Author(s): Akiko Hanyuda (1), Bernard A Rosner (2), Janey L Wiggs (3), Kazuno Negishi (4), Louis R Pasquale (5), Jae H Kang (6)

1 Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan;; Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan;. Electronic address: akihanyu@z6.keio.jp.
2 Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA;; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
3 Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
4 Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
5 Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
6 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

OBJECTIVE: To assess the association between intakes of total alcohol and individual alcoholic beverages and the incidence of exfoliation glaucoma/glaucoma suspect (XFG/XFGS).

DESIGN: Prospective cohort study.

PARTICIPANTS: A total of 195,408 participants of the Nurses' Health Study (1980-2018), the Health Professionals Follow-up Study (1986-2018), and the Nurses' Health Study II (1991-2019) were followed biennially. Eligible subjects at each 2-year risk period were 40+ years old and free of XFG/XFGS with available data on diet and ophthalmic examinations.

METHODS: We obtained cumulatively averaged total (primary exposure) and individual alcoholic beverages including beer, wine, and liquor from validated dietary information every 2-4 years.

MAIN OUTCOME MEASURE: Confirmed incident XFG/XFGS using medical records that included information on slit lamp examination, maximal untreated intraocular pressure, and data from reliable visual field tests. We used per-eye Cox proportional hazards models, accounting for inter-eye correlations, to estimate multivariable-adjusted relative risks (MVRRs) and 95% confidence intervals (CIs).

RESULTS: During 6,877,823 eye-years of follow-up, 705 eyes with XFG/XFGS were documented. Greater total alcohol consumption was significantly associated with higher XFG/XFGS risk: the MVRR for XFG/XFGS for cumulatively averaged alcohol consumption ≥15+ g/day vs. non-drinking was 1.55 (95% CI, 1.17-2.07; Ptrend=0.02). Long- and short-term alcohol intake was significantly associated with XFG/XFGS risk, with the strongest associations with cumulatively averaged alcohol intake as of 4 years before diagnosis (MVRR ≥15+ g/day vs. non-drinking=1.65 [95% CI, 1.25-2.18; Ptrend=0.002]). Stratifying alcohol consumption by type of beverage revealed a significant linear trend for liquor. Compared to non-drinkers, consuming 3.6+ drinks per week of beer, wine, or liquor was associated with the following MVRRs for XFG/XFGS: 1.26 (95% CI, 0.89-1.77; Ptrend=0.40), 1.30 (95% CI, 1.00-1.68; Ptrend=0.15), and 1.46 (95% CI, 1.15-1.85; Ptrend=0.01), respectively. We did not observe interactions by age, latitude, residential tier, and intakes of folate or vitamin A (Pinteraction>0.40); however, the association between alcohol and XFG/XFGS was suggestively stronger for those without a family history of glaucoma (Pinteraction=0.10).

CONCLUSION: Long-term alcohol consumption was associated with a higher risk of XFG/XFGS. Our findings provide further clues regarding the etiology of XFG/XFGS.

Copyright © 2022. Published by Elsevier Inc.

Ophthalmology. 2022 Aug 27;S0161-6420(22)00668-6. doi: 10.1016/j.ophtha.2022.08.023. PMID: 36041586 DOI: 10.1016/j.ophtha.2022.08.023

Keywords: alcohol consumption; environmental factors; exfoliation glaucoma; oxidative stress

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