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Global issues
Glaucoma-associated long-term mortality in a rural cohort from India: the Andhra Pradesh Eye Disease Study
  1. Rohit C Khanna1,2,
  2. Gudlavalleti V S Murthy3,4,
  3. Pyda Giridhar1,2,
  4. Srinivas Marmamula1,2,5,
  5. Hira B Pant4,
  6. Ghanshyam Palamaner Subash Shantha6,
  7. Subhabrata Chakrabarti2,
  8. Clare E Gilbert3,
  9. Gullapalli Nageswara Rao1,2
  1. 1 Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
  2. 2 Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
  3. 3 Department of Clinical Research, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
  4. 4 Indian Institute of Public Health, Hyderabad, India
  5. 5 Wellcome Trust, Department of Biotechnology (DBT) India Alliance, L V Prasad Eye Institute, Hyderabad, India
  6. 6 Division of Cardiovascular Medicine, Roy and Lucille J. Carver College of Medicine, University of Iowa Hospitals and Clinics, Lowa City, Lowa, USA
  1. Correspondence to Dr Rohit C Khanna, L V Prasad Eye Institute, Hyderabad 500034, India; rohit{at}lvpei.org

Abstract

Aim To evaluate glaucoma-associated mortality in a rural cohort in India.

Methods The study cohort comprised individuals aged 40 years and above who took part in the Andhra Pradesh Eye Disease Study (APEDS1) during 1996–2000. All participants underwent detailed comprehensive eye examination. Glaucoma was defined using International Society of Geographic and Epidemiologic Ophthalmology criteria. This cohort was followed up after a decade (June 2009 to January 2010; APEDS2). Mortality HR analysis for ocular risk factors was performed using Cox proportional hazards regression after adjusting for sociodemographic, lifestyle and clinical variables.

Results In APEDS1, 2790 individuals aged more than or equal to 40 years were examined. 47.4% were male. Forty-five participants had primary open angle glaucoma (POAG) and 66 had primary angle closure disease (PACD). Ten years later, 1879 (67.3%) were available, 739 (26.5%) had died and 172 (6.2%) had migrated; whereas 22 of the 45 (48.8%) with POAG and 22 of the 66 (33.3%) with PACD had died. In univariate analysis, a higher mortality was associated with POAG (HR 1.9; 95% CI 1.23 to 2.94), pseudoexfoliation (HR 2.79; 95% CI 2.0 to 3.89), myopia (HR 1.78; 95% CI 1.54 to 2.06) and unit increase in cup:disc ratio (HR 4.49; 95% CI 2.64 to 7.64). In multivariable analysis, only cup:disc ratio remained independently associated with mortality (HR 2.5; 95% CI 1.3 to 5.1). The association remained significant when other ocular parameters were included in the model (HR 2.1; 95% CI 1.03 to 4.2).

Conclusions This is the first longitudinal study to assess the association of glaucoma and mortality in a rural longitudinal cohort in India. Increased cup:disc ratio could be a potential marker for ageing and would need further validation.

  • Glaucoma
  • Mortality
  • APEDS

https://doi.org/10.1136/bjophthalmol-2017-311654

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    Footnotes

    • Contributors RCK: contributions to the conception and design of the work, acquisition, analysis and interpretation of data; drafting the work and revising it critically and final approval of the version published. GVSM, CEG, GNR: contributions to the conception and design of the work and interpretation of data; revising it critically and final approval of the version published. PG: contributions to acquisition of data; revising it critically and final approval of the version published. SM, HBP, GPSS: contributions analysis and interpretation of data; revising it critically and final approval of the version published. SC: contributions to interpretation of data; revising it critically and final approval of the version published.

    • Funding Sightsavers International.

    • Disclaimer The sponsor or funding agency has no role in design or conduct of this research.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The study was approved by the Institutional Review Board of Hyderabad Eye Research Foundation, L V Prasad Eye Institute, and adhered to the tenets of the Declaration of Helsinki. As most participants were not literate, verbal consent was obtained after explaining the purpose of the study in presence of the head of the village.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Part of the data involved in writing the manuscript can be shared on request.