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S. Jiang, J. Mohay; Long–Term Follow–Up in Primary Open Angle Glaucoma: Retrospective Analysis of Risk Factors for Progression . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3400.
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To identify risk factors for progression of primary open angle glaucoma in long–term (10–30 years) follow up.
The study design was a retrospective clinical chart review study. Medical records of patients with primary open angle glaucoma evaluated at The Kentucky Lions Eye Care Center from 1975 to 2005 were reviewed. Data on age, gender, ethnic origin, family history, systemic diseases, follow–up time, visual acuity (initial and final), rate of blindness, intraocular pressure (IOP, initial, maximal, and final), central corneal thickness, optic disc appearance, visual field, ocular complications, and therapies (topical ocular hypotensives, argon laser trabeculoplasty, and surgery) were recorded.
A total 39 patients and 77 eyes, including 3 patients who were blind in one eye from glaucoma on presentation, were followed up for a mean duration of 16.6 ± 0.8 years. Ages of patients ranged from 47 to 94 with mean of 71.3 ± 1.9. The average presenting IOP was 20.3 ± 0.67 and the maximal IOP was 26.9 ± 0.87. Twenty–four patients (61.5%) were on two or more ocular hypotensives, 36 eyes (46.8%) received argon laser trabeculoplasty, and 20 eyes (30%) had trabeculectomy. The mean IOP after standard glaucoma therapies was 14.9 ± 0.51 (p<0.0001). In spite of successful lowing of IOP, 49 eyes (63.6%) had glaucomatous visual field progression. However, only 12 eyes (15.6%) had greater than 3 line vision loss and 5 eyes developed blindness from glaucoma, which were associated with poor compliance, worse visual field on presentation, and older age. Argon laser trabeculoplasty and trabeculectomy prevented moderate (< 3 line) vision loss.
In this group of selected patients with primary open angle glaucoma with a long–term follow–up, the visual fields decline over time in spite of successfully lowing IOP by standard glaucoma therapies. However, the rate of severe vision loss and blindness is low. The unfavorable visual outcome is associated with poor compliance, worse visual field on presentation, and older age.
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