Elsevier

Ophthalmology

Volume 129, Issue 6, June 2022, Pages 637-652
Ophthalmology

Original Article
Alcohol, Intraocular Pressure, and Open-Angle Glaucoma: A Systematic Review and Meta-analysis

https://doi.org/10.1016/j.ophtha.2022.01.023Get rights and content
Under a Creative Commons license
open access

Topic

This systematic review and meta-analysis summarizes the existing evidence for the association of alcohol use with intraocular pressure (IOP) and open-angle glaucoma (OAG).

Clinical Relevance

Understanding and quantifying these associations may aid clinical guidelines or treatment strategies and shed light on disease pathogenesis. The role of alcohol, a modifiable factor, in determining IOP and OAG risk also may be of interest from an individual or public health perspective.

Methods

The study protocol was preregistered in the Open Science Framework Registries (https://osf.io/z7yeg). Eligible articles (as of May 14, 2021) from 3 databases (PubMed, Embase, Scopus) were independently screened and quality assessed by 2 reviewers. All case-control, cross-sectional, and cohort studies reporting a quantitative effect estimate and 95% confidence interval (CI) for the association between alcohol use and either IOP or OAG were included. The evidence for the associations with both IOP and OAG was qualitatively summarized. Effect estimates for the association with OAG were pooled using random effects meta-analysis. Studies not meeting formal inclusion criteria for systematic review, but with pertinent results, were also appraised and discussed. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Results

Thirty-four studies were included in the systematic review. Evidence from 10 studies reporting an association with IOP suggests that habitual alcohol use is associated with higher IOP and prevalence of ocular hypertension (IOP > 21 mmHg), although absolute effect sizes were small. Eleven of 26 studies, comprising 173 058 participants, that tested for an association with OAG met inclusion criteria for meta-analysis. Pooled effect estimates indicated a positive association between any use of alcohol and OAG (1.18; 95% confidence interval [CI], 1.02–1.36; P = 0.03; I2 = 40.5%), with similar estimates for both prevalent and incident OAG. The overall GRADE certainty of evidence was very low.

Conclusions

Although this meta-analysis suggests a harmful association between alcohol use and OAG, our results should be interpreted cautiously given the weakness and heterogeneity of the underlying evidence base, the small absolute effect size, and the borderline statistical significance. Nonetheless, these findings may be clinically relevant, and future research should focus on improving the quality of evidence.

Keywords

Alcohol
Intraocular pressure
Meta-analysis
Open-angle glaucoma
Systematic review

Abbreviations and Acronyms

ALDH2
aldehyde dehydrogenase 2
BWHS
Black Women’s Health Study
CI
confidence interval
GC-IPL
ganglion cell-inner plexiform layer
GRADE
Grading of Recommendations Assessment, Development and Evaluation
IOP
intraocular pressure
NHS/HPFS
Nurses’ Health Study and Health Professionals Follow-Up Study
OAG
open-angle glaucoma
OHT
ocular hypertension
OR
odds ratio
POAG
primary open-angle glaucoma
RNFL
retinal nerve fiber layer
ROBINS-E
Risk Of Bias In Non-randomized Studies of Exposures
RR
rate ratio

Cited by (0)

Supplemental material available at www.aaojournal.org.

Disclosure(s):

All authors have completed and submitted the ICMJE disclosures form.

The author(s) have made the following disclosure(s): L.R.P.: Consultant – Eyenovia, Skye Biosciences, Twenty Twenty.

J.L.W.: Consultant – Aerpio, Allergan, Editas, Maze, Regenxbio.

A.P.K.: Consultant or lecturer – Abbvie, Aerie, Allergan, Google Health, Heidelberg Novartis, Reichert, Santen, Thea.

P.J.F.: Consultant – Alphasights, GLG, Google Health, Guidepoint, PwC, Santen.

Financial support: K.V.S.: Receipt of a UCL Overseas Research Scholarship. K.V.S. and P.J.F.: Supported by grants from Fight for Sight, London (1956A) and The Desmond Foundation.

A.N.W.: Supported by the Wellcome Trust (220558/Z/20/Z).

R.N.L.: Supported by a Moorfields Eye Charity Springboard Award. L.R.P.: Supported by National Institutes of Health (NIH) EY015473, NIH EY032559, The Glaucoma Foundation (NYC), and an unrestricted Challenge Grant from Research to Prevent Blindness (NYC).

J.L.W.: Supported by NIH EY032559, NIH EY027129, NIH EY014104, NIH EY022305, NIH EY020928, NIH EY031820, an unrestricted grant from Research to Prevent Blindness (NYC), and an ARVO Foundation David Epstein Award. J.H.K.: Supported by the NIH. A.P.K.: Supported by a UK Research and Innovation Future Leaders Fellowship (Medical Research Council MR/T040912/1) and a Moorfields Eye Charity Career Development Fellowship. P.J.F.: Supported by an Unrestricted Grant from Alcon. A.P.K. and P.J.F.: A proportion of their financial support from the UK Department of Health through an award made by the National Institute for Health Research to Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology for a Biomedical Research Centre for Ophthalmology. The sponsors or funding organizations had no role in the design or conduct of this research.

HUMAN SUBJECTS: Human subjects were not included in this study. All research adhered to the tenets of the Declaration of Helsinki. This study involved only review and synthesis of existing literature, and was exempt from Institutional Review Board approval. The requirement for informed consent was waived because of the retrospective nature of the study.

No animal subjects were used in this study.

Author Contributions:

Conception and design: Stuart, Madjedi, Foster, Khawaja

Data collection: Stuart, Madjedi, Foster, Khawaja

Analysis and interpretation: Stuart, Madjedi, Luben, Chua, Warwick, Chia, Pasquale, Wiggs, Kang, Hysi, Tran, Foster, Khawaja

Obtained funding: Foster

Overall responsibility: Stuart, Madjedi, Luben, Chua, Warwick, Chia, Pasquale, Wiggs, Kang, Hysi, Tran, Foster, Khawaja

P.J.F. and A.P.K. are joint senior authors.

Members of the Modifiable Risk Factors for Glaucoma Collaboration are available at www.aaojournal.org