Association Between Serum Ferritin and Glaucoma in the South Korean Population

Abstract

laucoma is an optic neuropathy with retinal ganglion cell loss and structural alteration of the optic nerve head, accompanied by progressive vision loss. Glaucomatous disease is the leading cause of irreversible blindness worldwide 1 and a growing public health concern because of an aging worldwide population. 2 Elucidation of risk factors associated with disease pathogenesis may help prevent the resulting disability.Previously identified important risk factors for the development of glaucoma include greater intraocular pressure (IOP), age, and a family history of disease. 3 Other concomitant factors that have been postulated to play important roles in disease pathogenesis include high glutamate levels, 4 alterations in nitric oxide metabolism, 5 vascular alterations, 6 and oxidative damage. 7,8 An increasing body of evidence suggests that oxidative stress and free radical accumulation may harm the trabecular meshwork (TM), [9][10][11][12][13] resulting in an increase in IOP. Such oxidative stress may also be harmful to retinal ganglion cells, with resultant cell death leading to optic nerve damage characteristic of glaucomatous disease. 8 There has been considerable interest in the role of the body's alteration of iron metabolism as a cause of oxidative damage to several organ systems. Accumulation of iron has been implicated in oncogenesis, aging, and progression of chronic neurodegenerative conditions, such as Alzheimer and Parkinson disease. [14][15][16][17][18][19][20][21][22] The concentration of serum ferritin, an IMPORTANCE Evidence suggests that altered iron metabolism may be associated with oxidative damage to several organ systems, including the eye. Supplementary iron consumption is also associated with greater odds of self-reported glaucoma.OBJECTIVE To investigate the association between serum ferritin level and the likelihood of a glaucoma diagnosis in a cross-sectional, population-based study.DESIGN, SETTING, AND PARTICIPANTS Data were collected from 17 476 participants in the first and second years of the Fifth Korea National Health and Nutrition Examination Survey, a cross-sectional study of the South Korean population conducted from January 1, 2010, through December 31, 2011. Data pertaining to the serum ferritin level were aggregated and divided into quartiles. Demographic, comorbidity, and health-related behavior information was obtained via interview. MAIN OUTCOMES AND MEASURESThe presence or absence of glaucoma. The definition of glaucoma was based on criteria established by the International Society of Geographical and Epidemiological Ophthalmology. RESULTSParticipants whose serum ferritin level was greater than 61 ng/mL (to convert to picomoles per liter, multiply by 2.247) had significantly higher odds of a glaucoma diagnosis when compared with those with a level less than 31 ng/mL, after adjustment for potential confounders (ferritin levels of 31-61 ng/mL: odds ratio [

Relationship between high serum ferritin level and glaucoma in a South Korean population: the Kangbuk Samsung health study

“…To our knowledge, only one study1 has demonstrated this relationship, while a few other studies17 18 have suggested that this relationship might be important. Herein, we measure the strength of the association between serum ferritin levels and glaucoma development and explain how this relationship influences glaucoma pathogenesis.…”

“…The χ 2 test, Student's t test or Mann–Whitney U test was used to compare demographic characteristics. To evaluate the effects of systemic factors on glaucoma prevalence, we categorised serum ferritin level, serum iron level, serum total iron-binding capacity (TIBC) level, serum transferrin saturation level, serum white blood cell (WBC) level and serum high-sensitivity C-reactive protein (HsCRP) level into quartiles,1 19 21 while serum total vitamin D level was categorised into quintiles 22. Multivariate logistic regression models were constructed to assess possible associations between elevated glaucoma risk and systemic factors that revealed p<0.2 in univariate analysis 23.…”

“…In vitro studies have suggested that iron regulation plays a role in glaucoma pathogenesis in RGC 16. Some studies have demonstrated that dietary iron intake was associated with self-reported glaucoma,17 18 and another recent study found that high serum ferritin levels were associated with glaucoma in a South Korean population 1. These studies suggest potential roles for iron metabolism in instigating oxidative stress and glaucoma pathogenesis.…”

“…Intraocular pressure (IOP) is now thought to be the most important risk factor for glaucoma, even though glaucoma severity is not always directly correlated with increased IOP. Consequently, researchers have looked for other contributing factors to explain glaucoma pathogenesis, such as genetics, vascular dysregulation and oxidative stress 1 2…”

Refractive Error and the Risk of Age-Related Macular Degeneration in the South Korean Population

“…16,17 After an ophthalmology-focused interview, participants underwent visual acuity measurements, automated refraction, slit lamp examination, intraocular pressure measurement, fundus photography, and, when deemed appropriate, visual field examination.…”