Open-angle glaucoma and mortality: The Barbados eye studies

Objective: To evaluate the relationship between open-angle glaucoma (OAG) and mortality in a black population at 9-years' follow-up. Design: Population-based cohort study of 4092 black participants (aged 40-84 years at baseline) in the Barbados Eye Studies. Open-angle glaucoma was defined by visual field defects and optic disc damage, based on standardized examinations and photograph gradings. Ocular hypertension was defined by an intraocular pressure greater than 21 mm Hg or treatment, without OAG damage. Mortality was ascertained from death certificates. Cox proportional hazards regression analyses determined associations with mortality. Results: After 9 years, 764 (19%) participants were deceased. Mortality was unrelated to overall OAG at baseline (n=300) after adjustment for confounders. However, cardiovascular mortality tended to increase in persons with previously diagnosed/treated OAG (n=141; relative risk [RR], 1.38, P=.07) and was significantly higher with treatment involving timolol maleate (RR, 1.91, P=.04). Cardiovascular deaths also tended to increase in persons with ocular hypertension at baseline (n=498; RR, 1.28, P=.06). Conclusions: In this black population, cardiovascular mortality tended to increase in persons with previously diagnosed/treated OAG and ocular hypertension. The excess mortality associated with timolol maleate treatment of OAG, also found in a white population, warrants further investigation.