Ophthalmologic evaluation of severely obese patients undergoing bariatric surgery: A pilot, monocentric, prospective, open-label study

Abstract

Purpose The aim of this study was to investigate the pathogenic role of obesity on blinding eye diseases in a population of severely obese patients with no history of eye diseases, and to verify whether weight loss induced by bariatric surgery may have a protective effect. Methods This was a pilot, monocentric, prospective, and open label study conducted at the University Hospital of Pisa. Fifty-seven severely obese patients with a mean body mass index value of 44.1 ± 6 kg/m 2 were consecutively recruited and received a complete ophthalmological evaluation and optical coherence tomography. Twenty-nine patients who underwent gastric bypass were evaluated also 3 months, and 1 year after surgery. Results At baseline, blood pressure value were directly and significantly related to intraocular pressure values (p<0.05, R = 0.35). Blood pressure values were also significantly and inversely related to retinal nerve fiber layer thickness, particularly in the temporal sector (RE p<0.05 r-0.30; LE p<0.01, R = -0.43). Moreover, minimum foveal thickness values were significantly and inversely associated with body mass index (RE p<0.02, R = -0.40; LE p<0.02, R = -0.30). A significant reduction of body mass index (p<0.05) and a significant (p<0.05) improvement of blood pressure was observed three months and one year after gastric bypass, which were significantly associated with an increase in retinal nerve fiber layer thickness and minimum foveal thickness values in both eyes (p<0.05). Conclusions The results of this study suggest that obese patients may have a greater susceptibility to develop glaucomatous optic nerve head damage and age-related macular degeneration. Moreover, weight reduction and improvement of comorbidities obtained by bariatric surgery may be effective in preventing eye disease development by improving retinal nerve fiber layer and foveal thickness.

Subfoveal choroidal thickness and peripapillary retinal nerve fiber layer thickness in young obese males

“…In patients who had undergone gastric bypass surgery, an increase in RNFL thickness have been observed in both eyes, together with a significant improvement in blood pressure as well as decreased BMI at 3 months and 1 year after surgery. 39 Although the mechanisms of the diminished RNFL thickness in the temporal quadrant in our study may be related with the hypotheses stated above, it should be noted that these studies have been carried out with the participation of pediatric cases or mixed gender cohorts, with predominance of females in some. On the other hand, the reported RNFL thinning without reference to the quadrant in males with high BMI in the EPIC-Norfolk Eye Study Group study evaluating the factors influencing RNFL is partly in line with our observations.…”

Spectral-domain OCT measurements in obesity: A systematic review and meta-analysis

“…Hypertension was another factor that we could not examine in the meta-regression, but was previously introduced as a possible factor responsible for RNFL thinning. Hypertension seemed to affect the temporal RNFL quadrant more than the others that can partly explain why we observed significant RNFL thinning only in this quadrant [ 64 ]. Overall, we should holistically take these proposed mechanisms for RNFL thinning into account, as they are related to each other and not isolated pathways.…”

The association between bariatric surgery and cataract: a propensity score-matched cohort study

“…However, one small prospective study assessed lens opacity through the Lens Opacities Classification System III (LOCS) among 29 patients who underwent bariatric surgery. 17 A total of 8 patients had a cataract at bariatric surgery, and no change in lens opacity was observed at the 1-year follow-up examination. 17 Thus, bariatric surgery may neither trigger nor resolve cataracts.…”

“…17 A total of 8 patients had a cataract at bariatric surgery, and no change in lens opacity was observed at the 1-year follow-up examination. 17 Thus, bariatric surgery may neither trigger nor resolve cataracts. However, cataracts have risk factors [23][24][25] other than obesity, 5 such as increased levels J o u r n a l P r e -p r o o f of triglycerides, hbA1c (glycated hemoglobin), and blood pressure, which in turn are beneficially influenced by bariatric surgery.…”

“…To date, only one small prospective study (n=29) has assessed lens opacity one year after bariatric surgery, compared to the bariatric surgery date, and observed no changes. 17 Therefore, given the current knowledge, we hypothesized that weight loss might be negatively associated with incident or progression of cataracts. Therefore, this investigation aimed to assess the association between weight loss through bariatric surgery and cataract in a secondary care setting.…”