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Older age, peak IOP may speed glaucoma progression
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Identifying and aggressively treating factors leading to fast progression of glaucoma may decrease the visual disability of the disease, according to findings published in the American Journal of Ophthalmology.
Ji Hyun Kim, MD, and colleagues attempted to identify baseline and longitudinal risk factors for fast visual field decay in patients with open-angle glaucoma.
“Previous studies, including randomized clinical trials and large cohort studies, have evaluated risk factors for glaucoma progression, revealing a range of systematic factors,” Kim, a research fellow at the Stein Eye Institute at the David Geffen School of Medicine at the University of California Los Angeles, and colleagues wrote. “The identification of those factors associated with rapid deterioration in patients with glaucoma is important because it helps guide the appropriate use of resources to improve outcomes in patients at high risk for visual disability.”
The researchers examined data from a retrospective cohort study. Patients with six or more visual fields and 4 or more years of follow-up were included in the study.
Kim and colleagues analyzed 1,317 eyes of patients (n = 745; mean age, 63 years; 58% women; 66% white; median mean deviation – 2.4). The mean follow-up period was 11 years.
The researchers determined that older age (P < .001) and higher peak IOP (P < .001) were associated with faster rates of progression. Glaucoma surgery during the study period (P < .001) was also associated with faster progression rates.
Kim and colleagues discerned that worse baseline mean deviation was associated with mean deviation rate (P = .02).
Pseudoexfoliative glaucoma was associated with faster rates of progression with mean deviation (P = .008) and visual field index rates (P = .01) but not with the glaucoma rate index, the researchers wrote.
Kim and colleagues said that higher peak IOP (P = .005) was also a significant predictor for fast progression. – by Earl Holland Jr.
Disclosures: Kim reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Derek MacDonald, OD, FAAO
Open-angle glaucoma is a slowly progressive optic neuropathy (except when it’s not) that spares central vision until advanced disease (except when it doesn’t). As optometrists, we are charged with the early diagnosis of asymptomatic eye disease, including open-angle glaucoma. Post-diagnosis, we’re responsible for recognizing those rare but potentially catastrophic cases of rapid progression (visual field loss of 2 dB or more, or 5% visual field index per year) that can lead to significant visual impairment within a patient’s lifetime.
Kim and colleagues add to our understanding of risk factors by identifying several characteristics that predispose patients to more rapid disease progression:
- older age;
- elevated IOP;
- exfoliation; and
- advanced visual field loss at baseline.
Clinicians would be wise to stay vigilant should these or any of the following features be noted:
- family history of open-angle glaucoma;
- black or Hispanic ethnicity;
- concurrent cardiovascular disease and its aggressive treatment;
- initial visual field loss involving both hemifields or threatening fixation;
- frequent disc hemorrhages;
- thin central corneal thickness and/or low corneal hysteresis; and
- IOP fluctuations.
Informed by risk profile, at least six structural and functional assessments during the first 2 years post-diagnosis will allow the identification of precipitous change and the aggressive intervention that is necessary to maintain vision-related quality of life.
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