Researchers identify factors associated with severe vision loss in neovascular glaucoma
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Key takeaways:
- Older patients and women were more likely to progress to severe vision loss.
- Severe vision loss was less common among the insured.
- The severe vision loss group presented with worse average BCVA and higher IOP.
The progression of vision loss among patients with neovascular glaucoma appeared linked to factors such as the disease stage at diagnosis, age, sex, a history of type 2 diabetes and insurance status, according to study results.
Successful prevention and diagnosis of neovascular glaucoma (NVG), which can lead to elevated IOP and significant vision loss, involves a thorough understanding of the predictive factors of disease progression, according to Caroline C. Cotton, a medical student in the department of ophthalmology at University of Virginia (UVA) Health Sciences Center, and colleagues.
“Although there is extensive research describing the risk factors for developing NVG ... there are significantly fewer data investigating the predictive factors of disease progression,” Cotton and colleagues wrote in the study, published in Clinical Ophthalmology.
This prompted the researchers to perform a single-center retrospective chart review investigating the associations between demographic, socioeconomic and clinical factors and severe vision loss among 89 patients (99 eyes) with NVG who received treatment at UVA Ophthalmology between 2010 and 2020.
The researchers grouped patients into two categories based on their vision outcomes after 1 year of NVG treatment: mild to moderate vision loss — defined as best corrected visual acuity that remained better than light perception only (LP)/no light perception (NLP; n = 74) — or severe vision loss, which consisted of BCVA that declined to LP only or NLP (n = 25).
Compared with the mild to moderate vision loss group, the severe vision loss group appeared significantly older at diagnosis (71.04 years ± 13.9 vs. 61.76 years ± 12.3; P = .005) and had proportionally more women (68% vs. 29.7%; P < .001).
The researchers also found significant associations between vision loss and type of insurance (P = .002) and a history of type 2 diabetes (P = .033) in a univariate analysis.
Further, patients who progressed to severe vision loss presented with significantly worse average BCVA compared with those with mild to moderate vision loss (LogMAR 2.22 ± 0.5 vs. LogMAR 1.43 ± 0.8; P = .003). The average BCVA of the severe vision loss group declined significantly 1 year after treatment initiation (LogMAR 2.84 ± .01; P < .001), although the change was not significant in the mild to moderate group.
Patients who progressed to severe vision loss also presented with significantly higher IOP ( 47.7 mm Hg ± 14.3 vs. 40.86 mm Hg ± 13.3; P < .001), with both the severe (19 mm Hg ± 15.5; P < .001) and mild to moderate (17.85 mm Hg ± 6.9; P < .001) groups experiencing a significant decrease in IOP after 1 year of treatment, reaching levels that were comparable between groups.
According to a binary logistic regression analysis, patients with older age at diagnosis (OR = 1.074; P = .008) and women (OR = 3.281; P = .036) were more likely to exhibit severe vision loss. On the contrary, patients with Medicare (OR = 0.098; P = .005) or private insurance (OR = 0.11; P = .006) were less likely to have severe vision loss compared with patients without insurance. No association between a history of type 2 diabetes and vision loss occurred in this analysis.
The researchers also performed a sensitivity analysis by using only one eye per patient and found these associations persisted (P < .05 for all).
Cotton and colleagues noted several limitations to this study, including limited and unbalanced subgroup sizes and no evaluation of specific combinations of multiple treatments.
Further research that involves centers with larger sample sizes will help to verify the relationship between socioeconomic and demographic factors and BCVA outcomes, according to the researchers.
“Future prospective studies examining more aggressive treatments and lower IOP goals for patients who present with later stages of disease may help guide clinicians in providing individualized care for patients with NVG for more optimized visual outcomes,” they wrote.
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