Patients with Lower than Average Body Sizes at an Increased Risk for Glaucoma

The risk of primary open-angle glaucoma increases when a patient loses a substantial amount of weight, especially if they were categorized as “high” on the body mass index as a child. Maintaining an average body size can ensure that the risk of glaucoma doesn’t increase. Photo: Andrew Rixon, OD. Click image to enlarge.  A number of studies on the association between body mass index (BMI) and primary open-angle glaucoma (POAG) have been published in the past. However, patients’ weights shift over time, and they may present with larger body sizes as adolescents before losing weight in their adult years, and vice-versa. An association between POAG and changes to the body’s mass from childhood to adulthood has been unexplored; therefore, an investigation into how weight impacts the risk of developing POAG could further physicians’ understanding of who could be affected by this disease.Recently published in the American Journal of Ophthalmology, findings of a research team from China described the trajectory of body size from childhood to adulthood and how it altered the risk of POAG. The team collected data from the UK Biobank for their analysis. Childhood body sizes were determined through a questionnaire provided to participants. If they could recall their weight during childhood, then they selected one of three options: thinner, about average and plumper. Each person was then categorized as low, average or high in childhood body size.Adulthood body sizes were measured differently than childhood sizes. Since the majority of subjects fell in the overweight category according to the World Health Organization classification (BMI ≥25), researchers needed a different approach to ensure that their data could be compared to the established adolescent weight categories. Using methodology from previous studies, the researchers were able to categorize participants as either low, average or high in adulthood body size by predicting BMI based on age and age squared by sex. A total of 467,768 cases were analyzed for this study.Using their study’s statistical model, researchers determined the hazard ratios for developing POAG at different body sizes from childhood to adulthood. They discovered that the risk of POAG was elevated for patients who developed low body sizes as adults compared to those who developed average body sizes (HR=1.3). The risk for participants with high childhood body sizes (HR=1.14) differed from those with high adulthood body sizes (HR=0.9) compared to average. If someone with a low childhood body size became average or high in adulthood, then they had a reduced risk of POAG (average: HR=0.8; high: HR=0.58). However, if they had a high childhood body size and attained a low body size in adulthood, then they had an increased risk of POAG (HR=1.7).“The results of this study hold substantial implications for clinical practice and public health strategies concerning POAG,” shared the authors in their paper. “Clinicians should consider advocating moderate rather than drastic weight loss goals for overweight children, especially those with familial histories of POAG or other relative risk factors, thereby reducing the burden associated with high body size while avoiding the induction of POAG.”The researchers outlined three strategies that they believe should be practiced to mitigate the risk of POAG: People with low body sizes during childhood should be encouraged to gain the appropriate amount of weight to achieve an average or above-average body size in adulthood.People with average body sizes during childhood should continue to maintain an optimal state throughout adulthood.People with high body sizes during childhood should reduce their weight moderately to achieve an average adulthood body size, which does not significantly increase the risk of POAG.“Our study presents several notable strengths, including robust statistical power derived from a large sample size and rigorously defined objective POAG endpoints,” concluded the authors. “Our results underscore the significance of personalized weight management strategies throughout early life and suggest that maintaining an adequate body size in adulthood may be crucial for the prevention of POAG.” Click here for the journal source. Chen J, Ling Y, Zhu Y, et al. Early life body size trajectory and the risk of primary open-angle glaucoma: A retrospective cohort study. Am J Ophthalm. August 6, 2025. [Epub ahead of print].This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.