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B.J. Cho, C. Galvan, E. Uchiyama, J. Aronowicz, K.S. Kooner; Natural History of Glaucoma: Initial Presentation and Progression . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3438.
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The aim of this study was to investigate initial manifestations and course of progression of disease in newly diagnosed patients with glaucoma.
A retrospective chart review of patients initially diagnosed with glaucoma at the Dallas VA Hospital was conducted. Data collection included patient demographics, glaucoma risk factors, initial and follow–up ocular evaluations, visual acuity (VA), intraocular pressure (lOP), slit lamp exam, gonioscopy, fundus exam, visual fields, medications, ocular surgeries and/or laser treatments, evidence of noncompliance, and quality of control of glaucoma,. The data was collected at initial visit, at one month, 3 months and every subsequent six month interval.
There were 25 patients, whites: 9(36.0%); blacks: 16 (64.0%), all of whom were men. The average age of whites was 67.6 yrs and for blacks was 63.3 yrs. on their first visit. The average follow–up was 8.28 yrs. The prevalence of glaucoma risk factors was as follows: 68.0% hypertension, 44.0% tobacco use, 44.0% diabetes, 36.0% family history of glaucoma, and 32.0% alcohol abuse. The average initial visual acuity was 20/40 and the average final visual acuity was 20/80. The average initial IOP for both eyes was 27.7 mmHg. The average final IOP for both eyes was 19.2 mmHg (whites: 15.2 mmHg; blacks: 21.6 mmHg; p=0.001). The average initial cup–to–disk ratio for both eyes was 0.63. The average final cup–to–disk ratio for both eyes was 0.73. The average initial mean deviation on VF was –7.56 and the final was –8.70. The average number of medications prescribed initially was 1.5, increasing to 2.3 on final visit. Legal blindness (VA < 20/200) on initial presentation in at least one eye was seen in 6 (24.0%). This number increased to 11 (44%) during follow–up. Six (24%) patients underwent surgery during their course. 15 (60%) patients underwent laser therapy. Noncompliance was suspected in 15 (60%) patients. Poor control of glaucoma was observed in 16(64%) patients. Late detection of glaucoma was seen in 15 (60.0%) subjects.
The study demonstrates that early detection benefits all patients with glaucoma. Blacks tended not to fair well with lowering of their IOP over the course of treatment and underwent surgery earlier than white patients. In addition, black patients who were detected with advanced glaucoma tended to have their vision deteriorate faster than those who were detected early in their disease progression.
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