Dose-response association between metabolic abnormality burden and intraocular pressure in a population undergoing routine health examinations: a cross-sectional study

OBJECTIVE: To investigate the association between metabolic risk burden and intraocular pressure in individuals undergoing routine health examinations, and to assess the presence of a dose-response relationship, thereby informing IOP risk stratification in health check-up settings. METHODS: This cross-sectional study included 2,048 adults who received health examinations at the Health Examination Center of the Army Medical Center between September 2024 and December 2025. Metabolic abnormalities were defined using five routinely collected components-waist circumference, blood pressure, fasting plasma glucose, triglycerides, and high-density lipoprotein cholesterol-and were summed to generate a metabolic risk burden score (range:0-5). Participants were categorized into four groups (0, 1, 2, and ≥ 3). The primary outcome was the mean IOP of both eyes. Associations were evaluated using one-way analysis of variance, multivariable linear regression, and tests for trend. RESULTS: IOP increased progressively with higher metabolic risk burden. After adjustment for age and sex, compared with participants with a score of 0, mean IOP was higher by 0.93, 1.24, and 1.80 mmHg in those with scores of 1, 2, and ≥ 3, respectively (all P < 0.001). Further adjustment for body mass index attenuated the associations, but they remained statistically significant (β = 0.77, 0.93, and 1.37 mmHg, respectively).Each one-category increase in metabolic burden was associated with a 0.46-mmHg higher IOP (P-trend < 0.001). In sensitivity analyses, higher metabolic burden was associated with increased odds of high IOP (≥ 3 vs. 0: OR = 3.05, 95% CI: 1.73-5.36). Among individual components, elevated blood pressure and elevated fasting glucose showed the strongest associations with IOP. CONCLUSIONS: In this cross-sectional study, metabolic risk burden was independently associated with higher IOP in a dose-response manner. These findings suggest a graded relationship between metabolic abnormalities and IOP; however, causal inference and clinical implications require confirmation in longitudinal studies.