1. Association between normal tension glaucoma and allergic rhinitis  in Korean population based study
Soon Cheol Cha1, MD, PhD; Areum Jeong1, MD; Hee Jun Kim1,MD; Su Ho Lim2, MD;
1 Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Republic of Korea
2 Department of Ophthalmology, Daegu Veterans Health Service Medical center, Daegu, Republic of Korea
Introduction
#ORs were calculated Logistic regression test: Univariate
$Adjusted ORs were calculated Logistic regression test: Multivariate
: Adjusted 1: age, sex
Adjusted 2: age, sex, DM, HTN
Adjusted 3: age, sex, DM, HTN, Family No., Income, Eating-out, Smoking
*p<0.05, **p<0.01
: Adjusted 1: sex
Adjusted 2: sex, DM, HTN
Adjusted 3: sex, DM, HTN, Family No., Income, Eating-out, Smoking
: Adjusted 1: age
Adjusted 2: age, DM, HTN
Adjusted 3: age, DM, HTN, Family No., income, eating-out, smoking
Table 2. Prevalence rate, ORs, and 95% CIs for Allergic rhinitis among the sampled patients
NTG (n=604)
Control (n=8010)
P-Value
AR , n (%)
176(29.1%)
2000(25.0%)
OR#(95% CI)
1.24(1.03~1.48)
1.00
0.023
Adjusted 1 OR$(95% CI)
1.34(1.11~1.61)
0.002
Adjusted 2 OR$(95% CI)
1.34(1.12~1.16)
Adjusted 3 OR$(95% CI)
1.34(1.12~1.62)
Allergic rhinitis(AR), heterogeneous disease with a complicated pathophysiology
Inflammation of the mucous membranes of the nose, eye, middle ear, sinuses
Autonomic nervous system dysfunction, specifically sympathetic hypofunction, hyperfunction of the parasympathetic nervous system
Ishman SL et al. Otolaryngol Head Neck Surg. 2007
Dysregulation of vasodilation and vascular permeability
J.Bienenstock et al. Allergy and the Nervous System. 2012
Normal tension glaucoma(NTG), multifactorial optic neuropathy
Apoptosis of retinal ganglion cell axons
Ian F Gutteridge et al. Clinical and Experimental Optometry. 2000
Ischemia due to inadequate regulation of blood flow
Douglas R Anderson et al. Indian J Ophthalmol. 2011
Low diastolic BP was associated with glaucomatous visual field progression.
Okumura Y et al. Ophthalmol. 2012
Significantly greater reduction in nocturnal BP compared to healthy subjects
Soo Geun Joe et al. Korean Journal of Ophthalmol. 2009
AR likely induces localized hypoxia by blocking the middle meatus and ostium because of allergic swelling of the nasal mucosa.
Hypoxia was shown to be a factor leading to retinal ganglion cell damage.
Am J Rhinol Allergy. 2014
Table 3. ORs, and 95% CIs for Allergic rhinitis among subjects with NTG and controls by age
Presence of prior AR
Age group (yr)
40~49
50~59
60~69
70~79
NTG
n, (%)
Control
 Yes 29
(37.2)
652
(29.2) 34
(24.5)
625
(26.8) 58
(31.9)
425
(22) 48
(27.4)
267
(20.2)
OR#
(95% CI)
1.433
(0.897
~2.289)
1.00
0.886
(0.595
~1.318)
1.663**
(1.196
~2.313)
1.493*
(1.044
~2.137)
Adjusted
1 OR$
1.503
(0.938
~2.406)
0.876
(0.588
~1.304)
1.605**
(1.152
~2.238)
1.499*
(1.047
~2.145)
2 OR$
1.489
(0.930
~2.385)
0.890
(0.598
~1.327)
1.609**
(1.154
~2.243)
1.530*
(1.067
~2.195)
3 OR$
1.509
(0.942
~2.418)
0.888
(0.596
~1.325)
1.620**
(1.161
~2.261)
1.517*
(1.056
~2.178)
Purpose
To investigate the relationship between NTG and AR in a population-based setting, the Korea National Health and Nutrition Exam Survey
Methods
Retrospective, cross-sectional study using 5th Korean National Health and Nutrition Examination Survey (KNHNES, ) A B C
Subtraction A from B C
Table 4. ORs, and 95% CIs for Allergic rhinitis among subjects with NTG and controls by sex
Presence of prior AR
Male
Female
NTG, n(%)
Control, n(%)
99 (32.2)
831 (25.6)
77 (25.9)
1169 (24.5)
OR#
(95% CI)
1.381*
(1.074~1.777)
1.00
1.077
(0.824~1.408)
Adjusted 1OR$
1.413**
(1.096~1.820)
1.252
(0.983~1.698)
Adjusted 2OR$
1.422**
(1.103~1.833)
1.297
(0.987~1.706)
Adjusted 3OR$
1.301
(0.989~1.711)
Results
*chi-square test , ** Logistic regression test
Table 1. Characteristics of subjects with NTG and controls
Characteristics
NTG (n=604)
Control (n=8010)
P-value
Age(years)≥40
63.37±11.11
57.75±11.33
<0.001*
Sex(M/F)
307(50.8%)/297
3243(40.5%)/4767
DM(+/-)
91(15.1%)/513
859(10.7%)/7151
0.001*
HTN(+/-)
295(48.8%)/309
2982(37.2%)/5028
Residency
0.123*
Rural
161(26.7%)
1912(23.9%)
Urban
443(73.3%)
6098(76.1%)
Marital status
0.595*
Single
7(1.2%)
114(1.4%)
Married
597(98.8%)
7896(98.6%)
Family no.(crowding) ≤3
460(76.2%)
5218(65.1%) ≥4
144(23.8%)
2792(34.9%)
Quartile of household income
Low, Midlow
370(61.3%)
3799(47.4%)
Midhigh, High
234(38.7%)
4211(52.6%)
Stress level
0.794*
Low
462(76.5%)
6164(77.0%)
High
142(23.5%)
1846(23.0%)
Eating-out frequency
Low (＜1/day)
546(90.4%)
6846(85.5%)
High (≥1/day)
58(9.6%)
1164(14.5%)
Smoking status
0.003*
Current smoker
100(16.6%)
1270(15.9%)
Exsmoker
184(30.5%)
1801(22.5%)
Never smoker
320(53.0%)
4939(61.7%)
Current alcohol use
0.988*
＜1/month
319(52.8%)
4228(52.8%)
≥1/month
285(47.2%)
3782(47.2%)
Allergic Rhinitis(+/-)
176(29.1%)/428
2000(25.0%)/6010
0.023**
Limitations
Selection bias could have affected the results .
Some participants excluded due to unreliable test results.
Causal relationship between NTG and AR could not be identified.
AR was diagnosed only by their symptoms without laboratory tests.
Conclusion
This study shows that NTG was significantly associated with prior AR.
In particular, male subjects and subjects aged 60~79 years had the high ORs for prior AR among cases compared with controls.
Clinicians should pay special attention to AR patients to early diagnosis of glaucoma.
Further study will be needed to understand which factors of NTG account for increased risk of AR.
Sooncheol Cha, MD, PhD
Department of Ophthalmology, Yeungnam University College of Medicine 170, Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea Tel : , Fax : ,
Financial disclosure: The authors have no proprietary or commercial interest in any materials discussed in this poster