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Albuminuria and Primary Open-Angle Glaucoma: the Singapore Chinese Eye Study (SCES)
  1. Zhi Wei Lim1,2,
  2. Miao-Li Chee1,
  3. Sahil Thakur1,
  4. Xiaoling Fang1,3,
  5. Zhi Da Soh1,
  6. Shivani Majithia1,
  7. Zhen Ling Teo1,
  8. Charumathi Sabanayagam1,4,
  9. Tien Yin Wong1,4,5,
  10. Ching-Yu Cheng1,4,5,
  11. Yih-Chung Tham1,4
  1. 1 Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
  2. 2 Faculty of Medicine, University of New South Wales, Sydney, Australia
  3. 3 Shanghai Eye Diseases Prevention and Treatment Center, Department of Ophthalmology, Shanghai Jiao Tong University, Shanghai, China
  4. 4 Duke-NUS Medical School, Singapore, Singapore
  5. 5 Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
  1. Correspondence to Yih-Chung Tham, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore;tham.yih.chung{at}


Aims To determine the association between albuminuria and primary open-angle glaucoma (POAG).

Methods Participants of the Singapore Chinese Eye study were recruited and underwent standardised ocular and systemic examinations. Albuminuria was determined using urinary albumin-to-creatinine ratio (UACR, mg/g) based on random spot urinary albumin and creatinine measurements. POAG was defined using the International Society of Geographic and Epidemiological Ophthalmology classification. Multivariable logistic regression with generalised estimating equation model was used to evaluate the association between albuminuria and POAG, while accounting for correlation between eyes.

Results A total of 3009 Chinese adults (5963 eyes), aged 40–80 years, were included in this study, of which, 52 subjects (75 eyes) had POAG. Higher UACR (per 50 mg/g increase) was independently associated with POAG (OR=1.04, 95% CI 1.01 to 1.07, p=0.003) following adjustment for age, gender, intraocular pressure, diabetes mellitus, hyperlipidaemia, hypertension, anti-hypertensive medication, history of cardiovascular disease, current smoking status, alcohol intake, body mass index and estimated glomerular filtration rate. Further stratification revealed that individuals with macroalbuminuria were 8.00 times likely to have POAG (95% CI 2.97 to 21.54, p<0.001), compared with those with normoalbuminuria. Microalbuminuria was not significantly associated with POAG (OR=0.49, 95% CI 0.19 to 1.29, p=0.150). The association between macroalbuminuria and POAG remained significant among individuals who were diabetic (OR=9.89, 95% CI 2.49 to 39.30, p=0.001) and hypertensive (OR=8.39, 95% CI 3.07 to 22.94, p<0.001).

Conclusion In this population-based study of Chinese adults, albuminuria was independently associated with POAG. Our findings provide further understanding on the pathogenesis of POAG and may potentially help to better identify individuals at risk of POAG.

  • Epidemiology
  • Glaucoma
  • Imaging
  • Optic Nerve
  • Trauma
  • Treatment Surgery
  • Cornea
  • Iris
  • Public health
  • Angle
  • Vision
  • Tears
  • Ocular surface
  • Inflammation
  • Retina
  • Macula
  • Genetics
  • Intraocular pressure

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  • Contributors ZWL, M-LC, CS, TYW, C-YC and Y-CT conceived and designed the study. ST, XLF, ZDS, SM and ZLT collected data. ZWL, M-LC and Y-CT analysed and interpreted the data. ZWL, M-LC and Y-CT wrote the manuscript. ST, XLF, ZDS, SM, ZLT, CS, TYW and C-YC reviewed the manuscript. All authors approved the final manuscript.

  • Funding Funder: Ministry of Health, Singapore, National Medical Research Council NMRC/CIRG/1417/2015; NMRC/CIRG/1488/2018; NMRC/MOH-TA18nov-0002. The funder had no role in study design, data collection, data analysis, data interpretation or writing of the report.

  • Competing interests None declared.

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

  • Data sharing statement No data are available.

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