42-3.04), respectively.

Conclusion: This article summarizes the current knowledge on risk factors for POAG from published SRs. Our findings highlight the complexity of the disease and the nature of the factors that may affect various populations. Among the reported associations with low risk of bias, we found the highest effect estimates for OSA and H. pylori infections in relation to POAG. Our review helps advance understanding, guide future research and inform strategies for the prevention and treatment of POAG.

Keywords: Overview of systematic review; glaucoma; primary open-angle glaucoma; risk factors; systematic review.