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Catherine M Birt, Cindy M L Hutnik, Andrew C Crichton, Christoph Kranemann, Antony Clark; Glaucoma in the very elderly. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2744. doi: https://doi.org/.
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To compare the clinical characteristics of elderly (85+ years) glaucoma/ocular hypertension (OHT) patients with those of middle-aged (60-70years) patients.
This was a multi-centre comparative cross sectional study. Patients 85+ years (elderly) and 60-70 years (middle-aged) with a diagnosis of glaucoma or OHT who attended one of three eye clinics in Toronto and London, Ontario or Calgary, Alberta were invited to participate. Clinical information including visual acuity, recent intra-ocular pressure (IOP), current medications, recent visual field test results, previous medical and surgical history, and measures of independence were recorded. Comparisons between elderly and younger groups were made.
236 85+ yr old and 273 60-70 yr old patients participated. Their mean age ± standard deviation was 89.6 ± 3.3 and 65.9 ± 3.1 years respectively. There were significantly more females in the elderly cohort (61.0% vs 39.0%, chi-squared p=0.02). Both groups were predominantly Caucasian (90.7% 85+ yr olds and 75.5% 60-70 yr olds). Elderly patients were more likely to have medical and ocular comorbidities. Elderly patients had overall worse visual acuity than younger patients. The most common glaucoma diagnoses were primary open angle glaucoma (60% and 57%), normal tension glaucoma (9% and 12%), and pseudoexfoliation glaucoma (14% and 4%). Elderly patients had worse visual fields compared to middle-aged patients (difference in mean deviation = -4.41dB 95%CI -5.57 to -3.25dB, p<0.001). Elderly patients were more, but not significantly, likely to have undergone surgery. Similar proportions of elderly and middle-aged patients used topical ocular hypotensives (73% vs 69%, chi-squared p=0.37), or have undergone laser trabeculoplasty (43% vs 43%, chi-squared p=0.99). The mean number of topical ocular hypotensive agents was similar between groups (85+ yrs =1.5, 60-70 yrs=1.4, p=0.39), but elderly patients were more likely to require assistance instilling them (19% vs 6%, p<001). Elderly patients are more likely to live alone (44% vs 19%, chi-squared p<0.05) and require aids for mobility (46% vs 4.4%, p<0.05).
Patients over 85 years of age with glaucoma or OHT are an actively treated group, including surgery. They have significant medical and social issues that likely play an important role in compliance with treatment.
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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