High intraocular pressure and survival: The Framingham studies

PURPOSE: To examine whether high intraocular pressure (greater than or equa l to 25 mm Hg) or a history of treatment for glaucoma is associated with de creased 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 Feb ruary 1, 1975. Participants who reported a history of treatment for glaucom a were identified. Survival data, including information on the date of deat h, 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 (less than or equa l to 20 mm Hg), 264 persons had medium intraocular pressure levels (20 to 2 4 mm Hg), and 79 persons had high intraocular pressure (greater than or equ al to 25 mm Hg) or history of glaucoma treatment. During the follow-up peri od, 29%, 30%, and 47% died in the groups with low, medium, and high intraoc ular pressure (or history of glaucoma treatment), respectively. In an age-a nd-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 g roup 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, d iabetes, cigarette smoking, and body mass index, a positive relationship re mained, but at a borderline level of significance (P = .075). CONCLUSIONS: High intraocular pressure or the presence of glaucoma is a mar ker for decreased life expectancy in the Framingham Eye Study cohort. The r elationship is present even after adjustment for risk factors known to be a ssociated with higher mortality such as age, sex, hypertension, diabetes, c igarette smoking, and body mass index. Special attention to the general hea lth status of patients with high intraocular pressure or glaucoma seems war ranted. (Am J Ophthalmol 1999; 128:440-445. (C) 1999 by Elsevier Science In c. All rights reserved.).