September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Detection of Glaucoma Progression is Delayed in African Descent Compared to European Descent Subjects
Author Affiliations & Notes
  • Carolina Pelegrini Gracitelli
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
    Department of Ophthalmology , Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
  • Linda M Zangwill
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Alberto Diniz-Filho
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Ricardo Yuji Abe
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Robert N Weinreb
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Christopher A Girkin
    School of Medicine, University of Alabama, Birmingham, Alabama, Birmingham, Alabama, United States
  • Jeffrey M Liebmann
    Harkness Eye Institute, Columbia University Medical Center, New York, New York., New York, New York, United States
  • Felipe A Medeiros
    Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
  • Footnotes
    Commercial Relationships   Carolina Gracitelli, None; Linda Zangwill, Carl Zeiss Meditec Inc. (F), Heidelberg Engineering GmbH (F), Optovue Inc. (F); Alberto Diniz-Filho, None; Ricardo Abe, None; Robert Weinreb, Alcon Laboratories Inc (C), Allergan (C), Amateck (C), Bausch & Lomb (C), Carl Zeiss Meditec (C), Carl Zeiss Meditec (R), Forsight (C), Genentech (R), Heidelberg Engineering (R), Konan (R), National Eye Institute (R), Neurovision (R), Optovue (R), Quark (R), Reichert (R), Tomey (R), Topcon (C), Topcon (R), Valeant (C); Christopher Girkin, Carl Zeiss Meditech, Inc. (F), EyeSight Foundation of Alabama (F), Heidelberg Engineering, GmbH (F), National Eye Institute (F), Research to Prevent Blindness (F), SOLX (F); Jeffrey Liebmann, Alcon, Inc. (C), Allergan, Inc. (C), Bausch & Lomb, Inc. (C), Bausch & Lomb, Inc. (F), Carl Zeiss Meditech, Inc. (C), Carl Zeiss Meditech, Inc. (F), Diopysis, Inc. (C), Diopysis, Inc. (E), Diopysis, Inc. (F), Heidelberg Engineering Inc (C), Heidelberg Engineering Inc (F), Merz Phamaceuticals (C), National Eye Institute (F), New York Glaucoma Research Institute (F), Optovue, Inc. (F), Quark Pharmaceuticals (C), Reichert, Inc. (C), Reichert, Inc. (F), Sensimed, Inc. (C), SOLX, Inc. (F), SOLX, Inc. (E), Sustained Nano System (E), Sustained Nano System (P), Topcon, Inc. (F), Valeant Pharmacetiicals (C); Felipe Medeiros, Alcon Laboratories Inc (R), Alcon Laboratories Inc (F), Allergan Inc (F), Allergan Inc (R), Allergan Inc (C), Bausch & Lomb (F), Carl Zeiss Meditec Inc (F), Carl Zeiss Meditec Inc (R), Carl Zeiss Meditec Inc (C), Heidelberg Engineering Inc (F), Merck Inc (F), National Eye Institute (F), Novartis (C), Reichert Inc (R), Reichert Inc (F), Sensimed (F), Topcon Inc (F)
  • Footnotes
    Support  NIH grants EY019869, EY021818, EY025056, and core grant P30EY022589; an unrestricted grant from Research to Prevent Blindness (New York, NY); fellowship from Brazilian National Council for Scientific and Technological Development (CNPq) 233829/2014-8; fellowship from Brazilian National Research Council-CAPES 12309-13-3
Investigative Ophthalmology & Visual Science September 2016, Vol.57, No Pagination Specified. doi:
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      Carolina Pelegrini Gracitelli, Linda M Zangwill, Alberto Diniz-Filho, Ricardo Yuji Abe, Robert N Weinreb, Christopher A Girkin, Jeffrey M Liebmann, Felipe A Medeiros; Detection of Glaucoma Progression is Delayed in African Descent Compared to European Descent Subjects. Invest. Ophthalmol. Vis. Sci. 201657(12):.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : African Descent (AD) individuals have been reported to be at higher risk for becoming visually impaired from glaucoma compared to European Descent (ED) subjects. It is possible that delayed detection of progression may lead to delayed intervention and increased risk of visual impairment. We investigated the time to detect visual field (VF) progression in a cohort of AD and ED glaucoma patients followed over time.

Methods : The study included 445 eyes of 322 ED subjects and 334 eyes of 233 AD subjects recruited from the African Descent and Glaucoma Evaluation Study (ADAGES). Eyes had glaucomatous VF loss on standard automated perimetry (SAP) at baseline and were followed for an average of 8.0 ± 3.4 years with an average of 12.4 ± 5.9 SAP tests. Ordinary least squares linear regression (OLS) was used to regress SAP mean deviation values over time. Residuals were extracted from OLS regression to represent expected variability estimates for levels of mean deviation (MD). Distributions of residuals for each level of MD were obtained for each racial group. These distributions allowed reconstruction of visual field trajectories over time by computer simulation, according to expected “true” rates of glaucoma progression. 50,000 VF were then simulated for each racial group under different assumptions about rate of change and frequency of testing. Empirical cumulative distribution functions were built to investigate the probability of detecting progression over time.

Results : When controlling for the fitted (“true”) MD level and age, absolute residuals on existing data were significantly larger in AD versus ED patients (mean difference: 0.15dB; P<0.001). A significant interaction between MD level and race was seen, suggesting that AD subjects had greater increase in variability with worsening disease as compared to ED (P=0.022). When simulations were performed assuming baseline MD of -5dB, true rate of progression of -0.25dB/year (average rate of change in the cohort) and 1-year testing interval, the median time to detect progression was significantly longer in AD versus ED (difference=4.76 years; P<0.05).

Conclusions : Our results suggest that, due to increased VF variability, detection of glaucoma progression may be significantly delayed in AD versus ED glaucoma patients. This could explain, at least in part, higher incidence of glaucoma-related visual impairment in AD compared to ED subjects.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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