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Study: Exfoliation glaucoma patients older than POAG patients at diagnosis
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Researchers noted no significant differences in optic neuropathy at the time of diagnosis in patients with primary open-angle glaucoma and patients with exfoliation glaucoma.
However, Tarkkanen and colleagues reported in the European Journal of Ophthalmology that patients with exfoliation glaucoma (EG) were older than patients with primary open-angle glaucoma (POAG) and had higher intraocular pressures at the time of diagnosis.
Researchers designed a retrospective study, reviewing the records of 519 consecutive patients who applied for cost-free medication for their glaucoma from the Finnish National Social Insurance Institute.
Of the 519 patients, 329 had POAG and 176 had EG. Researchers analyzed measurements for visual acuity, IOP, cup-to-disc ratio of the optic nerve head and best-corrected visual acuity.
Results showed that patients with EG were older and their eyes had a slightly lower BCVA and higher mean IOP. Additionally, 26% of patients with EG had unilateral disease, and 12% of patients with POAG had low-tension glaucoma.
"The diagnosis of EG may be overlooked, resulting in sight-threatening conditions after inadequate management," the authors concluded. "High IOP level, large 24-hour IOP fluctuation and weaker efficacy of topical antiglaucomatous drug therapy will distinguish EG from POAG. Our findings support the importance of early diagnosis and lifelong effective treatment of EG."
Disclosure: The authors have no conflicts to disclose.
Perspective
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Carl H. Jacobsen, OD, FAAO
In this retrospective study of patients applying for free medication through the Finnish National Social Insurance Institution, the authors find that exfoliative glaucoma patients differ from patients with primary open-angle glaucoma in several ways.
It is no surprise that exfoliation glaucoma patients are older, have higher intraocular pressure and have reduced visual acuity compared with patients with primary open-angle glaucoma (POAG). Interestingly, the two groups had similar optic disc cupping and visual field loss.
It is well understood that exfoliation glaucoma is a volatile and progressive glaucoma type, yet this study found a similar level of disease severity compared with POAG.
In the U.S., there are many impediments to efficient and comprehensive health care. Perhaps patients in a socialized system who are free of health care-related financial burdens receive better glaucoma care. This is supposition, of course, but it is interesting to consider the impact a less costly and convoluted health care system might have on our ability to manage glaucoma.
Reference:
Rich R. Prog Brain Res. 2008;173:211-224.
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