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Editors Selection IGR 23-4

Risk Factors: Is Low Serum Vitamin D related to Higher IOP?

Shan Lin

Comment by Shan Lin on:

107559 Inverse Relationship between Serum 25-Hydroxyvitamin D and Elevated Intraocular Pressure, Lee JH; Kwon YJ; Lee HS et al., Nutrients, 2023; 15:

See also comment(s) by Ramin Talebi & Anne Coleman


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There has been controversy about the relationship of serum vitamin D levels and intraocular pressure (IOP). There is abundant data supporting the role of vitamin D in reducing inflammation as well as in promoting antioxidant pathways. Accordingly, there is good evidence to correlate low serum vitamin D with glaucoma. However, there has not been a previous study utilizing a large database to evaluate the correlation of serum vitamin D with IOP. Lee J-H. et al. have utilized the data of a large sample of patients from their Nowon Eulji Health Promotion Center to assess this topic. Data was available from 15,338 participants. Serum vitamin D is measured as 25-hydroxyvitamin D (25(OH)D). Subjects were classified into: 1) 25(OH)D deficiency (< 20 ng/mL); 2) 25(OH)D insufficiency (20-29 ng/mL), and 3) 25(OH)D sufficiency (30 ng/mL or greater). The numbers in each group were 9800, 3685, and 1853, respectively. The outcome was elevated IOP (22 mmHg or greater). The authors found that the proportions with elevated IOP were greatest in the 25(OH)D deficiency group (3.2%), followed by the 25(OH)D insufficiency group (2.4%), and the 25(OH)D sufficiency group (1.6%) (overall p<0.001). In pairwise comparisons, the differences between the deficiency group and either of the other two groups were statistically significant. However, the difference between the insufficiency and sufficiency groups was not (p = 0.051). Statistical analysis showed that there was an inverse relationship between 25(OH)D levels and IOP, i.e., lower 25(OH)D levels were associated with a greater IOP (p < 0.001). In subgroup analysis, the female and elderly subgroups did not show statistically significant relationships of 25(OH)D status and elevated IOP. The authors speculate that there may be an interaction of vitamin D and sex hormones on the effects on IOP. In males and the young, addressing vitamin D deficiency may be an avenue to prevent glaucoma. The main limitation of this study is that it is cross-sectional and provides evidence for an association but not a causal relationship.

The main limitation of this study is that it is cross-sectional and provides evidence for an association but not a causal relationship


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