Patients With Autoimmune Diseases Have Higher Glaucoma Risk

Surgeon preparing patient for eye surgery
Surgeon preparing patient for eye surgery
In a study of individuals undergoing ophthalmic surgery, more with autoimmune diseases developed POAG.

Patients with autoimmune diseases have a higher risk of developing primary open-angle glaucoma (POAG), according to findings published in Ophthalmology Glaucoma.

In a retrospective cross-sectional study, investigators reviewed medical records of POAG patients undergoing any ophthalmic surgery and participants in a control group undergoing cataract surgery at Massachusetts Eye and Ear. The study included 172 POAG patients and 179 participants in the control group.

The prevalence of autoimmune diseases was 17.4% in the POAG group and 10.1% in the control group (P =.044). More specifically, 6.4% of POAG patients and 3.4% of the control group had more than 1 autoimmune disease (P =.18). The most prevalent diseases in the POAG group were rheumatoid arthritis (4.6%) and psoriasis (4.1%), which also were the most common autoimmune disease found in the control group (2.8% each). Researchers found that having an autoimmune disease was associated with a 2.62-fold increased odds of developing POAG relative to controls (95% CI: 1.27-5.36, P =.009). Other risk factors for POAG included age (OR=1.04, P =.006), diabetes mellitus (OR=2.31, P =.008) and non-White ethnicity (OR=4.75, P <.001).

In a case-only analysis involving the eye with worse glaucoma, there was no statistical difference in visual field mean deviation or retinal nerve fiber layer (RNFL) thickness in POAG patients with (n=30) and without an autoimmune disease (n=142, P > 0.13, for both). However, because additional factors may have prevented a difference in RNFL thickness in POAG patients with and without an autoimmune disease, investigators say the role of autoimmunity in the pathogenesis of POAG should be explored further.

The study’s authors note several limitations to their work. Due to its retrospective design, potential sources of bias are present, the onset or duration of POAG and autoimmune diseases couldn’t be determined, and any systemic immunosuppressive therapy for the treatment of autoimmune diseases could not be uniformly collected. In addition, the POAG patients in the study were older than participants in the control group and autoimmune diseases that can potentially affect the visual field were included in the analysis. Lastly, the authors note that the role of autoimmunity in patients with POAG may be more complex than demonstrated by laboratory studies.

Disclosure: Some of the study’s authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Lorenzo MM, Devlin J, Saini C, et al. The prevalence of autoimmune diseases in primary open angle glaucoma patients undergoing ophthalmic surgeries. Ophthalmol Glaucoma. Published online August 18, 2021. doi:10.1016/j.ogla.2021.08.003