Does Gender Have an Effect in the Prevalence of Types of Glaucoma in Urban Population

Does gender feel an property in the Efficacy of likenesss of glaucoma in sophisticated population? Farah Akhtar1, §, Shazia Micheal2, Muhammad Imran Khan2, Sajeela yousaf 2, Muhammad Bilal3, Asifa Ahmed2, Raheel Qamar2, 4 1Al-Shifa Belief Eye Hospital Rawalpindi, Pakistan, 2Department of Biosciences, COMSATS Institute of Information Technology, Islamabad, Pakistan, 3POF Hospital, Wah Cantt, Pakistan, 4Shifa College of Medicine, Islamabad, Pakistan. §Correspondence should be addressed to: Farah Akhtar, FCPS, DOMS, MBBS, Al-Shifa Belief Eye Hospital, Jhelum Road, Rawalpindi -46000, Pakistan.Phone: +92-3335160266 email:[email protected] com Abstract Glaucoma is the prevent adventitious producer of the shortsightedness and epidemiologic studies of rationals demonstrated telling contrarietys betwixt the genders in the bent to enucleate sundry likenesss of glaucoma. Objective: To assess the efficacy of likenesss of glaucoma, shortsightedness and tyranny following a suitableness deference to gender contrarietys. Plan and Methods: Retrospective con-balance including 3021 endurings examined for likenesss of glaucoma to particularize the gender disproportion in mislaying of expectation.Data was analyzed following a suitableness the statistical software SPSS. Results: It was root that balanceall the harmony 2. 3: 1 of manlys unsupposable following a suitableness glaucoma is upper then effeminates. Males feel a past ordinary POAG likeness of glaucoma since effeminates are indisposition past from PCAG glaucoma. Although the balanceall efficacy is upper in manlys but the shortsightedness objurgate is senior in all likenesss of glaucoma in effeminates. Surgery of senior sum of effeminates is resulted due to violent provisions in POAG since PEXG and NTG are past pronounced in manlys.Conclusion: Females feel PCAG past ordinary suitableness manlys feel POAG which are the two senior likenesss. Overall the shortsightedness objurgate in incongruous likenesss of glaucoma is excellent in effeminates consequently the results of bestow con-balance indicated that gender does feel an property in the efficacy and shortsightedness due to incongruous likenesss of glaucoma. Introduction Glaucoma is a neurodegenerative indisposition of the optic firmness which occurs due to the newfangled mislaying of optic firmness axons and cessation of the retinal ganglion cells (RGCs) [1]. It is the prevent adventitious producer of shortsightedness solemn 70 favorite tribe worldwide and it has been estimated that the efficacy of glaucoma conciliate be increased and the depend balance of the sum of contingencys conciliate be 79. 6 favorite in the year 2020 [2]. As glaucoma is a discordant and multifactorial indisposition consequently it represents a sum of incongruous provisions which are binding for the decrepitude of the optic firmness and mislaying of expectation associated following a suitableness visual opportunity omissions and honorable intrademonstrable hurry [3].In fresh years the gender contrariety has attained ample vigilance in the efficacy of sundry likenesss of glaucoma in populations of incongruous countries and continents. There is a limitation of censorious consequence to gender contrarietys in shortsightedness for reason of targets for shortsightedness diminution and in the enucleatement of interventions. In incongruous neurodegerative and undiscerninging eye indispositions it has been observed that gender feel entirely essential targets and role in the truth, series and outset of the indisposition.Females feel 1. 9 upper destroy of enucleateing dementia and Alzheimer’s indisposition by 3. 1, most of the American studies reported correspondent objurgates since Europeans had shown upper objurgates of dementia in women. Besides effeminates feel increased destroy of enucleateing hypertension, hyperlipidemia, and diabetes as compared to men. It is observed that although gender contrarietys in neurodegenerative processes are stagnant unexplored, appears to exhibit exalted assurance for the forthcoming enucleatement of emend strategies for the recover of indispositions and emendment of endurings [4-7].In fresh years it is a theme of solicitude in the eye indispositions that do gender feel any property or not and there are incongruous reports explaining significance of gender. Rudnicka AR et al had concluded through a Meta-decomposition con-balance of 46 studies that manlys feel increased destroy of enucleateing chief unreserved prepossession glaucoma not-absolute to effeminates [8]. Similarly the contact of axial myopia, age, and retinal amalgamation fact as destroy contents for pseudophakic retinal amalgamation were seen predominantly in manlys [9]. Occurrence of myopia and hyperopia refractive errors, changes in precedent of astigmatism and corneal erection following a suitableness age are besides biasd by gender [10, 11]. The aim of the bestow con-balance is consequently to particularize the efficacy of sundry likenesss of glaucoma, shortsightedness due to incongruous likenesss of glaucoma, and actual parentage fact following a suitableness deference to gender. Materials and Methods The bestow retrospective con-balance is grounded on the decomposition of facts self-possessed following critiqueing the archives of the 3021 endurings who had visited the glaucoma clinic of the Al-Shifa eye belief hospital Rawalpindi from August 2006-August 2009.All the facts is developed frequently by the Ophthalmologist who had manufactured the constructive demonstration of all the endurings. The criteria for the facts were grounded on the gauge provisions of individuality for each likeness of glaucoma. The likenesss of glaucoma which were learned grasp chief unreserved prepossession (POAG), chief unsuited prepossession (PCAG), pseudoexfoliative (PEXG), natural intentness (NTG), neovascular (NVG), steroid innate (SIG), glaucoma doubts, and the fostering likenesss were graspd in the facts of other likenesss of glaucoma.The ophthalmic demonstration of the endurings graspd testing for best corrected visual acuity following a suitableness the acceleration of Snellen’s chart, Goldman applanation tonometer to appraise intrademonstrable hurry (IOP), slit lamp biomicroscopy, unconnected fundoscopy to particularize cup-to-disc harmony (c/d), visual opportunity omissions particularized following a suitableness Humphrey 30–2, and gonioscopy to assess likeness of glaucoma. Criteria of POAG grasp IOP of past than 21 mmHg, usual glaucomatous cupping of the optic disc (diluted or focal thinning of the disc rims and cup-to-disc harmony of past than 0. ), visual opportunity omission usual of glaucoma, an unreserved precursive room prepossession. PCAG was defined by the corresponding criteria as POAG save that in PCAG, a gonioscopically unsuited precursive room prepossession was distinguished. In contingency of PEXG, endurings were evaluated by slit lamp biomicroscopy for the closeness of exfoliative esthetic concurrently the papillary brim and on the iris following a suitablenessout dilating the eye. Following ward dilation the endurings were besides analyzed for the closeness of snowy esthetic deposits on the precursive lens demeanor.NTG endurings were classified as having IOP in natural concatenate but newfangled optic firmness changes following a suitableness unreserved prepossession and visual opportunity omissions. NVG catagoried by the neovascularization on the iris, increased IOP and violent suffering, and SIG by strong IOP due to the government of steroids and glucocorticoids. The other likenesss of glauocma grasp glaucoma associated following a suitableness incongruous syndromes, preventary glaucomas and enucleatemental, coeval, aphakic, pseudophakic, column traumatic, column vitrectomy, corneo-iridic scar, uveitic glaucoma etc.The facts was analyzed to particularize the balanceall efficacy of sundry likenesss of glaucoma, following a suitableness deference to the gender as courteous shortsightedness producerd by these likenesss and the sum of surgeries in manlys and effeminates by using statistical software SPSS statement 16. Results In the sum three thousand twenty one endurings of glaucoma the manly to femanly harmony is 2. 3:1 which indicates that in our tract-of-land manlys are past unsupposable then effeminates from glaucoma. In consultation 1 the balanceall efficacy of incongruous likenesss of glaucoma is represented and it is observed that POAG modescold the 40. % of the sum glaucoma endurings. PCAG is the prevent and PEXG is the 3rd ordinary likeness but it is shown in the consultation that past individuals are undiscerning due to PCAG and NVG likeness of glaucoma as compared to POAG which is past ordinary. In actual parentage fact of glaucoma it is observed that foremost measure not-absolutes of PCAG likeness of glaucoma feel a senior hazard of having glaucoma compared to other likenesss as shown in consultation 1 that 15. 4 % of the PCAG endurings feel their not-absolutes actual for glaucoma.The past violent provisions of glaucoma were observed in the POAG likeness, 32% of the endurings were operated for the increase of their expectation. In consultation 2 the likenesss of glaucoma were observed following a suitableness deference to gender and it is observed that manlys feel past hazards of enucleateing POAG, PEXG, NVG, SIG and traumatic glaucoma as compared to effeminates since effeminates are past bent to PCAG likeness of glaucoma. Although the hazard of enucleateing glaucoma are comparatively senior in manlys but the estimate of shortsightedness is upper in effeminates not-absolute to manlys.When the facts was analyzed following a suitableness deference to surgeries it has been observed that past manlys were operated for PEXG and NTG glaucoma which shows past tyranny in manlys suitableness effeminates feel past surgeries for POAG, PCAG, SIG and traumatic glaucoma as shown in consultation 2. Discussion Now-a- days gender contrarietys in glaucoma is a theme of contend consequently in the bestow retrospective con-balance we feel observed the efficacy of likenesss, shortsightedness and tyranny of provisions following a suitableness deference to gender in glaucoma. The results of our con-balance are in harmony to the prior studies we feel observed that effeminates are past unsupposable from PCAG likeness of glaucoma suitableness manlys are past propertyed conceive POAG likeness of glaucoma. It has been observed priorly that eyes of effeminates are on mean 1mm smaller then manlys as courteous the lens and corneal inflexion of effeminates is steeper consequently their applanation tonometric readings were past then half ace upper not-absolute to manlys [12-14].Most of the suited studies and fresh averments feel shown that effeminates statement for almost 64. 5% of the global shortsightedness [15]. Recently Casson RJ et al had root in his con-balance that femanly gender is associated following a suitableness 9. 2 periods increased destroy of unsuited prepossession glaucoma as courteous as following each millimeter retrench in precursive room profundity was associated following a suitableness 2. 6 periods senior destroy of this likeness of glaucoma [16]. Similarly in a con-balance of population of Nepal, the PCAG femanly endurings were outnumbered then manlys [17].In other undiscerninging eye indispositions according to the overlook of the Chinese Ophthalmological Society cataract the foremost adventitious producer of shortsightedness is past vile in effeminates then manlys [18]. Shortsightedness due to trachoma was besides observed two to indelicate periods at upper objurgate in effeminates then manlys [19-21], as courteous freshly in population of mediate Ethiopia gender contrarietys were observed for shortsightedness and low expectation and they had root that Women modescold 59. % of shortsightedness, and 70. 0% of low expectation. The contrariety in gender disposal and low expectation was statistically telling in all age groups. Women had 1. 46 extravagance destroy of bilateral shortsightedness [22]. All of these studies are in conformity to our results which supports the conception that gender does feel an property in the efficacy of incongruous likenesss of adventitious eye undiscerninging and neurodegenerative indispositions.Although in all of these studies effeminates are past undiscerning then manlys but in a con-balance of population of Iran they had root that the shortsightedness objurgate was upper in manlys as compared to effeminates which is in contrariety to our con-over. We were expecting our results correspondent to this beproducer twain of these populations are sharing the genetic fact following a suitableness each other and on the plea of which they feel contemplated a locomotion way of tribe from Iran to Pakistan but the correspondent results were observed in the population of Oman which besides feel locomotion ways fromOman to Pakistan and crime versa [23- 25]. Contradictory to these results in the population of India glaucoma is not gender favoring [26]. In sundry studies it has been observed now that in some contingencys manlys are past propertyed since other are past ordinary in femanly gender, it could to due to genetic contents or due to varying look of incongruous receptors and hormonal contrariety following a suitableness deference to gender.It has been observed that sex hormones feel an essential role in the harmonies of the structural characteristics and professional disembodiment of frequent demonstrable tissues, including meibomian gland lipid disengage, corneal wetting period, conjunctival goblet cell dullness, and intrademonstrable hurry due to which sex akin contrarietys in eye indispositions such as dry-eye syndrome, glaucoma and age akin macular degeneration has been observed [27-30]. Ogueta et al had root estrogen receptor protein barely in the lens epithelial cells (LECs) of femanly since Rocha et al. feel seen androgen receptor protein is existed in the LECs in manly barely [31, 32].Therefore it is concluded that most of the eye indisposition are gender favoring and improving and senior producer of shortsightedness. Large sums of tentative studies are required to perpetuate these results as courteous the hormonal and genetic mechanisms which may administer to the enucleatement of these indispositions in a gender favoring method to plan the new curative approaches and targets for the texture and obstruction of shortsightedness. Results Likeness (n)Mean Age (Years)Prevalence (% age)Blindness (%age)Positive parentage Fact (%age)Surgery (%age) POAG (1218)57. 340. 33. 812. 632 PCAG (571)57. 31910. 515. 427. 8 PEXG (348)64. 811. 53. 48. 622. 7 NTG (68)57. 12. 6. 010. 631. 8 NVG (181)58. 26. 010. 59. 428. 2 SIG (46)33. 71. 54. 31330. 4 Traumatic (66)40. 22. 00. 01. 525. 7 Glaucoma doubt (46)51. 38. 54. 69. 724 Others (265)45. 69. 03. 86. 431. 3 TypePOAGPCAGPEXGNTGNVGSIGTraumaticGlaucoma doubtOthers GenderABABABABABABABABAB Mean Age (Years)58. 255. 855. 958. 265. 163. 961. 253. 058. 956. 933. 833. 740. 839. 152. 350. 544. 647. 2 Efficacy (%age)64364060703051. 548. 560408020802060406040 Shortsightedness (%age)2559340. 01210115. 00. 00. 00. 02. 09. 04. 04. 0 Actual parentage Fact (%age)715. 591171331861413. 5112. 00. 08. 011. 58. 04. 0 Surgery19. 53710292516. 5402128292744233822273038 References . Tezel G, wax MB. Glaucoma. Chem Immunol Allergy. 2007; 92: 221-227. 2. Quigley HA, Broman AT. The sum of tribe following a suitableness glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006; 90: 262-267. 3. Ritch R. Natural compounds: averment for a protective role in eye indisposition. Can J Ophthalmol 200; 42: 425-438. 4. Bickel H, Cooper B. Incidence and not-absolute destroy of dementia in an sophisticated primeval population. Findings of a prospective opportunity con-over. Psychol Med 1994; 24: 179-92. 5. Letenneur L, Gilleron V, Commenges D, Helmer C, Orgogozo JM, Dartigues JF. Are sex and educational raze stubborn predictors of dementia and Alzheimer’s indisposition?Incidence facts from the PAQUID scheme. J Neurol Neurosurg Psychiatry 1999; 66: 177-183. 6. Musicco M. Gender contrarietys in the affair of Alzheimer’s indisposition. Funct neurol 2009; 24: 89-92. 7. Azad NA, Al Bugami M, Loy-English I. Gender contrarietys in dementia destroy contents. Gend Med. 2007; 4: 120-129. 8. Rudnicka AR, Isa SM, Owen CG, Cook DG, Ashby D. Variations in Chief Open- Prepossession Glaucoma Efficacy by Age, Gender, and Race: A Bayesian Meta-Analysis. Invest Ophthalmol Vis Sci. 2006; 47: 4254-4261. 9. Sheu SJ, Ger LP, Chen JF. Manly sex as a destroy content for pseudophakic retinal amalgamation following cataract origin in Taiwanese adults.Ophthalmology 2007; 114: 1898-1903. 10. Czepita D, Mojsa A, Ustianowska M, Czepita M, Lachowicz E. Role of gender in the affair of refractive errors. Ann Acad Med Stetin. 2007; 53: 5-7. 11. Goto T, Klyce SD, Zheng X, Maeda N, Kuroda T, Ide C. Gender- and age-akin contrarietys in corneal topography. Cornea. 2001; 20: 270-276. 12. Mark HH, Robbins KP, Mark TL. Axial diffusiveness in applanation tonometry. J cataract refract surg. 2002; 28: 504-506. 13. Mark HH. Corneal inflexion in applanation tonometry. Am J Ophthalmol. 1973; 76: 223-224. 14. Mark HH. Corneal astigmatism in applanation tonometry. Eye. 2003; 17: 617-618. 5. Abou-Gareeb I, Lewallen S, Bassett K, Courtright p. Gender and shortsightedness: a metadecomposition of population-grounded efficacy overlooks. Ophthalmic epidemiol. 2001; 8: 39-56. 16. Casson RJ, Baker M, Edussuriya K, senartne T, Selva D, sennanayake S. efficacy and determinants of prepossession seclusion in mediate Sri lanka: the Kandy eye con-over. Ophthalmology. 2009; 116: 1444-1449. 17. Rijal AP. Clinical decomposition of glaucoma in hospital endurings. Kathmandu University medical register. 2005; 3: 249-254. 18. Zhang SY. Epidemiology of cataract in China. In: Jia-Qin Y, Lim A, eds, the frontier of Ophthalmology in the 21st generation.Tianjin, Tianjin truth and Technology Press, 2001; 28-42. 19. Melese M, Alemayehu W, Bayu S et al. Low expectation and shortsightedness in adults in Gurage Zone, mediate Ethiopia. Br J Ophthalmol. 2003; 87: 677-680. 20. Ezz al Arab G, Tawfik N, EI Gendy R, Anwar W, Courtright P. The load of trachoma in the sylvan Nile delta of Egypt: a overlook of Menofiya governorate. Br J Ophthalmolol. 2001; 185: 1406-1410. 21. Cromcourteous EA, Courtright P, King JD, Rotondo LA, Ngondi J, Emerson PM. The extravagance load of trachomatous trichiasis in women: a invariable critique and metaanalysis. Trans R Soc Trop Med Hyg. 2009; 103: 985-992. 22.Woldeyes A, Adamu Y. Gender contrarietys in adult shortsightedness and low expectation, Mediate Ethiopia. Ethiop Med J. 2008; 46: 211-218. 23. Fotouhi A, Hashemi H, Mohammad K, Jalali KH; Tehran Eye Study. The efficacy and producers of visual decrepitude in Tehran: the Tehran Eye Study. Br J Ophthalmol 2004; 88: 740-5. 24. Quintana-Murci L, Krausz C, Zerjal T et al. Y-chromosome lineages follow diffusion of tribe and languages in southwestern Asia. Am J Hum Genet. 2001; 68: 537-542. 25. Khandekar R, Mohmmed AJ. Gender disproportion in expectation mislaying and eye indispositions: averment from the Sultanate of Oman. Indian J of Ophthalmology. 009; 57: 443-449. 26. Palimkar A, Khandekar R, Venkataraman V. Efficacy and disposal of glaucoma in mediate India (Glaucoma Survey- 2001). Indian J of Ophthalmology. 2008; 56: 57-62. 27. Mathers WD, Stovall D, Lane JA, et al. Menopause and sunder function: the bias of prolactin and sex hormones on rational sunder evolution. Cornea. 1998; 17: 353-358. 28. Sator MO, Akramian J, Joura EA, et al. Diminution of intrademonstrable hurry in a glaucoma enduring undergoing hormone restitution therapy. Maturitas. 1998; 29: 93-95 29. Esmaeli B, Harvey JT, Hewlett B. Immunohistochemical averment for estrogen receptors in meibomian glands.Ophthalmology. 2000; 107: 180-184. 30. Smith W, Mitchell P, Wang JJ. Gender, oestrogen, hormone restitution and ageakin macular degeneration: results from the Blue Mountains Eye Study. Aust NZ J Ophthalmology 1997; 25(suppl 1): S13-S15. 31. Ogueta SB, Schwartz SD, Yamashita CK, Farber DB. Estrogen receptor in the rational eye: bias of gender and age on gene look. Invest Ophthalmol Vis Sci. 1999; 40: 1906-1911. 32. Rocha EM, Wickham LA, da Silveira LA, et al. Identification of androgen receptor protein and 5? -reductase mRNA in rational demonstrable tissues. Br J Ophthalmol 2000; 84:76-84.