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Systematic review of the association between Alzheimer’s disease and chronic glaucoma

Authors Tsilis A, Tsilidis K, Pelidou S, Kitsos G

Received 17 June 2014

Accepted for publication 29 July 2014

Published 13 October 2014 Volume 2014:8 Pages 2095—2104


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Alexandros G Tsilis,1 Konstantinos K Tsilidis,2 Sygkliti-Henrietta Pelidou,3 George Kitsos1

1Department of Ophthalmology, 2Department of Hygiene and Epidemiology, 3Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece

Abstract: A potential association between Alzheimer’s disease (AD) and chronic glaucoma has been suggested but results of epidemiological studies have been inconsistent. Therefore, we performed a systematic review and critical appraisal of this literature. We searched systematically in PubMed from December 1964 to September 2013 and identified 239 articles potentially relevant for abstract and full-text review. Statistical heterogeneity (variability) across studies was evaluated using the Cochran Q test and the I2 statistic, and the Newcastle-Ottawa score was used to assess study quality. Ten studies were finally selected. Compared to non-demented participants, patients with AD had a statistically significant decreased risk of glaucoma but the results were very heterogeneous, and thus summary estimates were not reported (I2, 89%; Pheterogeneity, <0.001). The study results ranged from large positive relative risks identified in small and poorly-conducted studies to weak inverse associations or null estimates observed in some cohort and record-linkage studies, but the summary estimates were essentially driven by a large retrospective cohort using medical claims that may be afflicted by underdiagnosis bias. There was also evidence for substantial publication bias (Egger’s P≤0.01). The association of AD and glaucoma is heterogeneous and most studies are small and inadequately designed. Large prospective studies with long follow-ups are warranted to clarify this association.

Keywords: systematic review, Alzheimer disease, neurodegenerative diseases, glaucoma

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