Original Articles
High intraocular pressure and survival: the Framingham studies

https://doi.org/10.1016/S0002-9394(99)00187-7Get rights and content

Abstract

PURPOSE: To examine whether high intraocular pressure (greater than or equal to 25 mm Hg) or a history of treatment for glaucoma is associated with decreased survival and, if so, how such ocular markers might be explained.

METHODS: Eye examinations, including applanation tonometry, were conducted on members of the Framingham Eye Study cohort from February 1, 1973, to February 1, 1975. Participants who reported a history of treatment for glaucoma were identified. Survival data, including information on the date of death, were available from the time of the Eye Study through March 31, 1990.

RESULTS: Of the 1,764 persons under the age of 70 years at the baseline eye examination, 1,421 persons had low intraocular pressure (≤20 mm Hg), 264 persons had medium intraocular pressure levels (20 to 24 mm Hg), and 79 persons had high intraocular pressure (≥25 mm Hg) or history of glaucoma treatment. During the follow-up period, 29%, 30%, and 47% died in the groups with low, medium, and high intraocular pressure (or history of glaucoma treatment), respectively. In an age-and-sex adjusted Cox proportional hazards analysis, the death rate ratio for the group with medium intraocular pressure relative to the group with low intraocular pressure was 1.04. The corresponding death rate ratio for the group with high intraocular pressure was 1.56 with a 95% confidence interval of 1.11 to 2.19 (P < .001). After adjustment for age, sex, hypertension, diabetes, cigarette smoking, and body mass index, a positive relationship remained, but at a borderline level of significance (P = .075).

CONCLUSIONS: High intraocular pressure or the presence of glaucoma is a marker for decreased life expectancy in the Framingham Eye Study cohort. The relationship is present even after adjustment for risk factors known to be associated with higher mortality such as age, sex, hypertension, diabetes, cigarette smoking, and body mass index. Special attention to the general health status of patients with high intraocular pressure or glaucoma seems warranted.

Section snippets

Subjects and methods

Since 1948, the Framingham Heart Study cohort has undergone approximately biennial examinations to identify factors associated with cardiovascular disease.14 Between February 1, 1973, and February 1, 1975, at about the time of the 12th Heart Study examination, standardized eye examinations were conducted on the surviving members of the cohort (FES I).13

The ophthalmologic examination included measurement of intraocular pressure with applanation tonometry.13 Each person had three consecutive

Results

We included persons under age 70 years at the time of the eye examination in the analyses. At baseline (FES I) 1,862 persons were under the age of 70. We have excluded 98 persons with unknown or unreliable intraocular pressure measurements. Thus, our study population consisted of 1,764 persons with known intraocular pressure or on treatment for glaucoma (Table 1). There were 1,421 persons with intraocular pressure less than 20 mm Hg, 264 persons with intraocular pressure ranging from 20 to 24

Discussion

Persons with an intraocular pressure of 25 mm Hg or greater or a history of treatment for glaucoma were at higher risk of dying compared with persons with an intraocular pressure of less than 20 mm Hg. In age-sex-adjusted analyses the death rate ratio was 1.56 (95% confidence interval, 1.11 to 2.19). The most likely explanation of this finding is that higher intraocular pressure, glaucoma, or both are associated with some factors or diseases that increase the risk of dying. In a model that

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    The Framingham Eye Study was supported by contract N01-EY-2-2112 from the National Eye Institute, National Institutes of Health, Bethesda, Maryland.

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