Alcohol Abstinence After Glaucoma Diagnosis Could Lower Visual Impairment Risk

Abstinence from alcohol following an open-angle glaucoma diagnosis was associated with a statistically significantly lower risk of severe visual impairment or blindness compared with sustained drinking, according to new research.¹

The retrospective, nationwide, population-based cohort study used the Korean National Health Insurance Service claims and health examination database to enroll more than 13,000 newly diagnosed patients with open-angle glaucoma between January 2010 and December 2011 who were previously alcohol drinkers.

After analysis of the nationwide cohort in Korea, alcohol abstinence after newly diagnosed open-angle glaucoma was associated with an approximate 37% lower risk of severe visual impairment or blindness, in comparison with continued alcohol consumption.

“Lifestyle interventions, such as alcohol abstinence, could be essential in a comprehensive approach for patients with newly diagnosed OAG,” wrote the investigative team, led by Ahnul Ha, MD, of the department of ophthalmology at Jeju National University Hospital.

As the leading cause of irreversible blindness worldwide, many genetic and environmental factors have been linked to glaucoma development and progression, but the only modifiable risk factor has been identified as intraocular pressure (IOP).¹ Given the drive toward a more holistic approach in medicine, investigators stressed the importance of increased awareness of the positive effect of lifestyle modification on glaucoma prognosis.

New evidence has suggested alcohol consumption is associated with both elevated IOP and a higher prevalence of open-angle glaucoma.² However, the evidence was not sufficient to establish a correlation between alcohol abstinence and better outcomes, relative to those who sustain their drinking habits. Ha and colleagues noted that, given the unethical nature of an alcohol consumption-based randomized clinical trial, epidemiological studies remain most effective in analyzing the importance of alcohol abstinence.¹

The current analysis evaluated the association between alcohol consumption status after initial glaucoma diagnosis and the risk of incident severe visual impairment or blindness. Based on a self-reported questionnaire, patients who were drinkers at the time of the first health examination were categorized into 2 groups dependent on status at the second examination: sustained drinkers or abstainers from alcohol after glaucoma diagnosis. The analysis’ primary outcome was the incidence of severe visual impairment or blindness during the follow-up period until December 2020.

A total of 13,634 patients with newly diagnosed glaucoma, with a mean age of 53.7 years and consisting of 88.4% men, were included for analysis. Of this population, 21% of patients (n = 2866) quit drinking following the glaucoma diagnosis and 79% (n = 10 777) sustained drinking habits. Those who sustained drinking were primarily mild drinkers (69%) and tended to be younger, male, and have a lower prevalence of most comorbidities.

Over 91,366 person-years of follow-up, data showed 58 patients with open-angle glaucoma were diagnosed with incident severe visual impairment or blindness (64 per 100,000 person-years). Multivariable-adjusted Cox proportional hazards regression analysis revealed those abstaining from alcohol post-diagnosis were associated with a lower risk of severe visual impairment or blindness, compared to sustained drinkers (adjusted hazard ratio [aHR], 0.63; 95% CI, 0.45 - 0.87).

Both mild consumption (<105 g/week; aHR, 1.52 [95% CI, 1.01 - 2.28]) and moderate to heavy consumption (≥105 g/week; aHR, 1.78; 95% CI, 1.11 - 2.86) after glaucoma diagnosis were associated with a higher risk of severe visual impairment or blindness relative to abstainers. Meanwhile, a higher frequency of weekly drinking after glaucoma diagnosis was a significant risk factor for incident severe visual impairment of blindness (P <.001). Regular to frequent consumption (≥4 days) showed a significantly higher risk compared with abstinence (aHR, 2.56; 95% CI, 1.52 - 4.33).

A significant proportion of Korean patients with open-angle glaucoma (up to 77%) have normal IOP levels, but alcohol consumption remains substantial, averaging 10.2 L per capita, according to 2016 data.³ Despite surpassing the World Health Organization’s Western Pacific Region mean (7.2 L per capita), the team noted alcohol guidelines in the country remain unclear.¹

“Our results emphasize the need to integrate alcohol awareness and cessation into a comprehensive strategy for patients with newly diagnosed open-angle glaucoma,” investigators wrote.

References

1. _{Jeong Y, Kim SH, Kang G, Yoon H, Kim YK, Ha A. Visual Impairment Risk After Alcohol Abstinence in Patients With Newly Diagnosed Open-Angle Glaucoma. JAMA Netw Open. 2023;6(10):e2338526. doi:10.1001/jamanetworkopen.2023.38526}
2. _{Stuart KV, Luben RN, Warwick AN, et al. The Association of Alcohol Consumption with Glaucoma and Related Traits: Findings from the UK Biobank. Ophthalmol Glaucoma. 2023;6(4):366-379. doi:10.1016/j.ogla.2022.11.008}
3. _{World Health Organization. Global Status Report on Alcohol and Health 2018. World Health Organization; 2019}