Background
Glaucoma is a leading cause of irreversible vision loss, estimated to affect over 60 million people globally. Established risk factors for glaucoma include advanced age, family history, and elevated intraocular pressure. Other possible risk factors for glaucoma are conditions associated with systemic blood flow and systemic hypertension, such as diabetes and cardiovascular hypertension. As ischemic heart disease is the leading cause of death for men and women in the developed world, and shares many of the risk factors associated with glaucoma, analysis of associations between glaucoma and heart disease could provide valuable insight for management of glaucoma patients, who often present with complex comorbidities. 

Purpose
To perform a systematic review and meta-analysis to determine and quantify the relationships between various manifestations of ischemic heart disease (IHD) and ischemic heart disease associated mortality with glaucoma.

Methods
A systematic review was conducted by searching the literature through online databases including MEDLINE, EMBASE, SCOPUS, and Web of Science in combination with Grey literature sources till July 7th, 2019. Search results were inputted into Zotero and duplicates were removed. Two-levels of screening was conducted. Quality check for included articles was done using Modified Newcastle-Ottawa Scale. Data was extracted. Meta-analysis was performed using STATA 15.0. 

Results
Our search strategy identified 295 records, which were screened at 2 levels by 2 independent reviewers at each level. Title and abstracts of each record were screened at level 1, resulting in 35 records moving to level 2 screening. Full-text of records remaining after level 1 screening were screened at level 2, with κ coefficient of 0.73, resulting in 9 records moving to data extraction and analysis. We found significant odds (OR = 1.46, 95% CI: [0.96, 2.21]) of IHD in patients with glaucoma compared to controls. Results indicated a significant hazard of IHD in patients with open-angle glaucoma: (HR = 1.33; 95% CI: [1.07,1.64]). Significant proportions of normal tension glaucoma patients (ES = 0.07; 95% CI: [0.04, 0.1]), and low-tension glaucoma patients (ES = 0.24; 95% CI: [0.1, 0.37]) suffer from IHD.

Conclusions
Due to the extremely prevalent nature and universal human susceptibility associated with glaucoma, exploring a relationship between the disease and its potential for altering a patient’s risk of suffering from IHD is important. Results indicated a significant IHD risk in glaucoma patients compared to normal individual. More high-quality studies are required to come to more concrete conclusions.

Systematic review and meta-analysis of ischemic heart disease incidence in glaucoma patients

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