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S.L. Hoki, J. Zhao, L.R. Pasquale; The GON 10.9 Project: long–term visual prognosis of patients with advanced glaucomatous optic neuropathy. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5560.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:To document the long–term visual prognosis of patients who either present with, or develop advanced glaucomatous optic neuropathy (GON). Methods: We performed a retrospective review of Glaucoma Service charts at the Massachusetts Eye and Ear Infirmary to identify patients with photo–documentation of vertical cup–disc ratio of 0.9 and 10 years of follow–up. For each patient, basic demographic and ocular characteristics were entered into a database. We assigned one eye of each patient a level of visual impairment based on the International Classification of Disease (ICD) at baseline and after 10 years of follow–up. Only patients with "normal" or "near–normal" vision at baseline based on ICD classification were entered into analysis. Results: Fourteen of 68 patients (21%) progressed to an ICD classification of "severe visual impairment" (consistent with USA criteria for legal blindness) or worse attributable to glaucoma at 10 years. The majority of these patients who progressed to legal blindness (9/14) had open–angle glaucoma. The majority of the cohort (62%) demonstrated progressive visual field loss over the study period. There was no correlation between maximum IOP (23 +/– 6 mm Hg for the cohort), mean IOP in follow–up (14 +/– 2.5 mm Hg for the cohort) or IOP skewness with the development of "severe visual impairment" at 10 years. Conclusions: These data provide useful information about the visual prognosis for patients with advanced GON. More aggressive target IOPs in the range epsiscleral venous pressure or novel neuroprotection strategies are needed to improve the visual prognosis for these patients.
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