Retinal Arteriosclerosis and Fundus Photograph-Defined Glaucoma in Young Adults: Findings from the Gangnam Eye Cohort

Background/Objectives: To evaluate systemic and ocular factors associated with glaucoma in young adults using data from a large health screening cohort. Methods: This cross-sectional observational study analyzed baseline data from 16,002 Korean adults younger than 40 years (range, 18–39 years) in the Gangnam Eye Cohort. Participants underwent comprehensive health screening examinations, including standardized ophthalmic evaluation and fundus photography. Glaucoma was defined by structural glaucomatous changes on fundus photographs, and retinal arteriosclerosis was graded using a modified Scheie classification. Univariable and multivariable logistic regression models were used to identify factors associated with glaucoma. Results: Among 16,002 participants, 257 (1.61%) were classified as having glaucoma; 186 of these participants (72.4%) had unilateral glaucoma. In multivariable logistic regression analysis, retinal arteriosclerosis showed the strongest association with glaucoma (OR, 6.033; 95% CI, 4.417–8.240; p < 0.001). Older age, male sex, higher intraocular pressure, and higher low-density lipoprotein cholesterol level were also independently associated with glaucoma. A graded relationship was observed between retinal arteriosclerosis severity and glaucoma, with adjusted ORs of 5.51 (95% CI, 3.96–7.66) for grade 1 and 13.15 (95% CI, 6.41–26.99) for grade ≥ 2. Conclusions: In young adults, retinal arteriosclerosis was strongly and dose-dependently associated with glaucoma. These findings suggest that retinal microvascular abnormalities visible on routine fundus photographs may provide clinically accessible information for identifying young adults with structural features of glaucomatous optic neuropathy in health screening settings.