To study the ocular manifestations such as Cataract, Glaucoma and Age Related Macular Degeneration (ARMD) in Chronic obstructive pulmonary diseases (COPD) patients
A Retrospective study was conducted during the period from JAN 2018-SEP 2018 which included 100 patients. In all the cases a thorough history was obtained. A detailed ocular and medical history which included the duration of COPD, visual acuity and Slit lamp examination which included anterior and posterior segment examination and intra ocular pressure were recorded.
This study included 100 patients with Chronic Obstructive Pulmonary Disorder who presented with various ocular manifestation. The participants were in the age range of 40-70 years majority of cases were in the age group of 60-69 (40%) years followed by 50-59 (36%) years, 40-49 years (17%) and ≥ 70 years (7%). Ocular manifestations which were presented in majority of COPD cases were Cataract (88.63 %), Glaucoma (6.81 %), followed by ARMD (4.54%)
The result of this study shows that in this case of 100 COPD patients. Males are more commonly affected with majority of age group 60-69 years. And most common ocular manifestation was cataract followed by glaucoma and ARMD with more common in steroid inhalers.
Keywords:Ocular Manifestation, Cataract, Glaucoma, ARMD.
Chronic obstructive pulmonary diseases is a major cause of morbidity and mortality throughout the world due to the changes that occur due to tobacco smoking and steroid use. Chronic obstructive pulmonary disorder produces hypercapnia and hypoxia which may lead to choroidal thinning and also long term use of steroids lead to visual impairment. Ocular disorders which lead to visual impairment are Cataract, Glaucoma and ARMD.
To study the ocular manifestations in COPD and to study the incidence of are Cataract, Glaucoma and ARMD changes in COPD patients.
This study was conducted during the period from JAN 2018-SEP 2018 which included 100 patients who visited the ophthalmology department of Saveetha Medical College. In all the cases a thorough history was obtained with particular emphasis on the basis of duration of COPD.
An informed consent was obtained in every case. A detailed ocular history and medical history which included the duration of COPD and ocular examination which included visual acuity with Snellen’s chart and Slit lamp examination which included Anterior and Posterior segment examination, Intra Ocular Pressure, Macular Function Test, Automated Perimetry and OCT were recorded.
The patients included were at an age group of 40-70 yrs and known case of COPD with personal history of smoking.
Immuno compromised individuals and patients with corneal opacities were excluded.
This study included 100 patients with Chronic Obstructive Pulmonary Disorder who presented with various ocular manifestation during the period of JAN 2018- SEP 2018.In this study the participants were in the age range of 40-70 years majority of cases were in the age group of 60-69(40%) years followed by50-59 (36%) years ,40-49 years (17%) and ≥ 70 years (7%).
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| 40-49 YEARS | 17 | 17% |
| 50-59 YEARS | 36 | 36% |
| 60-69 YEARS | 40 | 40% |
| >70 YEARS | 7 | 7% |
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| Male | 70 | 70% |
| Female | 30 | 30% |
In the study majority of cases were males (70%) compare to females (30%)
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| Single ocular manifestation | 25 |
| Multiple ocular manifestation | 75 |
Most of the patients included in the study had shown more than one ocular manifestation
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| 1 | Diminished vision | 88 |
| 2 | Irritation | 13 |
| 3 | redness | 5 |
Decreased vision was the common presenting complaint followed by irritation and redness of eyes
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| CATARACT | 78 | 88.63% |
| GLAUCOMA | 6 | 6.81% |
| ARMD | 4 | 4.54% |
Ocular manifestation which was presented in majority of COPD cases were CATARACT (88.63 %), GLAUCOMA (6.81 %), followed by ARMD (4.54%)
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| Yes | 44 | 37 | 84.09% |
| No | 56 | 41 | 73.21% |
The incidence of cataract in COPD cases using steroid inhalers (84.09%) was more than the subjects who were not using steroid inhalers (73.21%).
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| 40-49 | 17 | 5 | 3 | 2 |
| 50-59 | 36 | 14 | 9 | 4 |
| 60-69 | 40 | 19 | 9 | 5 |
| ≥70 | 7 | 6 | 1 | 1 |
Posterior subcapsular cataract had higher incidence than Nuclear and cortical cataract
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| Yes | 44 | 3 | 6.8% |
| no | 56 | 3 | 5.3% |
Incidence of Glaucoma in COPD subjects using inhalational steroids showed no significant difference between steroid inhalers and non-inhalers
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| Yes | 44 | 2 | 4.54 % |
| No | 56 | 2 | 3.57 % |
In case of ARMD subjects there is no significant difference between steroid inhalers and non-inhalers.
In COPD, peripheral airways obstruction, parenchymal destruction and pulmonary vascular abnormalities reduce the lung capacity for gas exchange producing hypoxemia and later on hypercapnia, secondary Erythrocytosis and leukocytosis which contribute to hyperviscosity and an increased risk of thrombosis. These factors further contribute to ischemic and hypoxic environment of the tissue leading to various ocular diseases like Branch retinal vein occlusion and Non arteritic anterior ischemic optic neuropathy
Among the study subjects most common presenting complaint was diminished vision in this study. The incidence of Cataract was (88.63%), Glaucoma (6.81%) and ARMD (4.54%)
The aetiology of cataract is multifactorial and the mechanism of cataract formation is complex. Smoking is just one of many established or putative risk factors for cataract which also include age, trauma, intra ocular inflammation, ultraviolet radiation, diabetes mellitus and prolonged corticosteroid inhalation. [1]
Additional oxidative stress on the lens by nicotinamide and reduction of the level of nutrients such as ascorbic acid are caused by smoking [2]
Direct and structural lens injury may be caused by components of cigarette smoke [3]
Several prospective studies such as Hankinson et al [4] have investigated the relationship between cataract formation and cigarette smoking
Smoking was also strongly associated with posterior subcapsular opacities [5]
There is a growing consensus that smoking increases the risk of nuclear cataract and cortical cataract has also been reported [6]
Cumming et al found increased risk of posterior subcapsular cataract was associated with cumulative life time doses of Beclomethosone [7]
The evidence of involvement of primary open angle glaucoma is controversial. While several studies have indicated a strong association between smoking and Glaucoma, others have failed to do so
There is a weak co- relation between smoking and intra ocular pressure [8]
A recent population based study in West indies has shown that smoking is associated with a slightly higher intra ocular pressure [9]
A case control study has shown that cigarette smokers are more prone to glaucoma than non smokers [10] On the contrary another population based study has shown no difference in the frequency of glaucoma based on cigarette smoking [11]
Recent studies account the prevalence of ARMD among 70 years and above as 2% and 3.7% was comparable to western countries [12, 13]
Three population based studies the Beaver Dam Eye Study [14], Blue Mountain Eye Study [15] and the Rotterdam Study [16] report the prevalence rates to be 1.7% in US, 1.4% in Australia and 1.2% in Netherland
Incidence in Indian population is 1.82% in the Andhra Pradesh Eye Diseases Study and Jain et al study from North India report the prevalance rate to be 4.7% [17]
BOSS cohort found a prevalence of ARMD of 3.4%. A history of current smoking and number of pack and years smoked were associated with early ARMD [18]
The Eye Diseases Case Control Study found a association between incidence of ARMD and smoking [19]
Smoking is one of the most consistently modifiable risk factor by majority of workers. Strong history of smoking was present in all ARMD cases in a recent study from Europe, Australia and America
The damage could be directly through oxidative stress by promotion of atherosclerosis or by decrease in macular pigment density
It was a cross sectional study. Above diseases are multifactorial diseases and as we did not study all other confounding factors such as presence of diabetes, exposure to sunlight and diet we may have underestimated the adjusted effect of smoking on the risk of cataract
The result of this study shows that in this case of 100 COPD patients. Males (70%) are more commonly affected with majority of age group 60-69 years (40%). And most common ocular manifestation was Cataract (88.63%) followed by Glaucoma (6.81%) and ARMD (4.54%) Posterior subcapsular cataract had more incidence than nuclear and cortical cataract. Incidence of cataract, glaucoma and ARMD was more common in steroid inhalers (84.09%, 6.8%and 4.545).
doi:10.1001/archopht.122.4.581
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