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V Swetha E. Jeganathan, Ahmed El-Medhany, Andrew J Tatham; Glaucoma severity at first presentation. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3691.
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As glaucomatous visual loss is irreversible, advanced disease at presentation is an important risk factor for subsequent blindness. In the UK free eye examinations are available at community optometrists for those at risk, however some patients still present with severe glaucoma. The aim of this study was to identify the proportion of patients presenting with advanced glaucoma and to determine the risk factors for late presentation.
This was a cross-sectional study of 100 consecutive patients with suspected glaucoma referred from optometrists to Princess Alexandra Eye Pavilion Edinburgh. 84 of 100 patients were found to have glaucoma in at least one eye and were included subsequent analyses. All subjects had a comprehensive ophthalmic examination including slit lamp examination, intraocular pressure (IOP), central corneal thickness (CCT), fundus examination and standard automated perimetry (SAP). Information was also collected regarding family history of glaucoma. Patients were deemed to be late presenters if SAP mean deviation (MD) in the worse eye was worse than or equal to -6 dB and very late presenters if MD was worse than or equal to -10 dB. Logistic regression analysis was used to identify factors associated with late and very late presentation.
Patients had a mean ± standard deviation age of 73.2 ± 10.2 years. 36 of 84 patients (42.9%) were female and 28 (33.3%) had a first or second-degree family history of glaucoma. 48.8% had a MD in the worse eye of worse than -6 dB at first examination (late presenters) and 27.4% had a MD in the worse eye of worse than -10dB (very late presenters). Older age (P = 0.004) was a significant risk factor for late presentation, however gender (P=0.660), IOP (P = 0.712) CCT (P = 0.968), and family history (P = 0.108) were not associated with late presentation.
Although most patients with newly diagnosed glaucoma had early or moderate disease at diagnosis, almost half of patients presented with a MD of worse than -6 dB in at least one eye. Older patients were more likely to have advanced disease at presentation. Efforts to increase awareness of glaucoma in the elderly population may allow earlier diagnosis and reduce vision related morbidity.
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