July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Rapid Visual Field Progression in Uveitic Glaucoma: Evidence From ‘Big Data’ Collected in Glaucoma Clinics in the United Kingdom
Author Affiliations & Notes
  • Xiaoxuan Liu
    Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
    Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  • Stephen R Kelly
    Division of Optometry and Visual Sciences, City, University of London, London, United Kingdom
  • Robert John Barry
    Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
    Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals, Birmingham, United Kingdom
  • Susan R Bryan
    Division of Optometry and Visual Sciences, City, University of London, London, United Kingdom
  • Pearse Andrew Keane
    Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
  • Alastair K Denniston
    Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
    Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
  • David Crabb
    Division of Optometry and Visual Sciences, City, University of London, London, United Kingdom
  • Footnotes
    Commercial Relationships   Xiaoxuan Liu, None; Stephen Kelly, None; Robert Barry, None; Susan Bryan, None; Pearse Keane, Allergan (R), Bayer (R), DeepMind (C), Haag-Streit (R), Heidelberg (R), Novartis (R), Topcon (R), Zeiss (R); Alastair Denniston, None; David Crabb, Allergan (R), CentreVue (C), Roche (F), Santen (R)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 1138. doi:
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      Xiaoxuan Liu, Stephen R Kelly, Robert John Barry, Susan R Bryan, Pearse Andrew Keane, Alastair K Denniston, David Crabb; Rapid Visual Field Progression in Uveitic Glaucoma: Evidence From ‘Big Data’ Collected in Glaucoma Clinics in the United Kingdom. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1138.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Uveitic glaucoma (UG) occurs in up to 20% of patients with uveitis, and is associated with episodes of high intraocular pressure (IOP) and intense optic nerve damage. Glaucomatous loss of vision is irreversible, therefore it is important to identify high risk patients for targeted treatment to preserve visual function. We tested the hypothesis that UG eyes, as labelled in an electronic medical record (EMR) in glaucoma clinics, are at risk of faster visual field (VF) loss than those with primary open angle glaucoma (POAG).

Methods : 792,083 visual fields (122,500 patients), with matched data on diagnosis (n=51,929) and IOP (n=45,355), were extracted from the Medisoft (Medisoft Ltd., Leeds, UK) EMR from five regionally different glaucoma clinics in the UK and linked to the Royal College of Ophthalmologists’ National Ophthalmology Database (RCOphth NOD) for the purposes of an audit report. Rate of visual field loss, using mean deviation (MD) loss (dB/year), was calculated in eyes with >4 years of follow-up with ≥4 visual field tests. Eyes with ≥1.5dB loss per year were defined as having “rapid” VF progression. Age-adjusted relative risk (RR) was calculated as the ratio of the proportion of UG to POAG eyes having “rapid” VF progression.

Results : 672 “uveitis” plus “glaucoma” patients and 22,168 “POAG” patients were identified using diagnostic labels from the EMR. Median (IQR) baseline MD and age was –4.2 (-9.7, -1.5) dB 63 (53,73) years and –3.4 (-7.3, -1.3) dB 71 (63,77) years in 672 UG and 22,168 non-UG eyes respectively. Median (IQR) rate of MD loss was -0.2 (-0.7, 0.2) dB/year and -0.1 (-0.6, 0.2) dB/year in the UG and POAG groups respectively. UG and POAG groups had 27/219 (12.3%) and 655/9,632 (6.8%) rapid progressors respectively. Overall age-standardised RR for UG eyes versus POAG eyes for “rapid progression” was 1.89 (95% CI:1.84-1.95).

Conclusions : Analysis of ‘Big Data’ from multi-centre glaucoma services in the UK suggests that loss of visual function occurs faster in UG than in POAG, and the relative risk of progressing rapidly in UG is almost double that of POAG. Early identification of “rapid progressors” may enable targeted intervention to preserve optic nerve function in this high risk group.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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