Cardiovascular disease predicts structural and functional progression in early glaucoma

Henry Marshall*, Sean Mullany, Ayub Qassim, Owen Siggs, Mark Hassall, Bronwyn Ridge, Thi Nguyen, Mona Awadalla, Nicholas H. Andrew, Paul R. Healey, Ashish Agar, Anna Galanopoulos, Alex W. Hewitt, Stuart MacGregor, Stuart L. Graham, Richard Mills, Angela Shulz, John Landers, Robert J. Casson, Jamie E. Craig

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)


Purpose: To investigate the association between cardiovascular disease and baseline structural defects and disease progression in glaucoma. Design: Prospective, longitudinal study of preperimetric and perimetric glaucoma. Participants: Two thousand six hundred twenty-eight eyes from 1314 participants recruited to the Progression Risk of Glaucoma: Relevant SNPs with Significant Association (PROGRESSA) study were evaluated for baseline and longitudinal structural thinning using spectral-domain OCT and for visual field progression on Humphrey visual field (HVF) assessment. Methods: Patients were classified as either predominantly macula ganglion cell–inner plexiform layer (mGCIPL), predominantly peripapillary retinal nerve fiber layer (pRNFL), or both mGCIPL and pRNFL structural change at enrollment, and then evaluated for longitudinal OCT or HVF progression. Cardiovascular disease and medication characteristics of the participants were compared with a reference group of stable patients. Main Outcome Measures: OCT and HVF baseline status and longitudinal progression. Results: After accounting for age and cardiovascular characteristics, patients with predominantly mGCIPL thinning at baseline showed a higher prevalence of hypertension (odds ratio [OR], 2.70; 95% confidence interval [CI], 1.66–4.41; P < 0.001), antihypertensive use (OR, 2.03; 95% CI, 1.20–3.46; P = 0.008), and statin use (OR, 1.98; 95% CI, 1.07–3.66; P = 0.029) than reference patients. Patients with predominantly pRNFL thinning exhibited a comparable prevalence of cardiovascular disease or medication with reference patients. Review of longitudinal OCT and HVF data (mean follow-up, 5.34 ± 1.29 years) showed that hypertension was associated with an increased risk of both OCT (OR, 1.79; 95% CI, 1.17–2.75; P = 0.006) and HVF progression (OR, 1.92; 95% CI, 1.18–3.15; P = 0.013). A 1-standard deviation (approximately 21 mmHg) increase in systolic blood pressure at baseline was associated with a greater risk of OCT progression (OR, 1.27; 95% CI, 1.01–1.63; P = 0.041) and HVF progression (OR, 1.32; 95% CI, 1.01–1.73; P = 0.043). The association between systolic blood pressure and structural progression was comparable to that observed between intraocular pressure and structural progression (OR, 1.30; 95% CI, 1.01–1.67; P = 0.039). Conclusions: Cardiovascular disease is an important risk factor for glaucoma progression.

Original languageEnglish
Pages (from-to)58-69
Number of pages12
Issue number1
Publication statusPublished - Jan 2021


  • cardiovascular disease
  • glaucoma
  • OCT


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