Open-Angle Glaucoma and the Risk of

Erectile Dysfunction
A Population-based Case-control Study
Shiu-Dong Chung, MD,1,2,3 Chao-Chien Hu, MD,4,5 Jau-Der Ho, MD,6,7 Joseph J. Keller, MPH,8
Tsung-Jen Wang, MD,4,5 Herng-Ching Lin, PhD3

Purpose: Open-angle glaucoma (OAG) is associated with systemic metabolic and cardiovascular disorders,
and both share common risk factors with erectile dysfunction (ED). However, few studies have investigated the
association of ED with OAG. This study aimed to estimate the association of ED with prior OAG by using a
nationwide, population-based data with a retrospective case-control cohort design in Taiwan.
Design: Age-matched case-control study.
Participants and Controls: We identified 4605 patients with ED as the cases and randomly selected 23 025
subjects as the controls (5 controls to 1 case).
Methods: We used conditional logistic regression analysis to estimate the odds ratio and 95% confidence
interval of having previously been diagnosed with OAG according to the presence/absence of ED after adjusting
for patient’s monthly income, geographical location, hypertension, diabetes, coronary heart disease, hyperlip-
idemia, obesity, and alcohol abuse.
Main Outcome Measures: We identified OAG cases not only based on an International Classification of
Diseases, Ninth Revision, Clinical Modification code, but also by the prescription of topical antiglaucoma medication.
Results: In total, prior OAG was found among 137 subjects (0.5 %); 53 individuals (1.1% of the ED patients)
from the cases and 84 individuals (0.4% of patients without ED) from the controls. Conditional logistic regression
analysis demonstrated that, after adjusting for potential confounders, patients with ED were more likely to have
prior OAG than controls (odds ratio, 2.85; 95% confidence interval, 2.10 – 4.07).
Conclusions: This study identifies a novel association between ED and prior OAG.
Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials
discussed in this article. Ophthalmology 2012;119:289 –293 © 2012 by the American Academy of Ophthalmol-
ogy.

Glaucoma is among the leading causes of blindness world-
wide,1,2 and open-angle glaucoma (OAG) is among the
most prevalent forms.3 Risk factors for OAG include older
age, hypertension, diabetes, and a family history of glau-
coma. The prevalence of erectile dysfunction (ED) increases
with age and ED shares several risk factors with OAG, such
as hypertension, diabetes mellitus, and cardiovascular
disorders.4 –7
Ocular hypertension is a major risk factor for both OAG
and the metabolic syndrome (MS), the characteristics of
which are themselves risk factors for ocular hypertension
and include hypertension, diabetes, dyslipidemia, and obe-
sity.8,9 One previous population-based study established an
association of OAG with hyperlipidemia, diabetes mellitus,
and hypertension.10 These comorbidities are also major risk
factors for both MS and ED.11 The higher prevalence of
these metabolic and vascular disorders in patients with
OAG suggests that insulin resistance might be at play in the
pathophysiology of glaucoma.9,10 Taken together, both
OAG and ED are recognized to be associated with systemic
diseases, which are associated with insulin resistance and
metabolic disorders. However, to the best of our knowledge,
no study has attempted to explore the association between
ED and glaucoma. Using a population-based dataset, we
examined the association of ED with prior OAG by com-
paring the risk of prior OAG between patients with ED and
matched controls in Taiwan.
Methods
Database
We used data from the Longitudinal Health Insurance Database
2000 (LHID2000) to conduct this matched case-control study.
Taiwan began its National Health Insurance (NHI) program in
1995. To help researchers perform studies of issues relevant to the
NHI program, the Taiwan National Health Research Institute cre-
ated and released the LHID2000 to the public for research pur-
poses. The LHID2000 contains all the original claims data and
registration files of 1 000 000 individuals randomly sampled from
the 2000 Registry for Beneficiaries (n ⫽ 23.72 million) of the
Taiwan NHI program. The Taiwan National Health Research
Institute reported that there was no significant difference in the
gender distribution between the patients in the LHID2000 and all
the patients enrolled in the NHI program. The LHID2000 allows

© 2012 by the American Academy of Ophthalmology ISSN 0161-6420/12/$–see front matter 289
Published by Elsevier Inc. doi:10.1016/j.ophtha.2011.08.015

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 Ophthalmology Volume 119, Number 2, February 2012

researchers to follow-up on all the medical services utilized by
these 1 000 000 individuals since the initiation of the NHI in 1995.
Because the LHID2000 consists of deidentified secondary data
released to the public for research purposes, this study was ex-
empted from full review by the director of the Taipei Medical
University Institutional Review Board.
Study Population
A total of 4605 cases were considered eligible. The eligibility
selection criteria required all cases to be ⬎40 years of age and
have been newly diagnosed with ED (impotence, organic, Inter-
national Classification of Diseases, Ninth Revision, Clinical Mod-
ification [ICD-9-CM] code 607.84) between January 2002 and
December 2009. Because the administrative database is criticized
for its diagnostic validity, we only included ED cases in this study
if they received ⱖ2 ED diagnoses, with ⱖ1 being made by an
urologist. In Taiwan, physicians will not make a diagnosis of ED
unless he or she has enough clinical or laboratory data to support
it on account of the culturally taboo nature of the diagnosis. We,
therefore, believe that ED diagnosis made under the Taiwan NHI
demonstrates high validity. We assigned a subject’s first ED diag-
nosis between January 2002 and December 2009 as the index date.
Controls with no diagnosis of psychogenic or organic ED were
selected from the remaining male subjects of the LHID2000, and
matched with a control-to-case ratio of 5 (n ⫽ 23 025) on the basis
of age (40 – 49, 50 –59, 60 – 69, and ⬎69 years) and index year. For
controls, the first use of ambulatory care occurring in the index
year was designated as the index date.
We identified OAG cases based on a diagnosis of OAG (ICD-
9-CM codes 365.1 or 365.11). To increase the validity of OAG
diagnoses, we selected only those patients who had been pre-
scribed topical antiglaucoma medication. In addition, we only
included OAG diagnoses made before the index date.
Statistical Analysis
We used the SAS system (SAS System for Windows, Version 8.2,
SAS Inc., Cary, NC) to analyze data. We used the chi square test
for independence to compare the differences between cases and
controls in terms of monthly income (NT$0 –15 840, NT$15 841–
NT$25 000, ⱖNT$25 001), and the geographical location (North-
ern, Central, Eastern, and Southern Taiwan), and the urbanization
level of the patient’s residence (1 being the most urbanized and 5
being the least). We used conditional logistic regression to calcu-
late the odds ratios (ORs) and 95% confidence intervals (CIs) to
examine associations between ED and exposure to OAG. All
analyses were conditioned on the study matching factors of age
(10-year strata) and index year. We considered the following
variables as potential confounders on account of their possible
association with ED: hypertension, diabetes, coronary heart dis-
ease, hyperlipidemia, obesity, alcohol use, and alcohol abuse de-
pendence syndrome. These comorbidities were only included in
the model if they were diagnosed before the index date.
Results
Table 1 summarizes the demographic characteristics of cases and
controls. Of the 27 630 sampled patients, the mean age was 57.3
years (⫾11.3); 57.4 and 57.3 for cases and controls, respectively
(P ⫽ 0.596). Cases were more likely to have comorbid hyperlip-

Table 1. Demographic Characteristics of Patients with Erectile Dysfunction (ED) and Controls in
Taiwan, 2002–2009 (n ⫽ 27 630)

Patients With ED Controls

(n ⴝ 4605) (n ⴝ 23 025)
Variable Total No. % Total No. % P
Age (yrs) 1.000
40-49 1239 26.9 6195 26.9
50-59 1593 34.6 7965 34.6
60-69 1021 22.2 5105 22.2
⬎69 753 16.3 3765 16.3
Age, mean (standard deviation) 57.4 (11.4) 57.3 (11.2) 0.596
Monthly income (NT$) ⬍0.001
No income 283 6.2 1992 8.7
1–15,840 839 18.2 3468 15.1
15 841–25 000 1591 34.5 9779 42.4
ⱖ25 001 1892 41.1 7786 33.8
Hyperlipidemia 1323 28.7 4576 19.9 ⬍0.001
Diabetes 1154 25.1 4145 18.0 ⬍0.001
Hypertension 1834 39.8 8511 37.0 ⬍0.001
Coronary heart disease 1001 21.7 3945 17.1 ⬍0.001
Obesity 43 0.9 74 0.3 ⬍0.001
Alcohol abuse/alcohol dependence syndrome 26 0.6 128 0.6 0.943
Geographic region ⬍0.001
Northern 2393 52.0 10 777 46.8
Central 993 21.6 5502 23.9
Eastern 1107 24.0 6137 26.7
Southern 112 2.4 609 2.6
Urbanization level ⬍0.001
1 (most urbanized) 1625 35.3 6646 28.9
2 1395 30.3 6598 28.7
3 749 16.3 3811 16.6
4 485 10.5 3362 14.6
5 (least urbanized) 351 7.6 2608 11.3

290

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 Chung et al 䡠 Increased Risk of ED in Patients with OAG

Table 2. Prevalence and Crude Odds Ratios (ORs) for Open-Angle Glaucoma (OAG) among the
Sampled Patients

Patients with
Total Erectile Dysfunction Controls
(n ⴝ 27 630) (n ⴝ 4605) (n ⴝ 23 025)
Presence of OAG n % n % n %
Yes 137 0.5 53 1.1 84 0.4
No 27 493 99.5 4552 98.9 22 941 99.6
OR (95% CI) — 3.18* (2.25–4.49) 1.00

CI ⫽ confidence interval.
The OR was calculated by conditional logistic regressions, which was conditioned on age group and the year of index
date.
*P⬍0.001.

idemia (28.7% vs 19.9%; P⬍0.001), diabetes (25.1% vs 18.0%;
P⬍0.001), hypertension (39.8% vs 37.0%; P⬍0.001), coronary
heart disease (21.7% vs 17.1%; P⬍0.001), and obesity (0.9% vs;
0.3%; P⬍0.001) than controls. The prevalence of alcohol abuse/
alcohol dependence syndrome was similar for cases and control. In
addition, cases had a greater tendency to have monthly incomes of
ⱖNT$25 001 (P⬍0.001), and to reside in the northern part of Taiwan
(P⬍0.001), and in more urbanized communities (P⬍0.001) when
compared with controls.
Table 2 shows the association between ED and OAG. Among
all the subjects in the city, 137 (0.5%) suffered from OAG. Fifty-
three ED subjects (1.1%) and 84 of the non-ED controls (0.4%)
had OAG before the index date. Conditional logistic regression
analysis demonstrated that a significantly higher proportion of the
OAG cases that existed before the index date were found among
ED patients (OR, 3.18; 95% CI, 2.25– 4.49; P⬍0.001).
After adjusting for patient age, monthly income, geograph-
ical location, urbanization level, hypertension, diabetes, coro-
nary heart disease, and hyperlipidemia, the conditional logistic
regression analysis conditioned on age group and index year
revealed that, compared with controls, ED patients were more
likely to have OAG before the index date (OR, 2.85; 95% CI,
2.10 – 4.07; P⬍0.001; Table 3). Obesity and alcohol abuse/
alcohol dependence syndrome were not adjusted for in the
regression modeling because of the small number of cases in
some cells. In addition, the regression showed that hyperten-
sion, diabetes, coronary heart disease, and hyperlipidemia were
all associated with ED.

Table 3. Univariate and Covariate-Adjusted Odds Ratios (ORs) for Erectile Dysfunction (ED)
among the Sampled Patients (n ⫽ 27 630)

Presence of ED
Variables Univariate OR (95% CI) Adjusted OR (95% CI)
Patients with open-angle glaucoma
Yes 3.18† (2.25–4.49) 2.85† (2.10–4.07)
No 1.00 1.00
Age 1.00 (0.99–1.01) 1.01 (0.99–1.01)
Monthly income (NT$)
No income (reference group) 1.00 1.00
1–15 840 1.70† (1.47–1.97) 1.79† (1.54–2.07)
15 841–25 000 1.15* (1.00–1.31) 1.32† (1.15–1.52)
ⱖ25 001 1.71† (1.50–1.96) 1.81† (1.57–2.09)
Hyperlipidemia 1.62† (1.51–1.74) 1.43† (1.32–1.55)
Diabetes 1.52† (1.41–1.64) 1.33† (1.23–1.45)
Hypertension 1.91† (1.78–2.05) 1.70† (1.58–1.83)
Coronary heart disease 1.34† (1.24–1.45) 1.23† (1.13–1.34)
Geographic region
Northern (reference group) 1.00 1.00
Central 0.81† (0.75–0.88) 1.02 (0.93–1.11)
Eastern 0.81† (0.75–0.88) 0.92 (0.85–1.01)
Southern 0.83 (0.67–1.02) 1.12 (0.90–1.39)
Urbanization level
1 (most urbanized, reference group) 1.00 1.00
2 0.87† (0.80–0.94) 0.89* (0.82–0.97)
3 0.80† (0.73–0.88) 0.82† (0.74–0.90)
4 0.59† (0.53–0.66) 0.62† (0.55–0.70)
5 (least urbanized) 0.55† (0.49–0.62) 0.60† (0.52–0.68)

CI ⫽ confidence interval.
*P⬍0.01; †P⬍0.001.

291

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 Ophthalmology Volume 119, Number 2, February 2012
Discussion
In this study, after adjusting for confounding factors, we
found that ED patients had a 2.85-fold greater risk of prior
OAG diagnosis than controls. To our knowledge, this is the
first study to document the association between ED and
OAG based on a population-based dataset. This finding
suggests that there may be a common mechanism of disease
for ED and OAG, which is not entirely explained by the
variables included in the multiple logistic model. According
to the definition of the National Cholesterol Education Pro-
gram Adult Treatment Panel III, the MS is composed of
criteria relating to obesity, hyperglycemia, dyslipidemia,
and hypertension.12 In addition to its relationship to dia-
betes and cardiovascular risks, the MS recently has been
associated with glaucoma.8,11 The association between the
MS and ED is strongly suggested by epidemiologic and
basic studies.13–16 The main features of the MS, including
hyperglycemia and insulin resistance, may result in sys-
temic chronic inflammation and lead to endothelial damage
and atherosclerosis.12 Recently, chronic inflammatory status
has been identified to be associated glaucoma.17 Jiang et al18
evaluated retinal RNA obtained from canine eyes with
advanced glaucoma, and found that the genes with elevated
expression were largely associated with inflammation, and
had roles in antigen presentation, protein degradation, and
innate immunity. They speculated that pronounced retinal
neuroinflammation might develop during the final stages of
glaucoma in canines.
Nevertheless, the detailed mechanisms underlying im-
mune disarrangements and chronic inflammation remain
putative. While endothelial dysfunction progressed, vascu-
lar nitric oxide (NO) will be markedly reduced. There are
multiple crucial functions for NO in maintaining vascular
efficiency such as inhibiting adhesion of platelets and leu-
kocytes to the vascular wall and decreasing proliferation of
vascular smooth muscle to avoid the initiation of athero-
sclerosis.19 In addition, hyperglycemia would stimulate in-
creased production of free radicals, such as superoxide
anion, which inactivate NO normal functioning.19 Based on
these concepts, it is suggested that the strong relationship
between MS and endothelial dysfunction, vascular insuffi-
ciency and NO dysfunction, which both also have been
identified to be involved in the pathophysiology of ED.
Similarly, several previous studies have shown strong
associations between OAG and endothelial dysfunction or
NO dysfunction. It is agreed that vascular dysregulation,
which may be a consequence of endothelial dysfunction
because the endothelium is involved in the control of vas-
cular tone and blood flow, may play an important role in the
pathophysiology of glaucoma.20 Su et al21 recently conducted
a case-control study comparing endothelium-dependent,
flow-mediated dilatation and endothelium-independent,
nitroglycerin-mediated vasodilation in patients with normal-
tension glaucoma, OAG, and healthy aged- and sex-
matched controls.21 Based on their findings, patients with
both types of glaucoma have impaired flow-mediated dila-
tation. Furthermore, they demonstrated that both normal-
tension glaucoma and primary OAG are associated with
peripheral vascular endothelial dysfunction.21 These findings
292
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are supported by Fadini et al,22 whose study also demonstrated
that OAG and ocular hypertension patients presented with low
flow-mediated dilatation. They additionally demonstrated that
there was a marked reduction in circulating endothelial pro-
genitor cells, which are significant indicators of systemic vas-
cular endothelial dysfunction.
This study identified the link between ED and OAG.
Increasing evidence has elucidated the common risk factors
shared by ED and OAG. The pathomechanisms that exist in
subjects with the MS and contribute to the development of
endocrine and vasogenic disarrangements are speculated to
be involved in the pathology of ED and OAG. After adjust-
ing for the medical comorbidities related to the MS, ED
remained an independent risk factor for prior OAG.
The present study provided the framework for a concep-
tual relationship between ED and OAG, but future investi-
gations are required to elucidate what was begun here. The
results of this study suffer from a few limitations that should
be addressed. The first limitation of this study is the use of
ICD coding to diagnose ED. Discussing sexuality is rela-
tively culturally taboo in Taiwan and may contribute to the
seemingly low frequency of ED when compared with stud-
ies from Western countries. Furthermore, because this study
utilized ICD-9 data for the analyses, we had no way to
discern the severity of ED.
Nevertheless, in our nationwide, population-based anal-
ysis, we collected baseline conventional risk factors and
comorbidities, and despite their inclusion in our models, ED
remained a significant risk factor. Second, individual infor-
mation, such as a family history of OAG, migraines, steroid
use, and obesity, was not available through the administra-
tive dataset. All of these factors may contribute to OAG.
Third, the OAG diagnoses are sourced from an administra-
tive database and therefore may be less accurate than diag-
noses collected individually through a standardized proce-
dure. However, we only included the OAG diagnoses that
included a prescription for a topical antiglaucoma medica-
tion. Fourth, antiglaucoma medications may be more asso-
ciated with ED than OAG itself. In addition, some systemic
medications can result in ED.23 However, the present study
cannot rule out the confounding effects of medications on
ED. Finally, although we have adjusted for hypertension,
diabetes, coronary heart disease, and hyperlipidemia in the
regression model, the study’s design cannot preclude the
possibility of suffering from an ascertainment bias—that is,
patients with systemic conditions may be more likely to
undergo examinations, thus making it more likely that such
a patient’s OAG or ED status would be picked up on account
of greater exposure. Thus, it follows that patients with OAG,
by virtue of their greater exposure, are more likely to report ED
than those who have less contact with physicians. Therefore,
further studies are suggested to evaluate ED before medica-
tions are started and systemic conditions ascertained by exam-
ination in cases and controls before concluding a direct asso-
ciation between OAG and ED.
This study leveraged the data from the Taiwan
LHID2000 to succeed in identifying a novel association
between ED and prior OAG. Our findings suggest that
prospective studies should be undertaken to develop the
 Chung et al 䡠 Increased Risk of ED in Patients with OAG
appropriate clinical guidelines for evaluating concurrent or
subsequent ED in OAG patients.
References
1. Congdon NG, Friedman DS, Lietman T. Important causes of
visual impairment in the world today. JAMA 2003;290:2057– 60.
2. Munoz B, West SK. Blindness and visual impairment in the
Americas and the Caribbean. Br J Ophthalmol 2002;86:498 –504.
3. Quigley HA. Number of people with glaucoma worldwide.
Br J Ophthalmol 1996;80:389 –93.
4. Korpelainen JT, Kauhanen ML, Kemola H, et al. Sexual
dysfunction in stroke patients. Acta Neurol Scand 1998;98:
400 –5.
5. Blumentals WA, Gomez-Caminero A, Joo S, Vannappagari V.
Is erectile dysfunction predictive of peripheral vascular dis-
ease? Aging Male 2003;6:217–21.
6. Ma RC, So WY, Yang X, et al. Erectile dysfunction predicts
coronary heart disease in type 2 diabetes. J Am Coll Cardiol
2008;51:2045–50.
7. Chew KK, Finn J, Stuckey B, et al. Erectile dysfunction as a
predictor for subsequent atherosclerotic cardiovascular events:
findings from a linked-data study. J Sex Med 2010;7:192–202.
8. Oh SW, Lee S, Park C, Kim DJ. Elevated intraocular pressure
is associated with insulin resistance and metabolic syndrome.
Diabetes Metab Res Rev 2005;21:434 – 40.
9. Imai K, Hamaguchi M, Mori K, et al. Metabolic syndrome as
a risk factor for high-ocular tension. Int J Obes (Lond) 2010;
34:1209 –17.
10. Lin HC, Chien CW, Hu CC, Ho JD. Comparison of comorbid
conditions between open-angle glaucoma patients and a con-
trol cohort: a case-control study. Ophthalmology 2010;117:
2088 –95.
11. Guay AT, Traish A. Testosterone deficiency and risk factors in
the metabolic syndrome: implications for erectile dysfunction.
Urol Clin North Am 2011;38:175– 83.
Footnotes and Financial Disclosures
Originally received: May 17, 2011.
Final revision: August 5, 2011.
Accepted: August 5, 2011.
Available online: October 29, 2011. Manuscript no. 2011-743.
1
Division of Urology, Department of Surgery, Far Eastern Memorial
Hospital, Ban Ciao, Taipei, Taiwan.
2
Graduate Institute of Clinical Medicine, College of Medicine, National
Taiwan University, Taipei, Taiwan.
3
School of Health Care Administration, Taipei Medical University, Taipei,
Taiwan.
4
Department of Ophthalmology, Shin Kong Wu-Ho-Su Memorial Hospi-
tal, Taipei, Taiwan.
5
School of Medicine, Fu-Jen Catholic University, Hsingchuang, Taiwan.
Downloaded for Ryan Juliansyah (ryan.naturalis@gmail.com) at Tarumanagara University from ClinicalKey.com by Elsevier on September 24, 2019.
For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
12. Huang PL. A comprehensive definition for metabolic syn-
drome. Dis Model Mech 2009;2:231–7.
13. La Vignera S, Condorelli R, Vicari E, et al. Circulating en-
dothelial progenitor cells and endothelial microparticles in
patients with arterial erectile dysfunction and metabolic syn-
drome. J Androl 2011 Apr 7 [Epub ahead of print].
14. Koca O, Calişkan S, Oztürk Mİ, et al. Vasculogenic erectile
dysfunction and metabolic syndrome. J Sex Med 2010;7:
3997– 4002.
15. Lee YC, Liu CC, Huang CN, et al. The potential impact of
metabolic syndrome on erectile dysfunction in aging Taiwan-
ese males. J Sex Med 2010;7:3127–34.
16. Contreras C, Sánchez A, Martínez P, et al. Insulin resistance
in penile arteries from a rat model of metabolic syndrome. Br J
Pharmacol 2010;161:350 – 64.
17. Danesh-Meyer HV. Neuroprotection in glaucoma: recent and
future directions. Curr Opin Ophthalmol 2011;22:78 – 86.
18. Jiang B, Harper MM, Kecova H, et al. Neuroinflammation in
advanced canine glaucoma. Mol Vis [serial online] 2010;16:
2092-108. Available at: http://www.molvis.org/molvis/v16/
a225/. Accessed July 30, 2011.
19. Creager MA, Lüscher TF, Cosentino F, Beckman JA. Diabetes
and vascular disease: pathophysiology, clinical consequences,
and medical therapy: part I. Circulation 2003;108:1527–32.
20. Grieshaber MC, Mozaffarieh M, Flammer J. What is the link
between vascular dysregulation and glaucoma? Surv Ophthal-
mol 2007;52(suppl):S144 –54.
21. Su WW, Cheng ST, Ho WJ, et al. Glaucoma is associated with
peripheral vascular endothelial dysfunction. Ophthalmology
2008;115:1173– 8.
22. Fadini GP, Pagano C, Baesso I, et al. Reduced endothelial
progenitor cells and brachial artery flow-mediated dilation as
evidence of endothelial dysfunction in ocular hypertension
and primary open-angle glaucoma. Acta Ophthalmol 2010;88:
135– 41.
23. Flach AJ. Glaucoma and impotence [letter]. JAMA 1990;264:
3146.
6
Department of Ophthalmology, Taipei Medical University Hospital, Tai-
pei, Taiwan.
7
Department of Ophthalmology, Taipei Medical University, Taipei, Tai-
wan.
8
School of Medical Laboratory Sciences and Biotechnology, Taipei Med-
ical University, Taipei, Taiwan.
Financial Disclosure(s):
The authors have no proprietary or commercial interest in any of the
materials discussed in this article.
Correspondence:
Herng-Ching Lin, PhD, School of Health Care Administration, Taipei
Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan. E-mail:
henry11111@tmu.edu.tw.
293