When you’re living with glaucoma, eye pressure—also called intraocular pressure (IOP)—matters a lot. It’s the most important risk factor doctors can treat and control. Because of this, researchers spend a lot of time studying what can raise eye pressure and what might help lower it.

For years, scientists have looked at whether obesity plays a role in higher eye pressure. Some studies found a link, while others did not. A large study in South Korea suggests that metabolic health may be more important than body weight alone when it comes to eye pressure.*

Obesity, metabolic health, and IOP

Obesity is usually defined as having a body mass index (BMI) of 30 or higher. In a study published in the Journal of Clinical Medicine, researchers explained that many past studies showed obesity was linked to higher eye pressure—but not all studies agreed.

What’s becoming clearer is that how your body processes sugar, fat, and blood pressure (your metabolic health) may matter more than the number on the scale.

Researchers describe two important groups:

• Metabolically healthy but obese (MHO): People in this group may have a higher body weight but still have normal blood sugar, healthy cholesterol levels, good insulin sensitivity, and normal blood pressure.

• Metabolically unhealthy but normal weight (MUNW): These individuals may appear to have a “normal” weight, but they carry unhealthy deep body fat and have problems like high blood sugar, abnormal cholesterol, high blood pressure, or inflammation.

Previous research has already suggested that metabolic health and obesity together may influence eye pressure and glaucoma risk. This new study took a closer look at which factor matters more.

What the researchers did

The researchers analyzed eye pressure measurements from 20,385 adults between ages 19 and 35. Participants were divided into four groups based on body weight and metabolic health:

• Metabolically unhealthy and obese (MUO)
• Metabolically unhealthy with normal weight (MUNW)
• Metabolically healthy but obese (MHO)
• Metabolically healthy with normal weight (MHNW)

Someone was considered metabolically unhealthy if they had one or more of the following:

• Excess belly fat
• Unhealthy cholesterol or triglyceride levels
• Low “good” (HDL) cholesterol
• High blood pressure
• High fasting blood sugar

What they found

Normal eye pressure typically ranges from 12 to 21 mm Hg. When researchers compared the groups:

• The metabolically unhealthy and obese (MUO) group had the highest average eye pressure (14.38).
• The metabolically unhealthy but normal-weight (MUNW) group had the second-highest eye pressure (14.22).
• People who were metabolically healthy had lower eye pressure, even if they were obese.
  • Metabolically healthy but obese (MHO): 13.5
  • Metabolically healthy and normal weight (MHNW): 13.06

What it means

The key takeaway is simple: metabolic health mattered more than body weight alone.

People who were metabolically unhealthy had higher eye pressure—even if they were not overweight. Meanwhile, people who were metabolically healthy tended to have lower eye pressure, even if they were obese.

As the researchers explained, metabolic problems such as high blood sugar, abnormal cholesterol, and high blood pressure appear to raise eye pressure more than obesity by itself.

These findings suggest that improving metabolic health—through managing blood sugar, cholesterol, blood pressure, and overall inflammation—may play an important role in protecting eye pressure and eye health, especially for people at risk for glaucoma.

*Charters, L. (2023, March 14). Study examines links between metabolic health, obesity and IOP. Ophthalmology Times. https://www.ophthalmologytimes.com/view/study-examines-links-between-metabolic-health-obesity-and-iop

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