Лабораторные показатели крови как факторы глазных заболеваний

    Relevance

    According to the World Health Organization (WHO), at least 2,2 billion people globally have a visual impairment or blindness, of which approximately 1 billion have reversable vision loss [1]. At the same time, one of the fundamental tools for detecting the eye diseases at early stage is the assessment of its risk factors.

    Currently, ophthalmologists consider blood tests parameters mainly in the context of diagnosing and managing inflammatory eye diseases. However, changes in blood parameters are also present in other ophthalmological conditions. For example, patients with age-related macular degeneration (AMD) often have signs of dyslipidemia and hyperglycemia even in the early stages. At the same time, the global prevalence of late-stage AMD exceeds 15 cases per 1000, this is explained by the concealment of signs of the disease in the early stages, which may be asymptomatic and lack active patient complaints, thereby complicating early diagnosis and prevention [2–4].

    Understanding of the associations in the ophthalmopathology pathogenesis enables acurate diagnosis, prognosis and prevention, as well as the selection of optimal treatment tactics based on a comprehensive understanding the essence of the entire pathological process [5]. The analysis of blood tests can also be used for screening faciliating the early detection of certain eye diseases. Laboratory indicators are important diagnostic tools in medicine, providing valuable information about the patient’s health status. Every ophthalmologist should be knowledgable not only about clinical manifestations but also about the assocoated changes in laboratory parameters for diseases that pose a potential threat to vision, applying an integrated approach to diagnosis and therapy [6, 7].

    Purpose.

    To determine the relationship between major eye diseases with laboratory blood parameters within the population of the Southern Urals.

    Material and methods.

    In the period from 2015 to 2017 years, a clinical population-based study — Ural Eye and Medical Study (UEMS) was conducted at the Ufa Eye Research Institute to determine the prevalence and identify risk factors for ocular and systemic diseases among residents of the Southern Ural aged 40 years and older [8–12]. The UEMS was conducted in accordance with the Helsinki Declaration and was approved by the Local Ethics Committee of the Ufa Eye Research Institute. All patients provided written informed consent.

    Each study participant underwent a survey (containing questions about their socio-demographic status, lifestyle, and medical history), this was followed by a general somatic and ophthalmological examination. The diagnosis of eye disease was made by ophthalmologists based on the examination findings. The condition leading to the most significant impairment of central vision in the visually impaired eye was recorded as the primary cause of vision loss.

    All participants underwent blood sampling (including a leukoformula) and biochemical profile included aspartate aminotransferase, alanine aminotransferase, total bilitubin, total cholesterol, triglycerides, low-density lipoproteins, high-density lipoproteins, glucose, creatinine, urea, rheumatoid factor, C-reactive protein, residual nitrogen, total protein.

    Statistical analysis was performed using the IBM SPSS 27.0. Certain risk factors for eye diseases were determined using univariable and multivariable regression analysis excluding parameters that demonstrated high collinearity.

    The analysis calculated the standardized regression coefficient β, the unnstandardized regression coefficient B and its 95% confidence interval (CI), the odds ratio (OR) and its CI. The values obtained were assumed to be statistically significant at P less than 0,05.

    Results and discussions

    A total of 5899 people participated in the study, the mean age was 59.0±10.7 years (range: from 40 to 94 years), with 56,3% women (n=3319 people) and 43.7% men (n=2580).

    Analysis of causes of vision loss showed cataract (particularly the nuclear form), age-related macular degeneration (AMD) and glaucoma were predomonant causes of moderate to severe vision impairment and blindness (Table 1).

    We conducted a regression analysis, which determined the relationship of various exogenous and endogenous risk factors for the occurrence of eye diseases and pathological conditions. At the same time, there was no direct relationship between laboratory blood counts and eye diseases. However, some laboratory blood parameters correlated with conditions characteristic of eye diseases, which are among the four main causes of vision loss (cataracts, age-related macular degeneration, glaucoma).

    One of the manifestations of the early stage of the dry form of AMD is the presence of pseudodrusen [13, 14]. It was revealed that in the population of the Southern Urals the prevalence of reticular pseudodrusen correlated with a lower lymphocyte count (OR: 0.95; 95% CI: 0.93–0.97; p<0.001) (Table 2).

    High IOP is one of the risk factors for glaucoma development [8–10]. Higher intraocular pressure was inversely associated with a lower bilirubin concentration (B: −0.01; 95% CI: −0.02 to −0.003; β: −0.04; p=0.008) and serum urea (B: −0.11; 95% CI: −0.17 to −0.04; β: −0.04; p=0.003) was determined in a multivariable model (Table 3).

    Regression analysis also revealed that a low concentration of high-density lipoproteins (HDL) in blood serum is one of the risk factors for developing nuclear cataract (OR 0.91; 95% CI: 0.84–0.98) (Table 4).

    Discussion

    The data obtained emphasize that diagnosis and management of patients with eye diseases, should consider not only ophthalmological parameters, but also systemic health status of the patient and the Results of general and biochemical blood tests.

    We have not found any data in the literature that describes the correlation of the lymphocyte count and reticular pseudodrusen. However, study by Gu et al. described the relationship between changes in the functional activity of monocytes and the presence of age-related macular degeneration. It was found that the phagocytic function of monocytes was reduced in all patients with AMD, regardless of the stage of the disease [15]. Thus, it can be assumed that a violation of phagocytosis by monocytes can lead to insufficient activation of the lymphocytes, which, in turn, leads to lymphopenia.

    Literature sources describe the relationship between the level of bilirubin in the blood serum and glaucoma presence. In the study by Shao et al. it was found that patients with primary glaucoma had a higher concentration of blood bilirubin, which had a significant positive correlation with the severity of POAG in male patients [16]. High bilirubin levels can lead to changes in neurons, glial cells, as well as in cellular and mitochondrial membranes, exerting a toxic effect on optic nerve cells and exacerbating their condition in patients with POAG [16–18]. However, the literature data is contradictory. In a study by Shi et al. it has been described that glaucoma was associated with lower total bilirubin levels [19]. At the same time, it has been experimentally proven that total bilirubin can effectively absorb reactive oxygen species and inhibit the activity of nicotinamide adenine dinucleotide phosphatase (NADPH), which ultimately reduces oxidative stress [19, 20]. Also, in one of the retrospective case-control studies, it was noted that in patients with glaucoma, serum albumin and bilirubin levels were lower than in healthy people [21].

    In the process of analyzing the literature data, we did not find any studies describing the relationship between serum urea levels and ophthalmohypertension. The results we have obtained can become the basis for further research in this area. The mechanisms linking dyslipidemia and cataracts are still not fully understood. The Korea National Health and Nutrition Examination Survey conducted in 2008–2010 demonstrated that low levels of high-density lipoproteins (HDL), elevated triglycerides and glucose in peripheral blood taken on an empty stomach were positively associated with the risk of age-related cataracts among women, in addition, the prevalence of cataracts increased with age the level of the corresponding blood parameters. Such changes were also observed in nuclear cataract [22]. Similar data were found in The Beaver Dam Eye Study, where a higher concentration of HDL in the blood serum was associated with a reduced risk of cataracts developing [23]. A pronounced correlation was also found between low HDL levels in the blood and clouding of the lens in South Africans of both sexes [24].

    However, described findings contradict the results of other studies. In The Beijing Eye Study found no association between dyslipidemia and prevalence of glaucoma, retinal vascular abnormalities, or any type of age-related cataract [25]. The Singapore Malay eye study did not find a significant relationship between high triglyceride levels and low HDL levels in the blood serum and cataracts in the Malay population [26]. Such contradictory results highlight influence of genetic, ethnic geographical, climatic factors on disease pathogenesis.

    Conclusion.

    Low levels of lymphocytes, low serum levels of bilirubin, urea and HDL are significant risk factors for the development of reticular pseudodrusen, ophthalmohypertension and nuclear cataract. When treating and examining ophthalmological patients, ophthalmologists need to pay attention not standard ophthalmological examination, but also to changes in blood parameters. a collaborative approach involving ophthalmologists with therapists, immunologists, gastroenterologists, cardiologists and other specialists to manage systemic health through appropriate medications, as well as lifestyle modifications can improve the overall patient well-being, and potentially reduce the risk of the occurrence and progression of eye diseases.

    Information about the authors

    Ellina M. Iakupova — Candidate of Medical Sciences, Head of integrative ophthalmology department, Ufa Eye Research Institute of Bashkir State Medical University, rakhimova_ellina@mail.ru, https://orcid.org/0000-0002-9616-6261

    Jost B. Jonas — Professor emer. of Ophthalmology, Medical Faculty Mannheim, of the Ruprecht-Karls-University Heidelberg, Mannheim, Germany, jost.jonas@medma.uni-heidelberg.de, https://orcid.org/0000-0003-2972-5227

    Linara I. Faizullina — trainee doctor of the department of Integrative Ophthalmology Department, Ufa Eye Research Institute of Bashkir State Medical University, linarafazullina2019@gmail.com, https://orcid.org/0009-0004-1742-4544

    Songhomitra Panda-Jonas — doctor, Privatpraxis Prof Jonas und Dr.Panda-Jonas, Heidelberg, Germany, drsjonas@gmail.com, https://orcid.org/000-00300709-863X

    Информация об авторах

    Якупова Эллина Маратовна — к.м.н., зав. отделом интегративной офтальмологии, Уфимский НИИ ГБ ФГБОУ ВО БГМУ Минздрава России, rakhimova_ellina@mail.ru, https://orcid.org/0000-0002-9616-6261

    Йост Бруно Йонас — профессор, Госпиталь Фонда Ротшильда, Французский институт близорукости, Париж, Франция, jost.jonas@ medma.uniheidelberg.de, https://orcid.org/0000-0003-2972-5227

    Файзуллина Линара Ильшатовна — врач-стажер отдела интегративной офтальмологии Уфимского НИИ глазных болезней ФГБОУ ВО БГМУ Минздрава России, linarafazullina2019@gmail. com, https://orcid.org/0009-0004-1742-4544

    Панда-Йонас Сонгомитра — доктор Частной клиники профессора Йонаса и Доктора Панда-Йонас, Гейдельберг, Германия, drsjonas@ gmail.com, https://orcid.org/000-00300709-863X

    Аuthor’s сontribution:

    Iakupova E.M. — data curation, writing original draft, review and editing.

    Jonas J.B. — conceptualization, мethodology of investigation, data curation and analysis, review and editing.

    Faizullina L.I. — writing data curation.

    Panda-Jonas S. — мethodology of investigation, review and editing.

    Вклад авторов:

    Якупова Э.М. — сбор и обработка материала, написание текста, рецензирование и редактирование.

    Йонас Й.Б. — концепция и дизайн исследования, методология исследования, анализ и обработка данных, рецензирование и редактирование.

    Файзуллина Л.И. — написание оригинального текста.

    Панда-Йонас С. — методология исследования, рецензирование и редактирование.

    Financial transparency: Аuthors have no financial interest in the submitted materials or methods.

    Финансирование. Авторы не получали конкретный грант на это исследование от какого-либо финансирующего агентства в государственном, коммерческом и некоммерческом секторах.

    Конфликт интересов: Отсутствует.

    Conflict of interest: None.

    Поступила: 02.10.2025

    Переработана: 30.10.2025

    Принята к печати: 05.11.2025

    Received: 02.10.2025

    Revision: 30.10.2025

    Accepted: 05.11.2025