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Naira Khachatryan, Atsuya Miki, Sonia Jain, Feng He, Naama Hammel, Felipe Medeiros, Robert Weinreb, Jeffrey Liebmann, Christopher Girkin, Linda Zangwill; THE AFRICAN DESCENT AND GLAUCOMA EVALUATION STUDY (ADAGES): PREDICTORS OF GLAUCOMA PROGRESSION IN GLAUCOMA SUSPECTS. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3486.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate predictors of glaucomatous progression and to assess racial differences in the incidence of repeatable glaucomatous visual field (VF) damage in glaucoma suspects.
786 eyes from 501 glaucoma suspects in the African Descent and Glaucoma Evaluation Study, who had at least 2 years of follow-up and at least 4 VF tests, were included. Glaucoma suspects had a glaucomatous optic disc appearance (n=289) and/or elevated intraocular pressure (n=211), but normal VF at study entry. Conversion was defined as development of repeatable (3x) VF damage. Age, gender, race and baseline ocular risk factors were evaluated in multivariable logistic regressions to determine which of those factors were predictive of VF conversion.
124 glaucoma suspects (24.8%) developed VF damage (converts). A larger proportion of African descent (AD) participants (56/179 (31.3%)) converted than European descent (ED) participants (68/254 (21.1%)) (univariate OR=1.70; 95% CI: 1.12; 2.57). Mean (95% CI) age at baseline for converts was 63.1 years (60.9; 65.3), for non-converts 58.0 (56.8; 59.2) (p<0.0001). More participants with glaucomatous appearing optic disc at baseline developed VF damage than those with high IOP only (OR=2.25, 95% CI: 1.45; 3.50). Mean (95% CI) stereophotograph-based vertical cup/disc ratio in converts was 0.66 (0.63; 0.69), in non-converts was 0.62 (0.60; 0.64) (p=0.01). Mean (95% CI) baseline VF PSD in converts was 1.87 (1.80; 1.94), in non-converts 1.60 (1.56; 1.64) (p<0.0001). There was no significant difference (p>0.05 for all comparisons) among converts and non-converts in gender, follow up time, baseline IOP, perfusion pressure, CCT, axial length, and HRT-based disc area. In multivariable analysis, race was predictive of conversion (OR=1.90; 95% CI: 1.16; 3.10) even after adjusting for age, gender, glaucomatous optic disc appearance, vertical cup/disc ratio, disc area, and baseline VF PSD and MD (p=0.0047). Also, age, glaucomatous optic disc at baseline, and baseline VF PSD were predictive of VF conversion.
In the ADAGES cohort, glaucoma suspects of AD are twice as likely to develop VF loss as ED participants, even after adjusting for disc size. In addition, older age, higher baseline VF PSD, and a glaucomatous optic disc at baseline, each contribute to an increased risk of future VF loss.
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