Association Between Body Mass Index and Primary Open Angle Glaucoma in Three Cohorts

Henry Marshall, Ella C. Berry, Santiago Diaz Torres, Sean Mullany, Joshua Schmidt, Daniel Thomson, Thi Thi Nguyen, Lachlan S.W. Knight, Georgina Hollitt, Ayub Qassim, Antonia Kolovos, Bronwyn Ridge, Angela Schulz, Stewart Lake, Richard A. Mills, Ashish Agar, Anna Galanopoulos, John Landers, Paul R. Healey, Stuart L. GrahamAlex W. Hewitt, Robert J. Casson, Stuart MacGregor, Owen M. Siggs, Jamie E. Craig

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


Purpose: To evaluate the relationship between body mass index (BMI) and glaucoma progression. 

Design: Multicohort observational study. 

Methods: This study combined a retrospective longitudinal analysis of suspect and early manifest primary open angle glaucoma cases from the Progression Risk of Glaucoma: RElevant SNPs with Significant Association (PROGRESSA) study with 2 replication cohorts from the UK Biobank and the Canadian Longitudinal Study of Ageing (CLSA). In the PROGRESSA study, multivariate analysis correlated BMI with longitudinal visual field progression in 471 participants. The BMI was then associated with glaucoma diagnosis and cross-sectional vertical cup-disc ratio (VCDR) measurements in the UK Biobank, and finally prospectively associated with longitudinal change in VCDR in the CLSA study.

Results: In the PROGRESSA study, a lower BMI conferred a faster rate of visual field progression (mean duration of monitoring (5.28 ± 1.80 years (10.6 ± 3.59 visits) (β 0.04 dB/year/SD95% CI [0.005, 0.069]; P = .013). In the UK Biobank, a 1 standard deviation lower BMI was associated with a worse cross-sectional VCDR (β –0.048/SD 95% CI [–0.056, 0.96]; P < .001) and a 10% greater likelihood of glaucoma diagnosis, as per specialist grading of retinal fundus imaging (OR 0.90 95% CI [0.84, 0.98]; P = .011). Similarly, a lower BMI was associated with a greater risk of glaucoma diagnosis as per International Classification of Disease data (OR 0.94/SD; 95% CI [0.91, 0.98]; P = .002). Body mass index was also positively correlated with intraocular pressure (β 0.11/SD; 95% CI [0.06, 0.15]; P < .001). Finally, a lower BMI was then associated with greater VCDR change in the CLSA (β –0.007/SD; 95% CI [–0.01, –0.001]; P = .023).

Conclusions: Body mass index correlated with longitudinal and cross-sectional glaucomatous outcomes. This supports previous work illustrating a correlation between BMI and glaucoma.

Original languageEnglish
Pages (from-to)126-133
Number of pages8
JournalAmerican Journal of Ophthalmology
Early online date13 Aug 2022
Publication statusPublished - Jan 2023


  • Glaucoma
  • Primary open angle glaucoma
  • Body Mass Index (BMI)
  • Multicohort observational study


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