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Joseph Griffith, Jeffrey L Goldberg; The Prevalence of Co-Morbid Retinal Disease in Patients with Glaucoma at an Academic Medical Center. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4288.
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Patients with various retinal diseases and patients who have undergone retinal procedures and surgeries have an increased risk of developing ocular hypertension and glaucoma. Little is known about the epidemiology of co-morbid retinal diseases in glaucoma patients. This study evaluates the prevalence of retinal co-morbidities in a population of glaucoma patients.
A longitudinal, retrospective study was conducted using international classification of disease (ICD-9) billing records from 2003-2010 at an academic medical center. Patients were classified as having primary open-angle glaucoma (POAG), low tension open-angle glaucoma (NTG), pigmentary open-angle glaucoma (PG), chronic angle-closure glaucoma (CACG) or pseudoexfoliation glaucoma (PXG) if they had at least three clinic visits over two years with the same ICD-9 code. Patients were classified as having a retinal co-morbidity if they had two visits with the same retina code. Variables were analyzed with the Independent T-Test, χ2 Test or Fisher’s Exact Test.
5,154 patients had glaucoma, and 14.8% of these patients had a retinal co-morbidity. The prevalence of co-morbid retinal disease was higher with POAG patients (15.7%) than NTG (10.1%), PXG (10.1%) and PG (3.7%) (P< 0.05). 202 patients had diabetic retinopathy with POAG patients (4.5%) having a higher prevalence than CACG (1.4%) and PXG (0.6%) (P<0.001). 128 patients had a retinal vascular occlusion. There were no differences in the prevalence of retinal vascular occlusion or retinal vein occlusion between glaucoma types. 297 patients had macular degeneration with POAG (2.0%) and PXG patients (2.9%) having a higher prevalence of nonexudative macular degeneration than CACG (0%) (P<0.01). Patients with comorbid retinal disease had a higher prevalence of blindness and low vision than patients without comorbid retinal disease (1.97% vs 1.02%, P=0.02).
The high prevalence of co-morbid retinal disease and the nearly two-fold increase in blindness and low vision in this population demonstrate the need for ophthalmologists to determine if patients have multiple etiologies for their vision loss. The higher prevalence of co-morbid retinal disease, diabetic retinopathy and nonexudative macular degeneration in POAG patients may reflect common pathophysiologic processes that warrant further investigation.
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