Study Finds Significant Glaucoma Surgery, Mortality Risk Link in Elderly Patients

Elderly patients who underwent surgery for glaucoma had a greater risk of all-cause and cause-specific mortality than those who did not have surgery, including greater risk of cancer and neurologic cause–related mortality.

Glaucoma surgery may increase risk of mortality in elderly patients with glaucoma, according to study findings published this week in Scientific Reports.

As the leading cause of irreversible blindness worldwide, glaucoma has been associated with a greater risk of mortality, as well as increased risk of neurologic conditions such as Alzheimer disease and Parkinson disease. In managing the condition, patients whose intraocular pressure (IOP) and rate of glaucomatous damage are not sufficiently reduced by first-line treatment with topical medications are recommended to undergo surgery, which works to induce maximum IOP reduction.

However, researchers note that the glaucoma status of patients who undergo glaucoma surgery is likely to differ from that of patients who only received medical treatment, indicating that risks posed for patients with glaucoma who have and have not undergone surgery may differ as well.

With no studies having investigated the association between glaucoma surgery and mortality, researchers conducted a population-based, retrospective cohort study of elderly Korean patients with glaucoma registered in the Korean National Health Insurance Service-Senior cohort (KNHIS-Senior) database.

The study included 16,210 patients (mean [SD] age, 72.6 [5.6] years) diagnosed with open angle glaucoma or angle closure glaucoma from 2003 to 2012, with participants who underwent glaucoma surgery (n = 487) and those who did not (n = 15,723), referred to as the glaucoma diagnosis group, evaluated for all-cause and cause-specific mortality, including cancer, neurologic, and accident or trauma.

Of the study cohort, patients 70 years or older tended not to opt for glaucoma surgery (absolute standardized difference [ASD], 0.228), with individuals in the glaucoma surgery group significantly younger than those in the glaucoma diagnosis group (ASD, 0.237).

After accounting for covariates, including sociodemographic factors, Charlson Comorbidity Index score, and ocular comorbidities, the adjusted risk for all-cause mortality associated with glaucoma surgery indicated a 31% increased risk compared with that of the glaucoma diagnosis group (adjusted HR [aHR], 1.31; 95% CI, 1.05-1.62; P = .014).

Overall, the incidence of all-cause mortality was greater in the glaucoma surgery group than in the glaucoma diagnosis group (34.76/1000 person-years vs 27.88/1000 person-years).

In assessing cause-specific mortality, a significant association was found between glaucoma surgery and mortality due to a neurologic cause (aHR, 2.66; 95% CI, 1.18-6.00; P = .018), compared with the glaucoma diagnosis group.

Furthermore, a significantly greater risk of mortality due to cancer and accident or trauma was reported in participants of the glaucoma surgery group who had angle closure glaucoma but not open angle glaucoma (cancer: aHR, 2.03; 95% CI, 1.07-3.83; P = .029; accident or trauma: aHR, 4.00; 95% CI, 1.55-10.34; P = .004).

Addressing the differentiation in risk by the type of glaucoma reported in patients, the study authors concluded that continuous surveillance by health care providers and patients during follow-up is necessary for the reduction and prevention of deaths of patients who undergo glaucoma surgery.

“Additionally, we believe that it is important to detect and treat glaucoma early to minimize the need for surgical treatment.”

Reference

Lee SY, Lee H, Lee JS, et al. Association between glaucoma surgery and all‑cause and cause‑specific mortality among elderly patients with glaucoma: a nationwide population-based cohort study. Sci Rep. Published online August 23, 2021. doi:10.1038/s41598-021-96063-7