Childhood or adolescent abuse and primary open-angle glaucoma in a longitudinal cohort of women

Abstract

Objective: To examine associations of childhood/adolescence abuse with primary open-angle glaucoma (POAG) and POAG subtypes. Methods: We included US female nurse participants from the Nurses’ Health Study II (1989–2019). Participants (n = 59,712) were ≥40 years old, reported follow-up eye exams, had no glaucoma, and had early-life adverse experience data. Self-reported childhood/adolescence abuse was assessed in 2001 with the Revised Conflict Tactics Scale (CTS) and the 2-item sexual maltreatment scale of the parent–child CTS. We evaluated associations by type (any, physical, sexual) and timing (childhood, adolescence). POAG cases (n = 255) were confirmed and subtyped with medical record review. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Severe childhood/adolescent abuse was reported by 16.5%. There was no association between any childhood/adolescent abuse (HR 1.03; 95% CI: 0.79–1.35), physical abuse, abuse experienced during childhood only or adolescence only, and POAG risk. Compared to no sexual abuse history, any sexual abuse was modestly associated with POAG (HR 1.31; 95% CI: 1.01–1.69). Specifically, we observed adverse associations with sexual abuse for the POAG subtype with paracentral vs. peripheral VF loss (Pheterogeneity = 0.04). For paracentral POAG, we observed a 1.80-fold higher risk (95% CI: 1.14–2.85) with any sexual abuse history, a 2.38-fold higher risk (95% CI: 1.25–4.53) with a threat of/actual forced sexual activity, and a significant dose-response relationship with increasing severity of sexual abuse (Ptrend = 0.005; Ptrend_FDR corrected = 0.045). Conclusions: While any childhood/adolescence abuse history was not associated with POAG, the modest adverse associations with early-life sexual abuse history warrant confirmation in future studies.