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Laura A Edwards, Luke J Saunders, David Crabb; Mars vs Venus: Are men or women more likely to present with advanced glaucoma at the time of diagnosis?. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1559. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
People at greatest risk of visual impairment from glaucoma are often those detected at a late stage in the disease process (late presentation). In many diseases and medical conditions late presentation is more of a problem for men than women. We performed a retrospective study in a large number of clinical records to test the hypothesis that men, when compared to women, are more likely to have advanced glaucoma at the time of diagnosis.
Cases of advanced visual field (VF) loss recorded by automated perimetry at the first visit to secondary care were used as a surrogate measure for late presentation of glaucoma. We used 152,918 Humphrey VF’s from 32,147 patients from three regionally different hospitals in England; no other clinical data was made available apart from patient’s age, sex and dates of VF tests. The study population comprised of patients with measureable VF loss in at least one eye at diagnosis. (See Figure 1) Patients with mean deviation (MD) worse than -12dB in the worse eye were defined as having advanced VF loss (late presentation). Proportions of women and men with this proxy measure were determined and age stratified Relative Risk (RR) was calculated as the ratio of the proportion of men to women with late presentation.
Median (interquartile range) ages for 3998 men and 4585 women was 71 (62, 78) and 73 (64, 80) years respectively. Median MDs (worse eye) for men and women were -6.0 (-11.1, -3.6) and -5.8 (-10.7, -3.6) dB respectively. Overall proportion of patients with advanced VF loss at diagnosis (late presentation of glaucoma) was slightly higher in men (892/3998; 22.3%) than in women (934/3651; 20.4%); this difference was statistically significant (Chi-Square Test; p=0.03). RR for patients older than 70 years was not statistically significant (RR = 1.05; p = 0.37) but it was for those younger than 70 years (RR = 1.26; p = 0.002). A patient diagnosed with late presentation of glaucoma is, on average, 26% more likely to be male than female in this age group.
One in five patients diagnosed with glaucomatous VF defects have advanced loss in at least one eye at referral to secondary care in England. Risk for men more likely presenting with late disease than women is evident in people younger than 70 years old but the effect is small. Still, this information could be useful to healthcare professionals involved in case finding glaucoma.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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