Patients With Cushing Syndrome Face Higher Glaucoma Risk

TOPLINE:

Patients with endogenous Cushing syndrome (CS) have a higher risk for glaucoma than the general population, with the clinical manifestations appearing at a younger age. The risk persisted regardless of the remission status of CS or the degree of elevation of urinary free cortisol levels.

METHODOLOGY:

• Researchers conducted a retrospective study of an Israeli database to evaluate the risk for glaucoma in patients with CS compared with matched control individuals from the general population without the condition.
• They included 609 patients with CS (65% women; mean age, 48.1 years) and 3018 matched controls, with approximately 14 years of follow-up.
• The diagnosis of glaucoma for both patients with CS and control individuals was obtained by using the International Classification of Diseases.
• The main outcomes measured were the incidence of glaucoma and its age of onset.

TAKEAWAY:

• A higher proportion of patients with CS developed glaucoma at the last follow-up than individuals in the control group (12.8% vs 8.3%), with the risk for glaucoma being 74% higher in those with CS (hazard ratio, 1.74; P = .002).
• The onset of glaucoma occurred at a younger age in patients with CS than in individuals in the control group (62 vs 66 years; P = .02).
• The overall risk for glaucoma was elevated in both individuals in remission and those with persistent hypercortisolism; however, patients with persistent hypercortisolemia were diagnosed with glaucoma approximately 6 months earlier than those in remission and control individuals.
• No correlation was observed between the degree of elevation of urinary free cortisol levels and the risk for glaucoma.

IN PRACTICE:

“In this nationwide retrospective matched cohort study, the first of its kind to assess the risk for glaucoma in patients with CS, we demonstrated that individuals with endogenous CS exhibit a heightened risk of early-onset glaucoma,” the authors of the study wrote. “Additionally, patients with CS tended to develop glaucoma at a significantly younger age compared to matched controls from the general population. Importantly, this difference persisted even after excluding both cases and controls with a prior diagnosis of glaucoma.”

Delayed diagnosis of both CS and glaucoma can result in significant ocular and systemic morbidities, the researchers added. “Guidelines should also incorporate recommendations for periodic monitoring for intraocular pressure and/or glaucoma development to be routinely performed for patients with CS,” they wrote.

SOURCE:

The study was led by Yael Sharon, MD, from the Ophthalmology Department of Beilinson Hospital at the Rabin Medical Center in Petah Tikva, Israel. It was published online on November 5, 2024, in Acta Ophthalmologica.

LIMITATIONS:

The retrospective design of the study may have led to missing data, affecting the identification of patients with CS and glaucoma. Patients with CS may have been diagnosed with glaucoma more frequently owing to more regular ophthalmologic examinations. Surveillance bias may have also resulted in an overestimation of the association between CS and glaucoma.

DISCLOSURES:

This study did not receive any specific grant from funding agencies. Two authors reported receiving scientific fees for consulting, research support, and some other ties with various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.