Ocular changes and disorders associated with Obesity

Burak Turgut*

Published: 27 July, 2018 | Volume 2 - Issue 1 | Pages: 018-020

Obesity is a chronic and metabolic disease with a high increasing prevalence worldwide. It has multifactorial pathogenesis including genetic and behavioral factors [1-5]. Overweight and obesity have been defined and classified by the World Health Organization (WHO) and the National Institutes of Health (NIH) [2,3]. A person with a normal weight has Body Mass Index (BMI) of 18.5-24.9. A person with a BMI under 18.5 is called underweight. An adult having a BMI of 25-29.9 is overweight and pre-obese. Class 1 obesity is defined as a BMI between 30.00-34.99. Class 2 (Severe) Obesity is to have a BMI between 35.00-39.99. Morbid (Extreme, Class 3) obesity is to have a BMI over 40 [1-5]. Obesity is significantly associated with enhanced morbidity and mortality rates. It has also various economic, medical and psychological effects and causes health problems including many systemic diseases, economic costs and burdens, social and occupational stigmatization and discrimination and productivity loss [4-6]. Obesity carries the increased risk of development of many systemic and chronic diseases, including sleep apnea, depression, insulin resistance, Type 2 (adult-onset) diabetes, Gout and related arthritis, degenerative arthritis, hypertension, dyslipidemia, heart disease such as myocardial infarction, congestive heart failure, or coronary artery disease, polycystic ovary syndrome and reproductive disorders, Pickwickian syndrome (obesity, red face and hypoventilation), metabolic syndrome, non-alcoholic fatty liver disease, cholecystitis, cerebrovascular accident, colonic and renal cancer, rectal and prostatic cancer in males, and gallbladder, uterus and breast cancer in females [6-12].

In recent years, some publications reported that obesity has been strongly associated with some ocular diseases including age-related cataract and maculopathy, glaucoma, and diabetic retinopathy [13-16].

The recent reports demonstrated that the central corneal thickness and intraocular pressure were increased while as mean thickness of RNFL and retinal ganglion cell and choroidal thickness (CT) were decreased in the morbidly obese subjects [17-19]. However, another study has reported that CT increased in obese children [20]. On the other hand, a recent study reported that all values of the specific tests used to evaluate the ocular surface were within the normal range [21]. In some experimental studies, it has been demonstrated that obesity may cause retinal degeneration [22,23]. Additionally, in a past meeting presentation, it has been speculated that keratoconus is associated with severe obesity [24]. Teorically, idiopathic intracranial hypertension, and papilledema may also be associated with obesity [25]. Obesity may be also a cause of mechanical eyelid abnormalities such as entropion [26]. However, further investigations are needed to detect the significant relationship between these diseases and obesity.

On the other hand, the ocular surgeries of obese patients are difficult compared to normal weight-subjects. The posterior capsule rupture and vitreous loss may easily develop during cataract surgery of these patients because obese patients have an elevated vitreous pressure and operating table cannot often be lowered or surgeon’s chair cannot be elevated sufficiently to provide the clear viewing of the operating area and tissues. So, some different surgical manipulations such as standing phacoemulsification technique and reverse Trendelenburg position have been developed. Additionally, the standing vitrectomy technique has been used for vitreoretinal interventions in morbidly obese patients [27,28].

In conclusion, all obese subjects should be subjected to a completed ophthalmological examination and to relevant clinics for the detection of possible comorbidities and diseases

Read Full Article HTML DOI: 10.29328/journal.ijceo.1001015 Cite this Article Read Full Article PDF


  1. Purnell JQ. Definitions, Classification, and Epidemiology of Obesity. [Updated 2018 Apr 12]. In: De Groot LJ, Chrousos G, Dungan K, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000.
  2. Web source. 2018. Ref.: https://tinyurl.com/nvs7gp .
  3. Web source. 2018. Ref.: https://tinyurl.com/ybnerz4z.
  4. Haslam DW, James WP. Obesity. Lancet. 2005; 366: 1197-1209. Ref.: https://tinyurl.com/yb35z5ds
  5. Sturm R, Hattori A. Morbid Obesity Rates Continue to Rise Rapidly in the US. Int J Obes (Lond). 2013; 37: 889-891. Ref.: https://tinyurl.com/yb5sdzrd
  6. Abdelaal M, le Roux CW, Docherty NG. Morbidity and mortality associated with obesity. Ann Transl Med. 2017; 5: 161. Ref.: https://tinyurl.com/yb8oxkvl
  7. Bianchini F, Kaaks R, Vainio H. Weight control and physical activity in cancer prevention. Obes Rev. 2002; 3: 5-8. Ref.: https://tinyurl.com/y8a8gu47
  8. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S adults. N Engl J Med. 2003; 348: 1625-1638. Ref.: https://tinyurl.com/y9rqw44d
  9. Eckel RH, Krauss RM. American Heart Association call to action: obesity as a major risk factor for coronary heart disease. AHA Nutrition Committee. Circulation. 1998; 97: 2099-2100. Ref.: https://tinyurl.com/y9d3wtk9
  10. Grundy SM. Metabolic complications of obesity. Endocrine. 2000; 13: 155-165. Ref.: https://tinyurl.com/y88fnzkn
  11. Lawrence VJ, Kopelman PG. Medical consequences of obesity. Clin Dermatol. 2004; 22: 296-302. Ref.: https://tinyurl.com/ya9hk7qq
  12. Pi-Sunyer FX. Medical hazards of obesity. Ann Intern Med. 1993; 119: 655-660. Ref.: https://tinyurl.com/y9y9sxv5
  13. Habot-Wilner Z, Belkin M. Obesity is a risk factor for eye diseases. Harefuah. 2005; 144: 805-809. Ref.: https://tinyurl.com/y97ghpjm
  14. Cheung N, Wong TY. Obesity and Eye Diseases. Surv Ophthalmol. 2007; 52: 180-195. Ref.: https://tinyurl.com/y8xp9hwo
  15. Mbata O, Abo El-Magd NF, El-Remessy AB. Obesity, metabolic syndrome and diabetic retinopathy: Beyond hyperglycemia. World J Diabetes. 2017; 8: 317-329. Ref.: https://tinyurl.com/yap6or2l
  16. Atchison E, Barkmeier A. The Role of Systemic Risk Factors in Diabetic Retinopathy. Curr Ophthalmol Rep. 2016; 4: 84-89. Ref.: https://tinyurl.com/yd84jm7a
  17. Dogan B, Kazim Erol M, Dogan U, Habibi M, Bulbuller N, et al. The retinal nerve fiber layer, choroidal thickness, and central macular thickness in morbid obesity: an evaluation using spectral-domain optical coherence tomography. Eur Rev Med Pharmacol Sci. 2016; 20: 886-891. Ref.: https://tinyurl.com/yahc6vy6
  18. Dogan B, Dogan U, Erol MK, Habibi M, Oruc MT. Comparison of anterior segment parameter values obtained with Scheimpflug-Placido topographer, optical low coherence reflectometry and noncontact specular microscopy in morbid obesity. Eur Rev Med Pharmacol Sci. 2017; 21: 438-445. Ref.: https://tinyurl.com/yaurdaoy
  19. Pacheco-Cervera J, Codoñer-Franch P, Simó-Jordá R, Pons-Vázquez S, Galbis-Estrada C, et al. Reduced retinal nerve fibre layer thickness in children with severe obesity. Pediatr Obes. 2015; 10: 448-453. Ref.: https://tinyurl.com/ybxfgcch
  20. Bulus AD, Can ME, Baytaroglu A, Can GD, Cakmak HB, et al. Choroidal Thickness in Childhood Obesity. Ophthalmic Surg Lasers Imaging Retina. 2017; 48: 10-17. Ref.: https://tinyurl.com/ybsjtf2b
  21. Marques NPN, Felberg S, Barros JN, Malheiros CA. Evaluation of the ocular surface following bariatric surgery. Arq Bras Oftalmol. 2017; 80: 247-251. Ref.: https://tinyurl.com/ycmoblg9
  22. Tiruvalluru M, Ananthathmakula P, Ayyalasomayajula V, Nappanveettil G, Ayyagari R, et al. Vitamin A supplementation ameliorates obesity-associated retinal degeneration in WNIN/Ob rats. Nutrition. 2013; 29: 298-304. Ref.: https://tinyurl.com/yax57k63
  23. Marçal AC, Leonelli M, Fiamoncini J, Deschamps FC, Rodrigues MA, et al. Diet-induced obesity impairs AKT signaling in the retina and causes retinal degeneration. Cell Biochem Funct. 2013; 31: 65-74. Ref.: https://tinyurl.com/ydd7ptws
  24. Kristinsson JK, Carlson AN, Kim T. Keratoconus and Obesity-A Connection? Invest Ophthalmol Vis Sci. 2003; 44: 812.
  25. Krispel CM, Keltner JL, Smith W, Chu DG, Ali MR. Undiagnosed papilledema in a morbidly obese patient population: a prospective study. J Neuroophthalmol. 2011; 31: 310-315. Ref.: https://tinyurl.com/y98byy4h
  26. Raina J, Foster JA. Obesity as a cause of mechanical entropion. Am J Ophthalmol. 1996; 122: 123-125. Ref.: https://tinyurl.com/y7ke7xnc
  27. Mansour AM, Al-Dairy M. Modifications in cataract surgery for the morbidly obese patient. J Cataract Refract Surg. 2004; 30: 2265-2268. Ref.: https://tinyurl.com/yajezpm7
  28. Mansour AM. Standing vitrectomy in morbid obesity. Retina. 2006; 26: 963-964. Ref.: https://tinyurl.com/y9flj4rk

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