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Alopecia areata patients are associated with increased risk of glaucoma: a multicenter; retrospective cohort study
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DOI：10.3389/fimmu.2026.1870857.png)
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Abstract
En 中文
BackgroundAlopecia areata (AA) is a T cell–mediated autoimmune disease characterized by systemic immune activation that may extend to ocular tissues. However; whether AA increases the long-term risk of glaucoma remains unclear.MethodsWe conducted a multicenter retrospective cohort study using the TriNetX Global Collaborative Network; comprising over 144 million patients across 147 healthcare organizations. For cross-database validation; we additionally performed a parallel analysis in another dataset; the US collaborative network; restricting the population to patients from healthcare organizations in the United States. Adults (≥18 years) with at least two visit records and a diagnosis of AA between 2005 and 2023 were included and matched 1:1 with individuals undergoing general health examinations without an AA diagnosis. Exclusion criteria included prior glaucoma; malignancy; or death before the index date. Propensity score matching incorporated demographic; socioeconomic; and clinical factors; including hypertension; diabetes; conjunctivitis; and Sjögren syndrome. The primary endpoint was new-onset glaucoma; with additional assessment of subtypes. Stratified analyses were performed by age and sex; and sensitivity analyses applied alternative definitions; matching models; and washout periods. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated.ResultsThe final matched cohort included 28; 966 patients with AA and 28; 966 controls. During a 15-year follow-up; AA was associated with a higher risk of glaucoma (HR = 1.89; 95% CI; 1.51–2.38); consistent across models and sensitivity analyses. The risk was elevated for primary glaucoma (HR = 1.99; 95% CI; 1.10–3.62) and glaucoma-suspect states. Stratified analyses revealed stronger associations in females (HR = 1.78; 95% CI; 1.36–2.33) and older adults (≥65 years; HR = 2.76; 95% CI; 1.95–3.89). For the cross-database validation; the association remained significant in the US collaborative network; with a hazard ratio of 2.11 (95% CI; 1.72–2.59).ConclusionsAA was associated with a higher long-term risk of glaucoma across the primary; sensitivity; and cross-database analyses. However; this observational study establishes an epidemiologic association only and does not demonstrate a direct biological or immune-mediated link. Further prospective studies incorporating detailed ophthalmic examinations; longitudinal intraocular pressure measurements; retinal imaging; and systemic or ocular immune biomarkers are needed to determine whether shared inflammatory pathways contribute to this association.
Keywords:
glaucoma
cohort
alopecia areata
real world evidence
TriNetX
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22.7W
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