Associations with intraocular pressure across Europe: The European Eye Epidemiology (E3) Consortium

Anthony P. Khawaja*, Henriët Springelkamp, Catherine Creuzot-Garcher, Cécile Delcourt, Albert Hofman, René Höhn, Adriana I. Iglesias, Roger C.W. Wolfs, Jean François Korobelnik, Rufino Silva, Fotis Topouzis, Katie M. Williams, Alain M. Bron, Gabriëlle H.S. Buitendijk, Maria da Luz Cachulo, Audrey Cougnard-Grégoire, Jean François Dartigues, Christopher J. Hammond, Norbert Pfeiffer, Angeliki SalonikiouCornelia M. van Duijn, Johannes R. Vingerling, Robert N. Luben, Alireza Mirshahi, Julia Lamparter, Caroline C.W. Klaver, Nomdo M. Jansonius, Paul J. Foster, behalf of the European Eye Epidemiology (E³) Consortium On behalf of the European Eye Epidemiology (E³) Consortium, Niyazi Acar, Eleftherios Anastosopoulos, Augusto Azuara-Blanco, Arthur Bergen, Geir Bertelsen, Christine Binquet, Alan Bird, Lionel Brétillon, Gabrielle Buitendijk, Usha Chakravarthy, Michelle Chan, Petrus Chang, Annemarie Colijn, Philippa Cumberland, José Cunha-Vaz, Vincent Daien, Gabor Deak, Marie Noëlle Delyfer, Anneke den Hollander, Martha Dietzel, Maja Gran Erke, Sascha Fauser, Robert Finger, Astrid Fletcher, Panayiota Founti, Arno Göbel, Theo Gorgels, Jakob Grauslund, Franz Grus, Catherine Helmer, Hans Werner Hense, Manuel Hermann, René Hoehn, Ruth Hogg, Frank Holz, Carel Hoyng, Sarah Janssen, Caroline Klaver, Mélanie Le Goff, Sergio Leal, Yara Lechanteur, Terho Lehtimäki, Andrew Lotery, Irene Leung, Matthias Mauschitz, Bénédicte Merle, Verena Meyer zu Westrup, Edoardo Midena, Stefania Miotto, Sadek Mohan-Saïd, Alyson Muldrew, Michael Mueller, Sandrina Nunes, Konrad Oexle, Tunde Peto, Stefano Piermarocchi, Elena Prokofyeva, Jugnoo Rahi, Olli Raitakari, Luisa Ribeiro, Marie Bénédicte Rougier, José Sahel, Clarisa Sanchez, Steffen Schmitz-Valckenberg, Cédric Schweitzer, Tatiana Segato, Jasmin Shehata, Giuliana Silvestri, Christian Simader, Eric Souied, Robyn Tapp, Virginie Verhoeven, Therese Von Hanno, Stela Vujosevic, Christian Wolfram, Jennifer Yip, Jennyfer Zerbib, Isabella Zwiener

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    12 Citations (Scopus)


    Raised intraocular pressure (IOP) is the most important risk factor for developing glaucoma, the second commonest cause of blindness globally. Understanding associations with IOP and variations in IOP between countries may teach us about mechanisms underlying glaucoma. We examined cross-sectional associations with IOP in 43,500 European adults from 12 cohort studies belonging to the European Eye Epidemiology (E3) consortium. Each study conducted multivariable linear regression with IOP as the outcome variable and results were pooled using random effects meta-analysis. The association of standardized study IOP with latitude was tested using meta-regression. Higher IOP was observed in men (0.18 mmHg; 95 % CI 0.06, 0.31; P = 0.004) and with higher body mass index (0.21 mmHg per 5 kg/m2; 95 % CI 0.14, 0.28; P < 0.001), shorter height (−0.17 mmHg per 10 cm; 95 % CI –0.25, −0.08; P < 0.001), higher systolic blood pressure (0.17 mmHg per 10 mmHg; 95 % CI 0.12, 0.22; P < 0.001) and more myopic refraction (0.06 mmHg per Dioptre; 95 % CI 0.03, 0.09; P < 0.001). An inverted U-shaped trend was observed between age and IOP, with IOP increasing up to the age of 60 and decreasing in participants older than 70 years. We found no significant association between standardized IOP and study location latitude (P = 0.76). Novel findings of our study include the association of lower IOP in taller people and an inverted-U shaped association of IOP with age. We found no evidence of significant variation in IOP across Europe. Despite the limited range of latitude amongst included studies, this finding is in favour of collaborative pooling of data from studies examining environmental and genetic determinants of IOP in Europeans.

    Original languageEnglish
    Pages (from-to)1101-1111
    Number of pages11
    JournalEuropean Journal of Epidemiology
    Issue number11
    Publication statusPublished - 1 Nov 2016

    Bibliographical note

    Funding Information:
    EPIC-Norfolk infrastructure and core functions are supported by Grants from the Medical Research Council (G1000143) and Cancer Research UK (C864/A14136). The clinic for the third health examination was funded by Research into Ageing (262). Mr Khawaja is a Wellcome Trust funded Clinical Research Fellow. Professor Foster has received additional support from the Richard Desmond Charitable Trust (via Fight for Sight) and the Department for Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital and the UCL Institute of Ophthalmology for a specialist Biomedical Research Centre for Ophthalmology. None of the funding organisations had a role in the design or conduct of this research. Rotterdam Study and Erasmus Rucphen Family Study: Supported by Stichting Lijf en Leven, Krimpen aan de Lek; MD Fonds, Utrecht; Rotterdamse Vereniging Blindenbelangen, Rotterdam; Stichting Oogfonds Nederland, Utrecht; Blindenpenning, Amsterdam; Blindenhulp, The Hague; Algemene Nederlandse Vereniging ter Voorkoming van Blindheid (ANVVB), Doorn; Landelijke Stichting voor Blinden en Slechtzienden, Utrecht; Swart van Essen, Rotterdam; Stichting Winckel-Sweep, Utrecht; Henkes Stichting, Rotterdam; Laméris Ootech BV, Nieuwegein; Medical Workshop, de Meern; all in The Netherlands. Henriët Springelkamp is supported by the NWO Graduate Programme 2010 BOO (022.002.023). None of the funding organisations had a role in the design or conduct of this research. The Aliénor study received financial support from Laboratoires Théa (Clermont-Ferrand, France). Laboratoires Théa participated in the design of the study, but not in the collection, management, statistical analysis and interpretation of the data, nor in the preparation, review or approval of the present manuscript. Funding for the Montrachet Study was provided by an inter regional grant (PHRC) and the regional Council of Burgundy. The sponsors had no role in the design nor conduct of the research. TwinsUK was funded by the Wellcome Trust; European Community’s Seventh Framework Programme (FP7/2007-2013). The study also receives support from the National Institute for Health Research (NIHR)- funded BioResource, Clinical Research Facility and Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London. Miss Williams acknowledges support from a Medical Research Council Clinical Research Training Fellowship. None of the funding organisations had a role in the design or conduct of this research. The Gutenberg Health Study is funded through the government of Rheinland-Pfalz (“Stiftung Rheinland-Pfalz für Innovation”, contract AZ 961-386261/733), the research programs “Wissen schafft Zukunft” and “Center for Translational Vascular Biology (CTVB)” of the Johannes Gutenberg-University of Mainz, and its contract with Boehringer Ingelheim, PHILIPS Medical Systems and Novartis Pharma, including an unrestricted grant for the Gutenberg Health Study. Funders were involved in the development of the study design as scientific consultants. However, they played no role in data collection, analysis, decision to publish, or preparation of the manuscript. The Coimbra Eye Study was supported by Novartis. Novartis had no role in the design or conduct of the research. The Thessaloniki Eye Study has been co‐financed by the European Union (European Social Fund—ESF) and Greek national funds through the Operational Program “Education and Lifelong Learning” of the National Strategic Reference Framework (NSRF)—Research Funding Program: THALES. Investing in knowledge society through the European Social Fund. None of the funding organizations had a role in the design or conduct of this research.

    Publisher Copyright:
    © 2016, The Author(s).


    • Blood pressure
    • Body mass index
    • Epidemiology
    • Glaucoma
    • Intraocular pressure
    • Refractive errors


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