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Social history and glaucoma progression: the effect of body mass index, tobacco and alcohol consumption on the rates of structural change in patients with glaucoma
  1. Asmaa A Youssif1,2,
  2. Ndidi-Amaka Onyekaba1,
  3. Rizul Naithani1,
  4. Khaled Abdelazeem2,
  5. Ahmed M Fathalla2,
  6. Mohamed S Abdel‐Rhaman2,
  7. Alessandro A Jammal1,3,
  8. Felipe A Medeiros1,3
  1. 1Duke Eye Center, Duke University, Durham, North Carolina, USA
  2. 2Ophthalmology, Assiut University Faculty of Medicine, Assiut, Egypt
  3. 3Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA
  1. Correspondence to Professor Felipe A Medeiros, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA; fmedeiros{at}


Background/aims Although obesity, tobacco and alcohol consumption were linked to the progression of numerous chronic diseases, an association of these social history aspects with glaucoma progression is not yet determined. This study aims to investigate the effect of body mass index (BMI) and history of tobacco and alcohol use on the rates of retinal nerve fibre layer (RNFL) change over time in glaucoma patients.

Methods 2839 eyes of 1584 patients with glaucoma from the Duke Ophthalmic Registry were included. Patients had at least two spectral-domain optical coherency tomography (SD-OCT) tests over a minimum 6-month follow-up. Self-reported history of alcohol and tobacco consumption was extracted from electronic health records and mean BMI was calculated. Univariable and multivariable linear mixed models were used to determine the effect of each parameter on RNFL change over time.

Results Mean follow-up time was 4.7±2.1 years, with 5.1±2.2 SD-OCT tests per eye. 43% and 54% of eyes had tobacco or alcohol consumption history, respectively, and 34% were classified as obese. Higher BMI had a protective effect on glaucoma progression (0.014 µm/year slower per each 1 kg/m2 higher; p=0.011). Tobacco and alcohol consumption were not significantly associated with RNFL change rates (p=0.473 and p=0.471, respectively). Underweight subjects presented significantly faster rates of structural loss (−0.768 µm/year; p=0.002) compared with normal weight.

Conclusions In a large clinical population with glaucoma, habits of tobacco and alcohol consumption showed no significant effect on the rates of RNFL change. Higher BMI was significantly associated with slower rates of RNFL loss.

  • Glaucoma
  • Optic Nerve
  • Imaging

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Presented at Presented in part at the ARVO Annual Meeting, 2020.

  • Contributors Conception and design: AAJ and FAM. Data collection: AAY, N-AO, RN and AAJ. Analysis and interpretation: AAY, N-AO, RN, AAJ and FAM. Obtained funding: AAY, N-AO and FAM. Overall responsibility: AAY, N-AO, RN, KA, AMF, MSA‐R, AAJ and FAM. The authors declare full responsibility for the finished work and the conduct of the study, had access to the data and controlled the decision to publish.

  • Funding This work was supported in part by the National Institutes of Health/National Eye Institute grant numbers EY029885 and EY031898 (FAM), The Glaucoma Foundation/Research to Prevent Blindness (NEO) and Egyptian government scholarship grant (AY).

  • Competing interests FAM: Aerie Pharmaceuticals (C); Allergan (C, F), Annexon (C); Biogen (C); Carl Zeiss Meditec (C, F), Google (F); Heidelberg Engineering (F), nGoggle (P), Novartis (F); Stealth Biotherapeutics (C); Reichert (C, F).

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.