In this systematic review and meta-analysis, 7 articles were analysed, with 570,694 subjects and a reported total of 45,957 fractures. The study protocol (CRD42024527785) was registered prospectively. PubMed, EMBASE, and Web of Science were searched from their inception to April 2024. Glaucoma was identified by the presence of a visual field defect (VFD) consistent with glaucomatous optic neuropathy, ICD codes (or similar disease-classifying codes) and self-report. Visual field damage severity was classified using the Hodapp-Anderson-Parrish criteria, with study-specific criteria for severity deemed suitable on a case-by-case basis. Both frequentist inference meta-analysis and Bayesian network meta-analysis were conducted. Mild and severe glaucoma VFDs were associated with an 80% increased relative risk (RR) of fractures compared with healthy counterparts (RR mild: 1.8, 95% credible interval (95% CrI): 1.5 to 2.3; RR severe: 1.8, 95% CrI: 1.3–2.4). A higher hazard ratio (HR) of fractures was observed in individuals with mild (HR: 1.2; 95% CrI: 1.1–1.3) and moderate (HR: 1.4; 95% CrI: 1.1–1.8) glaucoma compared with healthy subjects. The authors concluded that individuals with mild-to-moderate glaucoma VFD had the highest HR and RR of fractures, based on low-to-moderate quality evidence. The results from this review highlight the effect of visual loss in glaucoma, and that patients with VFDs should be educated on falls risk reduction to prevent adverse outcomes on quality of life.
Risk of fractures with glaucoma
Reviewed by Su Young
Glaucoma and risk of fractures: a systematic review, meta-analysis, and network meta-analysis.
CONTRIBUTOR
Su Young
Tennent Institute of Ophthalmology, NHS Greater Glasgow and Clyde, UK.
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