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L. E. Patty, J. Chung, M. Torres, R. Varma, The LALES Group; Impact of Demographic Factors on Diagnosis and Management of Open-Angle Glaucoma in the Los Angeles Latino Eye Study (LALES). Invest. Ophthalmol. Vis. Sci. 2008;49(13):5462.
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To identify the demographic and clinical factors that differ between undiagnosed vs. previously diagnosed open-angle glaucoma (OAG) as well as treated and untreated groups in the Los Angeles Latino Eye Study (LALES).
The LALES is a large population-based study of adult Latinos in Los Angeles in which participants underwent a detailed interview and an eye examination including measurement of intraocular pressure (IOP), visual field (VF) testing, and simultaneous stereoscopic fundus photography of the optic disc. OAG was defined as the presence of an open angle as well as a glaucomatous VF abnormality and/or evidence of glaucomatous optic disc damage in at least one eye. Demographic and clinical factors collected for those with previously undiagnosed, previously diagnosed, treated and untreated OAG included: education, acculturation, employment, insurance status, income, co-morbidities, visual acuity, horizontal and vertical cup to disc ratio (HCDR, VCDR), mean deviation on VF testing and treatment (eye drops, surgery, and laser). Student t-tests and chi-squared analyses were used to determine differences in these factors by disease and treament status of the individual.
Of the 290 cases of OAG identified in LALES, 70 participants self-reported a diagnosis of OAG and 220 were initially diagnosed at time of clinical exam. Of the 70 previously diagnosed, 51 reported receiving previous treatment and 19 reported no treatment. The 220 participants who were previously undiagnosed had lower IOP (p=0.003), less diffuse disc rim thinning (p=0.04), smaller HCDR (p=0.03) and VCDR (p=0.007), and a smaller VF mean deviation (p=0.01) compared to those previously diagnosed. The participants previously undiagnosed and untreated were also younger in age (p=0.04), had lower IOP (p=0.01) and smaller VF mean deviation (p=0.02) than those who reported treatment. Finally, persons previously treated were more likely to have health insurance compared to those previously diagnosed and untreated (p=0.04).
Persons who were previously undiagnosed and untreated appear to be younger, have lower IOPs and less severe glaucomatous optic nerve damage. It is likely that strategies for detecting early glaucomatous optic nerve damage (such as optical coherence tomography, frequency doubling perimetry) should be considered in screening programs to identify persons with early damage for referral to care. Provision of health insurance is also likely to increase the numbers of persons with OAG identified and treated.
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