Relationship Between Body Mass Index and Intraocular Pressure in Men and Women

A Population-Based Study

Eytan Cohen, MD; Michal Kramer, MD; Tzippy Shochat, MSc; Elad Goldberg, MD; Moshe Garty, MD; Ilan Krause, MD


J Glaucoma. 2016;25(5):e509-e513. 

In This Article

Abstract and Introduction


Purpose: To assess the possibility of a relationship between body mass index (BMI) and intraocular pressure (IOP) in both men and women.

Materials and Methods: A retrospective cross-sectional analysis of a database from a screening center in Israel which assessed 18,575 subjects, within an age range 20 to 80 years.

Results: The mean (±SD) age of the study sample was 46 (±10) years, 68% were men. A positive linear correlation was found between BMI and IOP for both men and women (r=0.166, P<0.0001 in men and r=0.202, P<0.0001 in women). Mean (95% confidence interval) IOP in subjects with BMI<25 kg/m2 was 12.8 mm Hg (range, 12.7 to 12.9 mm Hg) and increased significantly to 13.4 (range, 13.3 to 13.5 mm Hg); 13.9 mm Hg (range, 13.8 to14.0 mm Hg), and 14.3 mm Hg (range, 14.1 to 14.5 mm Hg) for BMI subcategories 25 to 29.9, 30 to 35, and >35 kg/m2, respectively (P<0.0001). These differences remained significant after multivariate adjustment for age, hypertension, and diabetes mellitus (P<0.0001). Similar multivariate adjustments showed that the coefficient factors for BMI (95% confidence interval) affecting IOP were 0.087 (range, 0.076 to 0.098) P<0.0001 and 0.070 (range, 0.058 to 0.082) P<0.0001 for men and women respectively, indicating that in men and women, the changes in IOP associated with a 10 kg/m2 increase in BMI were 0.9 and 0.7 mm Hg, respectively. Subjects with abnormal BMI compared with subjects with normal BMI had increased odds ratio of having IOP≥18 mm Hg after adjusting for confounding factors (P<0.001).

Conclusions: This study shows that obesity is an independent risk factor for increasing IOP in both men and women. We consider this finding particularly pertinent in the context of the current obesity epidemic.


After cataracts, glaucoma is the second leading cause of blindness worldwide.[1] It is the main reason for blindness among African Americans.[2,3]

The major risk factors for developing open-angle glaucoma include age, black race, family history, and elevated intraocular pressure (IOP).[4,5] Other risk factors include hypertension,[6] diabetes mellitus,[7] and hypothyroidism.[8] A large body of literature has described the association between elevated IOP and both the development and progression of open-angle glaucoma.[9–11] Treatment of glaucoma, however, still focuses on lowering IOP.

Overweight and obesity have become global epidemics[12] and a question has arisen concerning a possible relationship between obesity and IOP. Indeed, several studies have assessed the possible relationship between body mass index (BMI) and IOP. Most studies have shown a positive relationship between BMI and IOP,[13–21] whereas in 2 studies, carried out in a small cohort of children and adults, no such relationship could be found.[22,23] Studies have been carried out in a subgroup population from the far East;[13–16,21] with children[17,22] and elderly subjects.[18] Only 3 studies have been carried out in western populations,[18–20] all of which included a relatively small number of subjects and did not isolate the effect of BMI from common comorbidities such as hypertension and diabetes mellitus.

The aim of the current study was to assess a possible relationship between BMI and IOP in both men and women in a large cohort from Israel.