Purchase this article with an account.
Hana L. Takusagawa, Christina Sheppler, Cory VanAlstine, Stuart K. Gardiner, Steven L. Mansberger; Prevalence Of Glaucomatous Optic Neuropathy In A Telemedicine Population. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6380.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Glaucoma is the second most common blinding disease in the United States, however many patients do not get evaluated for glaucoma until the disease is advanced. In addition, glaucoma has been associated with diabetes mellitus in many studies. This project aims to evaluate the prevalence of glaucomatous optic neuropathy and risk factors for glaucomatous optic neuropathy in a telemedicine population being screened and followed for diabetic retinopathy.
This is a retrospective review of 567 patients participating in telemedical diabetic retinopathy screening in two tribal populations in the Northwest and Midwestern United States. Retinal images were obtained with a non-mydriatic camara using the modified Diabetic Retinopathy Study protocol. These images were then transferred in a store-and-forward method to expert readers at Devers Eye Institute. Information from only the first full visit was used in the analysis to prevent bias.
Of the 567 patients reviewed, 280 (49.3%) described their primary ethnicity as non-white, with the largest sub-populations being African-American (n = 102), American Indian/Alaskan Native (n = 95), and Hispanic/Latino (n= 65). 439 patients had adequate imaging of the optic nerve to determine features of glaucomatous optic neuropathy (GON) as determined by expert evaluators at Devers Eye Institute. Of these patients, 46 (10.5%) demonstrated evidence of GON. In a univariate analysis of risk factors for GON, systolic blood pressure (p = 0.027), presence of age-related macular degeneration on telemedical evaluation (p = 0.049), evidence of diabetic retinopathy on telemedical evaluation (0.002), and self-reported non-white primary ethnicity (0.014) were found to be statistically significant. Diastolic blood pressure (p = 0.066), age (p=0.084), and evidence of macular edema on telemedical evaluation (p = 0.063) were found to be borderline significant. Hemoglobin A1c (p = 0.897), and gender (p = 0.706) were found not to be significant. On further analysis by multivariate logistical regression, the presence of diabetic retinopathy (p=0.021) and non-white ethnicity (p=0.039) were the only two significant risk factors for GON.
There is a high prevalence of glaucomatous optic neuropathy as determined by telemedical evaluation of the optic nerve in this multi-ethnic diabetic patient population. Risk factors for GON include the evidence of diabetic retinopathy and non-white primary ethnicity. These patients should be screened carefully for evidence of GON.
This PDF is available to Subscribers Only