The edition · Ophthalmology
Rheumatic disease was linked to two-thirds higher odds of glaucoma across 5.7 million people
A meta-analysis of 18 studies supports looking for glaucoma in patients with rheumatic disease, especially those on steroids. Also: an American Academy of Ophthalmology review of OCT as a marker of multiple sclerosis progression, statins and glaucoma escalation, and reassuring data on semaglutide and wet macular degeneration.
The edition in brief
Today's ophthalmology edition leads on glaucoma in rheumatic disease. An International Ophthalmology meta-analysis of 18 studies and 5,766,143 people found a pooled glaucoma incidence of 4% among people with rheumatic disease and higher odds than in the general population (OR 1.66, 95% CI 1.15 to 2.40). An American Academy of Ophthalmology assessment of 21 studies found thinner, faster-thinning or more asymmetric peripapillary nerve fibre and macular ganglion cell layers on OCT were associated with future disability, relapse and MRI progression in multiple sclerosis and its precursors. A TriNetX cohort associated statin use with lower open-angle glaucoma incidence at five years (HR 0.85) and less escalation to surgery, MIGS or laser trabeculoplasty. A 12-database network study of 227,971 new semaglutide users with type 2 diabetes found no association with neovascular age-related macular degeneration (self-controlled IRR 0.92 and 1.02). All three of the glaucoma and retina findings are observational. The pearl covers recognising acute angle closure in a red, painful eye.
OCT nerve fibre and ganglion cell thinning predicts multiple sclerosis progression, an AAO review finds
Share baseline and follow-up OCT on the same device with the neurologist for patients with multiple sclerosis.
Statin users had less glaucoma and less escalation to surgery or laser
Statins are not a glaucoma treatment; this association needs a trial before it changes practice.
No link between semaglutide and wet macular degeneration in 227,971 users with type 2 diabetes
Semaglutide showed no association with wet macular degeneration; the optic neuropathy question is separate.
A red, painful eye with halos and a mid-dilated pupil is angle closure until proved otherwise
Refer a red, painful eye with halos and a mid-dilated pupil the same day, and do not dilate it.
Rheumatic disease and glaucoma: odds two-thirds higher across 5.7 million people
Look for glaucoma — pressure and disc — in patients with rheumatic disease, particularly those on corticosteroids.
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