Leong, Tan Kok
(2017)
The effect of cigarette smoking and physical activity on the severity of primary open angle glaucoma in Malay patients.
Masters thesis, Universiti Sains Malaysia.
Abstract
INTRODUCTION
Primary open angle glaucoma (POAG) is the most common type of glaucoma. Data
regarding this disease among Malay population is scarce. Currently, intraocular
pressure is the only modifiable risk factor of POAG that was consistent among past
studies. Influence of lifestyle factors such as cigarette smoking and physical activity
on the severity of POAG is still inconclusive.
OBJECTIVE
The aim of this study is to determine the association of cigarette smoking and
physical activity with the severity of POAG among Malay patients in Malaysia.
METHODOLOGY
A cross sectional study involving Malay POAG patients was conducted between
November 2014 and December 2016. The smoking status was documented using a
validated Malay language questionnaire adopted from Singapore Malay Eye Studies
(SiMES), which also has been used among glaucoma patients. The physical activity
assessment was carried out using the validated Malay version of International
Physical Activity Questionnaire (IPAQ). Humphrey visual field (HVF) 24-2 test was
conducted. POAG severity was determined according to modified Advanced
Glaucoma Intervention Study (AGIS) scoring system, based on two consecutive
reliable HVF, by two masked investigators. Severity of POAG was catogerized into
mild (score of 0 to 5), moderate (score of 6 to11) and severe (score of 11 to 20).
Univariate analysis was done to evaluate risk factors associated with POAG. Theassociation of cigarette smoking, and physical activity level with AGIS score was
analyzed using multiple linear regression. Confounders such as age, gender,
education status, and systemic co-morbidities were considered in the analysis.
RESULTS
A total of 150 Malay patients with POAG were recruited; comprising of 101 males
and 49 females. This study did not find any significant association between physical
activity and the AGIS score of Malay POAG patients. There was a significant
correlation between cigarette smoking status and the AGIS score (r = 0.175, p =
0.032) among Malay POAG patients. However, the duration of smoking was not
found to be significantly correlated with the AGIS score (r = 0.142, p = 0.083). There
was a positive linear relationship between age of POAG patient and AGIS score.
CONCLUSION
Cigarette smoking is a potential modifiable risk factor for POAG among Malays.
This study found significant association of smoking status with POAG severity.
However further study is needed to quantify the influence of smoking on POAG
severity. POAG patient should be advised and properly educated to refrain from
cigarette smoking, as smoking could to lead to more severe POAG and progression
of the disease. There was no significant association between physical activity and
severity of POAG in Malays. Limitation of cross sectional study and IPAQ may not
reflect the actual influence of physical activity on the severity of POAG.
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