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The Association between Metabolic Abnormalities and Ocular Perfusion Pressure in Healthy Korean Adults

Glaucoma is defined as a progressive optic neuropathy, in which specific damage to the optic nerve and visual field defect are present. Although the exact mechanisms of the anatomic and functional damage in glaucoma are unknown, the most important risk factor of glaucoma is elevated intraocular pressure (IOP). Many previous studies demonstrated systemic risk factors of higher IOP. Oh et al. and Imai et al. showed that metabolic syndrome (MS), a cluster of obesity, hypertension, hyperglycaemia, and hyperlipidaemia, was a risk factor for elevated IOP. Jaen-Díaz et al. described the relationship between hyperlipidaemia and higher IOP. In addition, obesity and elevated body mass index (BMI) have been associated with elevated IOP. Therefore, MS, or a component thereof, may influence elevated IOP. Studies have provided conflicting information regarding factors associated with glaucoma. Some large population-based studies have shown that hypertension and diabetes mellitus are positively correlated with open-angle glaucoma (OAG). There was no association between hypertension and OAG or diabetes mellitus and OAG shown in other 정상 성인 한국인에서 대사증후군의 인자와 안구 관류압 사이의 상관관계


Introduction
Glaucoma is defined as a progressive optic neuropathy, in which specific damage to the optic nerve and visual field defect are present. 1 Although the exact mechanisms of the anatomic and functional damage in glaucoma are unknown, the most important risk factor of glaucoma is elevated intraocular pressure (IOP). [2][3][4] Many previous studies demon-strated systemic risk factors of higher IOP. [5][6][7][8][9] Oh et al. 5 and Imai et al. 6 showed that metabolic syndrome (MS), a cluster of obesity, hypertension, hyperglycaemia, and hyperlipidaemia, was a risk factor for elevated IOP. Jaen-Díaz et al. 7 described the relationship between hyperlipidaemia and higher IOP. In addition, obesity and elevated body mass index (BMI) have been associated with elevated IOP. 8 Therefore, MS, or a component thereof, may influence elevated IOP. 9 Studies have provided conflicting information regarding factors associated with glaucoma. 10 studies. Furthermore, several studies demonstrated that a higher BMI was associated with a lower risk of OAG. [14][15][16] Recently, mean ocular perfusion pressure (MOPP) has been found to be an important risk factor for OAG, because a vascular factor may play a critical role in the pathogenesis of normal tension glaucoma. 17

Materials and Methods
We examined 40,193 healthy subjects visiting the Health Promotion Center. The majority of the subjects were office workers and their families who resided in Busan City (population: 3.5 million). The participation rate was 1.1% of the total population of Busan City. Informed consent was obtained from all participants. The study was performed following the tenets set forth in the Declaration of Helsinki and was approved by the Institutional Review Board at Pusan National University Hospital (IRB No. 1702-030-052).
For this study, we used seven age groups divided by decades ranging from 20 to 29 years to 80 plus years. Before

Results
The present study consisted of 40,193 healthy Korean participants (19,674 men and 20,519 women). Table 1 shows the distribution of subjects by age and gender. The mean age of the participants was 48.38 ± 10.58 years (range 20-89 years) for men and 48.29 ± 10.52 years (range 20-88 years) for women. There were significant differences in total cholesterol, HDL, TG, waist circumference, BMI, and MOPP between men and women ( Table 2).

Discussion
The present study showed that individuals with components of MS were more likely to have higher MOPP after adjusting for confounding factors. In addition, we found a significant positive correlation between BMI and MOPP among women, but not among men.
Although many previous studies demonstrated the pos- Previous reports suggested the mechanism of the protective effect of obesity on developing glaucoma. Pasquale et al. 16 suggested that adipose tissue, which secretes oestrogen that has a neuroprotective effect, may be the protective mechanism of higher IOP against OAG. Therefore, a higher BMI in women had a protective influence against OAG by producing more oestrogen in the adipose tissue. Since oestrogen affects direct vasodilatory actions, previous reports demonstrated that oestrogen might also play a role in the enhancement of ocular blood flow. 16,20,29 Given that persons at risk of glaucoma tend to have a lower MOPP, 17,19,30 our findings might support that persons with components of MS, or women with a There were several limitations in our study. The first was the inaccuracy of NCT for the measurement of IOP. Although the variation of IOP measurement using NCT was greater than that using Goldmann applanation tonometry (GAT), it was reported that NCT is reliable within normal IOP range. 31 In addition, NCT has been shown to correlate well with GAT. 32,33 Second, the calculation of MOPP based on the theoretical formula may not reflect the real physiological status of ocular perfusion. Direct measurement of ocular blood flow could result in a different outcome.
In conclusion, individuals with metabolic abnormalities and women with higher BMI tend to have a higher MOPP.
Based on the results of the present study, investigating the mechanism of how metabolic abnormalities affect ocular perfusion may help find the precise associations of anthropometric measures with glaucoma.