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Scott Fraser, Catey Bunce, Richard Wormald; Risk Factors for Late Presentation in Chronic Glaucoma. Invest. Ophthalmol. Vis. Sci. 1999;40(10):2251-2257.
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purpose. To identify the risk factors for having advanced glaucomatous visual
field loss on the first visit at three hospital eye services.
methods. This was a hospital-based, case–control study involving patients newly
diagnosed with glaucoma at first visit to one of three ophthalmic
departments in the United Kingdom. Patients with a previous history of
ocular hypertension or any documented suspicion of glaucoma (within the
hospital eye service) were excluded.
results. Occupational group, initial intraocular pressure (IOP), family history
of glaucoma, method of referral to hospital, and the number of years
since the last visit to an optometrist were found to be independently
associated with late presentation. A linear trend of increasing odds of
late attendance was associated with increasing Standard Occupational
Classification. Those in managerial (category II) and skilled (category
III) groups estimated (95% confidence intervals) to be, respectively,
0.2 (0.00, 0.16) and 0.27 (0.1, 0.8) as likely to attend with
advanced glaucomatous field loss as unskilled (category V) people with
similar initial IOP, family history, referral route, and time since
last optometrist visit. The data strongly suggest an association
between IOP and advanced field loss at initial hospital examination.
There was a 1.2 (1.12, 1.28) increase in the OR of late presentation
per unit increase in millimeters of mercury after adjustment for the
other mentioned factors. People with a family history of glaucoma were
estimated to be almost one third (adjusted OR, 0.29 [0.12, 0.74]) as
likely to have advanced field loss as those with no family history.
People referred by any source other than an optometrist who has made
the correct diagnosis of glaucoma were 4.5 times (adjusted OR, 4.53[
1.52, 13.48]) more likely to be late attenders than patients so
referred but similar in other mentioned factors. These data also
provide strong evidence that the more years since the last visit to an
optometrist, the greater the likelihood of having advanced glaucomatous
visual field loss on the first visit to the eye service (adjusted OR
per year, 1.25 [1.10, 1.42]).
conclusions. These data strongly suggest that certain subgroups of people with
glaucoma were at greater risk of having advanced and irremediable field
loss on first visiting the eye services
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