CAREDS2 Glaucoma Study: Prevalence of Glaucoma in a Large Prospective Observational Cohort of Older Women from the Women’s Health Initiative

Abstract

Purpose : We determined the prevalence of primary open-angle glaucoma (POAG) among older women participating in a follow-up of the Carotenoids in Age-Related Eye Disease Study (CAREDS2 2016-2018). We developed methods for assessing glaucoma status, including retinal nerve fiber layer optical coherence tomography (RNFL OCT), through a combination of in-person study visits and medical records review to study the relationship between macular pigment optical density levels and glaucoma risk.

Methods : Methods to identify CAREDS2 participants with glaucoma were based on a literature search to determine appropriate criteria for high-risk glaucoma characteristics. In addition to patient self-reported diagnosis of glaucoma or use of glaucoma medications, prior epidemiologic studies informed glaucoma risk criteria based on intraocular pressure (IOP) and stereoscopic disc photographs. RNFL OCT criteria were based on clinical studies that tested its sensitivity and specificity for glaucoma diagnosis.

Results : A total of 685 women participants enrolled in CAREDS2. The median age was 81 years (range 69 – 98) and 98% were white. Among all participants with adequate data to assess glaucoma status (n=660), 208 (32%) had at least one glaucoma risk factor. Two glaucoma specialists independently-adjudicated the diagnosis of POAG, which had a prevalence of 11% (n=74) ((8% manifest and 3% pre-perimetric). The sensitivity (S), specificity (Sp), positive (PPV) and negative predictive values (NPV) for POAG using the following tests were: c:d ratio of 0.6 or higher in either eye (S=38%, Sp=95%, PPV=53%, NPV=90%), c:d ratio of 0.7 or higher in either eye (S=18%, Sp=99%, PPV=67%, NPV=92%), and RNFL OCT thinning (<5^th percentile (S=82%, Sp=78%, PPV=27%, NPV=97%), <1^st percentile (S=75%, Sp=93%, PPV=58%, NPV=97%)).

Conclusions : This is the first large scale epidemiologic study in older women systematically utilizing RNFL OCT, together with other glaucoma risk factors, to identify participants with POAG. The prevalence of POAG was consistent with prior epidemiologic studies. RNFL OCT thickness within the normative range in both eyes had a high negative predictive value for glaucoma. The identification of participants with POAG in the CAREDS2 cohort will allow us to assess the longitudinal relationship between macular pigment levels and glaucoma risk in subsequent studies.

This is a 2020 ARVO Annual Meeting abstract.