Cholesterol and glaucoma: a systematic review and meta‐analysis

PURPOSE: Intraocular pressure is the main risk factor for glaucoma; however, additional risk factors may also matter. This systematic review and meta‐analysis were conducted to summarize the evidence regarding the association of cholesterol parameters (total cholesterol, low‐density lipoprotein (LDL) and high‐density lipoprotein (HDL) levels) and glaucoma. METHODS: Four electronic databases were searched for all publications containing ‘glaucoma’ and one of various forms of ‘cholesterol’ or ‘lipoprotein’. Two independent reviewers screened abstracts and potentially full texts of identified articles for eligibility. Risk of bias was assessed with the Newcastle–Ottawa Scale. A random‐effects meta‐analysis was used to investigate the differences in total cholesterol, LDL and HDL levels between patients with and without glaucoma. RESULTS: Overall, 29 observational studies were included in the systematic review and 26 reported quantitative information to investigate differences in cholesterol parameters between patients with glaucoma (N = 7196) and patients without glaucoma (N = 350 441). Patients with glaucoma had significantly higher total cholesterol levels than patients without glaucoma (Mean Difference (MD) 7.9 mg/dl, 95% CI 3.3 to 12.5, p = 0.001) and lower mean HDL levels (MD −2.0 mg/dl, 95% CI: −3.1 to −0.9, p = 0.001). Patients with glaucoma had higher mean LDL levels than patients without glaucoma, albeit not statistically significant (MD 6.1 mg/dl, 95% CI: −4.3 to 16.4, p = 0.251). CONCLUSION: This systematic review and meta‐analysis of observational studies found an association of glaucoma and high total cholesterol and low HDL levels, respectively. Although this supports the hypothesis that lipid levels pose an additional risk for glaucoma development, heterogeneity was substantial and causality cannot be presumed from identified observational studies.