- Design
- Systematic review and meta-analysis of 18 observational studies
- Population
- 5,766,143 participants with and without rheumatic disease
- Primary outcome
- Glaucoma incidence and odds compared with the general population
- Effect
- Incidence 4% (3% to 6%); OR 1.66 (95% CI 1.15 to 2.40)
A meta-analysis registered with PROSPERO pooled 18 studies of 5,766,143 participants to examine glaucoma in people with rheumatic diseases.
The pooled incidence of glaucoma among people with rheumatic disease was 4% (95% CI 3% to 6%) — 3% in cohort studies, 9% in case-control and 8% in cross-sectional studies. Compared with the general population, rheumatic disease was associated with higher odds of glaucoma (OR 1.66, 95% CI 1.15 to 2.40).
The abstract does not separate individual diseases or the role of corticosteroids, which are a well-recognised cause of raised intraocular pressure and an obvious confounder. Uveitis in conditions such as spondyloarthritis also raises glaucoma risk. Whatever the mechanism, these patients are worth examining for glaucoma rather than assuming eye checks are only for hydroxychloroquine.
- Check intraocular pressure and the optic disc when seeing patients with rheumatic disease, not only screening for hydroxychloroquine toxicity.
- Ask about long-term oral, inhaled, topical or periocular corticosteroid use, a recognised cause of raised pressure.
- Consider glaucoma assessment in patients with a history of uveitis.
- Encourage rheumatologists to include an eye examination at baseline and periodically.
- Record the rheumatic diagnosis and treatment in the eye record so risk can be assessed at follow-up.
Why it matters
Eye referrals in rheumatic disease often focus on hydroxychloroquine screening and can miss glaucoma.
Don't overread it
The pooled odds are observational and not separated by disease or steroid use; steroid exposure may explain much of the excess.
The statistics, in plain English
An odds ratio of 1.66 means the odds of glaucoma were about two-thirds higher. The interval (1.15 to 2.40) is wide, and estimates varied by study design, from 3% in cohort studies to 9% in case-control studies.
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