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Trace Metals Associated with Glaucoma Risk

Lower blood manganese levels and higher blood mercury levels were associated with greater incidence of glaucoma diagnosis, according to a study.

Dr. Shan C. Lin from the University of California, San Francisco, and colleagues investigated the relationship between body levels of five trace metals (manganese, mercury, lead, cadmium, and arsenic) and the prevalence of glaucoma by sampling blood and urine from 2,680 individuals (19 years and older) who participated in the fourth Korea National Health and Nutrition Examination Survey between January 2008 and December 2009. Participants were in the second and the third years of the survey (2007–09) and a representative sample of the South Korean population was included.

After adjustment for potential confounders, analysis indicated that lower blood manganese levels and higher blood mercury levels were associated with greater glaucoma prevalence. No association was found between blood lead or cadmium levels or urine arsenic levels and a diagnosis of glaucoma in the study population.

Clinical Associate Professor Ivan Goldberg described the findings as “interesting observations” that required further exploration.

“As glaucoma is regarded increasingly as a neurological disease, it makes sense to search for pathological mechanisms that involve trace metals, which could be neurotoxic in over or under supply. If identified, new treatment strategies could become feasible,” said Clinical Assoc. Prof. Goldberg.

“In this context, Lin et al’s article uses a large data base from the Korean National Health and Nutrition Examination Survey to identify an association between glaucoma and either lower blood manganese or higher blood mercury levels.

“As the authors point out, this is a cross-sectional study that cannot address causation, a dose-response risk profile was not evident, the trace elements were measured once only with no time-related level information available and the diagnosis of glaucoma was not universally confirmed with perimetry (frequency doubled thresholds were the default functional assessment tool). Furthermore, the blood manganese levels showed a wide confidence interval and the blood mercury level elevation odds risk ratio was a very modest 1.01.

“Before these interesting observations can be applied clinically, both confirmation from other population sets and a prospective study are needed.

The authors are to be complimented for opening this field wider for scientific exploration,” concluded Clinical Assoc. Prof. Goldberg.

The study was published online by JAMA Ophthalmology.