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Undiagnosed open-angle glaucoma associated with cup-to-disc ratio, not visiting ophthalmologist

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Failing to visit an ophthalmologist regularly may be a major risk factor for undiagnosed open-angle glaucoma, a study by researchers in the United States and Greece suggests. Specifically, primary open-angle glaucoma may be more likely to go undiagnosed than pseudoexfoliative glaucoma, the authors noted.

“Since cup-to-disc ratio was associated with undiagnosed primary open-angle glaucoma, standardized protocols involving thorough evaluation of the optic disc are recommended for ophthalmologists,” the authors said.

Fotis Topouzis, MD, and colleagues at Aristotle University of Thessaloniki and six universities in the United States classified 2,554 randomly selected participants aged 60 years or older from the Thessaloniki Eye Study as having either primary open-angle-glaucoma or pseudoexfoliative glaucoma. The researchers performed logistic regression analysis to identify factors associated with undiagnosed open-angle, primary open-angle and pseudoexfoliative glaucoma.

The investigators defined undiagnosed glaucoma as the absence of either prior diagnosis of or medical treatment for glaucoma or ocular hypertension, as well as the absence of prior glaucoma surgery, according to the study.

The prevalence of undiagnosed glaucoma was 57.1% (56 of 98 patients) for participants with primary open-angle-glaucoma, significantly higher compared with 34.9% (15 of 43 patients) among participants with pseudoexfoliative glaucoma (P = .017).

Patients with primary open-angle-glaucoma were at “three to four times increased risk” to be undiagnosed compared with pseudoexfoliative glaucoma patients (P = .02 and P = .04, respectively).

Patients with open-angle-glaucoma who had not visited an ophthalmologist during the last year were six times more likely to go undiagnosed (P = .003), the authors reported.

Among patients with primary open-angle-glaucoma, a smaller vertical cup-to-disc ratio was statistically significantly linked with an increased risk of going undiagnosed (P = .008), according to the study, published in the February issue of American Journal of Ophthalmology.